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A decade of pediatric Mycoplasma pneumoniae infections: clinical features, extrapulmonary findings, and predictors associated with advanced care markers abstract

Year 2026, Volume: 8 Issue: 1, 167 - 173, 06.01.2026

Abstract

Aims: This study aimed to to describe clinical and radiological characteristics of cold agglutinin-positive pediatric patients and to evaluate factors associated markers of disease severity, including CT utilization, respiratory support and length of hospitalization, in patients with suspected Mycoplasma pneumonia infection and cold agglutination positivity.
Methods: A retrospective analysis was conducted on patients aged 0-18 years who presented to the pediatric clinics of Necmettin Erbakan University between January 2015 and January 2025 and had cold agglutinin positivity. Demographics, presenting symptoms, pulmonary and extrapulmonary findings, imaging results, treatment settings, respiratory support needs, and laboratory parameters were extracted from medical records. Comparative analyses between patients with and without chest CT imaging were performed using appropriate statistical tests.
Results: A total of 242 patients (52.9% female; mean age 8.31±4.41 years) were included. The most frequent symptoms were cough (83.5%), nonspecific complaints (42.6%), and fever (38.4%). Abnormal respiratory findings were present in 45.0%, most commonly bilateral crackles. Extrapulmonary manifestations occurred in 20.2% of patients. Chest X-rays showed bilateral involvement in 47.9%. Patients who underwent CT imaging had significantly higher rates of abnormal respiratory findings, increased need for supplemental oxygen or noninvasive support, and longer hospital stays (p<0.001).
Conclusion: Cold agglutination–positive pediatric patients demonstrated a wide clinical spectrum. The association between CT utilization and markers of more severe disease underscores the need for careful monitoring and early recognition of high-risk cases.

Ethical Statement

This study was approved by the Institutional Ethics Committee for Non-Pharmaceutical and Non-Medical Device Research (Date: March 21, 2025; Approval No: 2025/5641),

Supporting Institution

None

Project Number

23062.R1

Thanks

None

References

  • Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev. 2008;32(6):956-973. doi: 10.1111/j.1574-6976.2008.00129.x
  • Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372 (9):835-845. doi:10.1056/NEJMoa1405870
  • Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother. 2010;16(3):162-169. doi: 10.1007/s10156-010-0044-x
  • Meyer Sauteur PM, Unger WW, Nadal D, Berger C, Vink C, van Rossum AM. Infection with and Carriage of Mycoplasma pneumoniae in Children. Front Microbiol. 2016;7:329. doi: 10.3389/fmicb.2016.00329
  • Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association; China National Clinical Research Center of Respiratory Diseases; Editorial Board, Chinese Journal of Pediatrics. Evidence-based guideline for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023). Pediatr Investig. 2025;11:9(1):1-11. doi: 10.1002/ped4.12469
  • Jacobs E. Mycoplasma pneumoniae: now in the focus of clinicians and epidemiologists. Euro Surveill. 2012;17(6):20084.
  • Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004;17(4):697-728. doi:10.1128/C MR.17.4.697-728.2004
  • Chalker V, Stocki T, Mentasti M, Fleming D, Harrison T. Increased incidence of Mycoplasma pneumoniae infection in England and Wales in 2010: multiocus variable number tandem repeat analysis typing and macrolide susceptibility. Euro Surveill. 2011;16(19):19865.
  • Lenglet A, Herrador Z, Magiorakos AP, Leitmeyer K, Coulombier D; European Working Group on Mycoplasma pneumoniae surveillance. Surveillance status and recent data for Mycoplasma pneumoniae infections in the European Union and European Economic Area. Euro Surveill. 2012;17(5):20075. doi: 10.2807/ese.17.05.20075-en
  • Principi N, Esposito S. Mycoplasma pneumoniae and Chlamydia pneumoniae cause lower respiratory tract disease in paediatric patients. Curr Opin Infect Dis. 2002;15(3):295-300. doi: 10.1097/00001432-200206 000-00013
  • Cho YJ, Han MS, Kim WS, et al. Correlation between chest radiographic findings and clinical features in hospitalized children with Mycoplasma pneumoniae pneumonia. PLoS One. 2019;14(8):e0219463. doi:10.1371/jo urnal.pone.0219463
  • Youn YS, Lee KY. Mycoplasma pneumoniae pneumonia in children. Korean J Pediatr. 2012;55(2):42-47. doi:10.3345/kjp.2012.55.2.42
  • Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the respiratory tract and beyond. Clin Microbiol Rev. 2017;30(3):747-809. doi: 10.1128/CMR.00114-16
  • Narita M. Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae infection on the basis of possible pathogenesis. Front Microbiol. 2016;7:23. doi: 10.3389/fmicb.2016.00023
  • Irodi A, Leena RV, Prabhu SM, Gibikote S. Role of computed tomography in pediatric chest conditions. Indian J Pediatr. 2016;83(7):675-690. doi: 10.1007/s12098-015-1955-4
  • Kurian J, Levin TL, Han BK, Taragin BH, Weinstein S. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 2009;193(6): 1648-1654. doi: 10.2214/AJR.09.2791
  • Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53 (7):e25-e76. doi: 10.1093/cid/cir531
  • Esposito S, Cohen R, Domingo JD, et al. Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat? Pediatr Infect Dis J. 2012;31(6):e78-e85. doi: 10.1097/INF.0 b013e318255dc5b
  • Williams DJ, Zhu Y, Grijalva CG, et al. Predicting severe pneumonia outcomes in children. Pediatrics. 2016;138(4):e20161019. doi: 10.1542/p eds.2016-1019
  • Jacobs E. Serological diagnosis of Mycoplasma pneumoniae infections: a critical review of current procedures. Clin Infect Dis. 1993;17(1):S79-S82. doi:10.1093/clinids/17.supplement_1.s79
  • Berentsen S, Randen U, Tjønnfjord GE. Cold agglutinin-mediated autoimmune hemolytic anemia. Hematol Oncol Clin North Am. 2015;29 (3):455-471. doi: 10.1016/j.hoc.2015.01.002
  • Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-e1502. doi:10.1542/peds.2014-2742
  • Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017;389(10065): 211-224. doi:10.1016/S0140-6736(16)30951-5
  • Swingler GH, Hussey GD, Zwarenstein M. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet. 1998;351(9100):404-408. doi: 10.1016/S0140-6736(97)07013-X
  • Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66:2:ii1-ii23. doi:10.1136/thoraxjnl-2011-200598
  • Shi T, McAllister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390(10098):946-958. doi:10.1016/S01 40-6736(17)30938-8

