Mycoplasma pneumoniae is a significant pathogen responsible for respiratory infections in older children.Aim of study: Study of the varied pulmonary manifestations of Mycoplasma pneumoniae pneumonia (MPP) in older children, focusing on macrolide-resistant Mycoplasma pneumoniae (MRMP) and refractory Mycoplasma pneumoniae pneumonia (RMPP).Materials and methods: All children below 18 years, admitted between July 15, 2024 and January 15, 2025, with MPP were studied.MPP was diagnosed in children with typical symptomatology, blood counts, and Mycoplasma polymerase chain reaction (PCR) and/or significant Mycoplasma immunoglobulin M (IgM) positivity.Data was collected from the electronic medical records of our hospital.Results: Forty-two children with a mean age of 8 years SD 2.7 years (range from 3 to 13 years); 20 girls and the rest boys, were admitted with MPP during the 6 months to the four pediatric units of our hospital.Mean total count was 7,793 SD 5.294/mm 3 ; and mean quantitative C-reactive protein (CRP) was 91.15 SD 115.06 mg/L; in the eight cases where lactate dehydrogenase (LDH) was done, the mean value was 914 SD 457 (all eight had MRMP), and four were direct Coombs test (DCT) positive.Five were both serology and respiratory panel PCR positive, 16 were QIASTAT respiratory panel PCR positive and 21 were Mycoplasma IgM positive.Twenty-three presented with bronchopneumonia or consolidation, 15 had pneumonia with exudative pleural effusion without loculation; four being moderate to massive pleural effusion, requiring intercostal drainage.Two children developed pneumothorax; one was a child with spinal muscular atrophy.A 12-year-old with Mycoplasma pneumonia postinfectious bronchiolitis obliterans (PIBO) responded to high-dose pulse methylprednisolone and intravenous immunoglobulin (IVIG).A 12-year-old who required multiple interventions, including extracorporeal membrane oxygenation (ECMO), diagnosed as RMPP, was the only child in this cohort who expired.All children received first-line macrolide initially (azithromycin, in all except three who received clarithromycin), and 26 children (62%) who continued to have fever and respiratory symptoms after 72 hours of first-line macrolide were considered to have MRMP and were administered intravenous (IV) levofloxacin for the rest of therapy.Four children required mechanical ventilation, while seven recovered with noninvasive ventilation (NIV), and one child required ECMO.All children except the child who expired recovered fully without sequelae.Conclusion: Though classically, Mycoplasma pneumonia is called walking pneumonia, during outbreaks, as in this case series, severe respiratory manifestations could require hospitalization for treatment of various complications with appropriate regimens.Diagnosis of MPP, MRMP, and RMPP in resource-poor settings, where not all confirmatory tests are possible to perform due to financial constraints, is discussed.
Unni et al. (Mon,) studied this question.