Çocuklarda görülen mikoplazma pnömonisi enfeksiyonlarının on yılı: klinik özellikler, akciğer dışı bulgular ve ileri bakım gereksinimlerini belirleyen faktörler

Year 2026, Volume: 8 Issue: 1, 167 - 173, 06.01.2026

Abstract

Amaç: Bu çalışma, soğuk aglütinasyon testi pozitifliği olan pediatrik hastalarda klinik, radyolojik ve laboratuvar özelliklerini tanımlamayı ve Mycoplasma pneumoniae enfeksiyonlarında şiddetle ilişkili faktörleri belirlemeyi amaçlamıştır.
Yöntemler: Ocak 2015 ile Ocak 2025 tarihleri ​​arasında Necmettin Erbakan Üniversitesi pediatri kliniklerine başvuran ve soğuk aglütinasyon testi pozitif olan 0-18 yaş arası hastalar üzerinde retrospektif bir analiz yapılmıştır. Demografik bilgiler, başvuru semptomları, akciğer ve akciğer dışı bulgular, görüntüleme sonuçları, tedavi ayarları, solunum desteği ihtiyaçları ve laboratuvar parametreleri tıbbi kayıtlardan çıkarılmıştır. Göğüs BT görüntülemesi olan ve olmayan hastalar arasında uygun istatistiksel testler kullanılarak karşılaştırmalı analizler yapılmıştır.
Sonuçlar: Toplam 242 hasta (kadın oranı %52,9; ortalama yaş 8,31±4,41 yıl) çalışmaya dahil edilmiştir. En sık görülen semptomlar öksürük (%83,5), spesifik olmayan şikayetler (%42,6) ve ateş (%38,4) olmuştur. Anormal solunum bulguları %45,0 oranında mevcuttu ve en sık olarak bilateral çıtırtılar görüldü. Akciğer dışı belirtiler hastaların %20,2'sinde ortaya çıktı. Göğüs röntgenlerinde %47,9 oranında bilateral tutulum görüldü. BT görüntülemesi yapılan hastalarda anormal solunum bulguları, ek oksijen veya noninvaziv ventilasyon ihtiyacı ve daha uzun hastane yatış süreleri anlamlı derecede daha yüksekti (p<0,001).
Sonuç: Soğuk aglütinasyon pozitif pediatrik hastalar geniş bir klinik spektrum sergiledi. BT kullanımının daha şiddetli hastalık belirteçleriyle ilişkisi, yüksek riskli vakaların dikkatli bir şekilde izlenmesi ve erken teşhisinin gerekliliğini vurgulamaktadır.

Ethical Statement

Bu çalışma Kurumsal İlaç ve Tıbbi Cihaz Dışı Araştırmalar Etik Kurulunca onaylanmıştır (Tarih: 21 Mart 2025; Onay No: 2025/5641),

Supporting Institution

Yok

Project Number

23062.R1

Thanks

Yok

References

  • Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev. 2008;32(6):956-973. doi: 10.1111/j.1574-6976.2008.00129.x
  • Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372 (9):835-845. doi:10.1056/NEJMoa1405870
  • Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother. 2010;16(3):162-169. doi: 10.1007/s10156-010-0044-x
  • Meyer Sauteur PM, Unger WW, Nadal D, Berger C, Vink C, van Rossum AM. Infection with and Carriage of Mycoplasma pneumoniae in Children. Front Microbiol. 2016;7:329. doi: 10.3389/fmicb.2016.00329
  • Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association; China National Clinical Research Center of Respiratory Diseases; Editorial Board, Chinese Journal of Pediatrics. Evidence-based guideline for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023). Pediatr Investig. 2025;11:9(1):1-11. doi: 10.1002/ped4.12469
  • Jacobs E. Mycoplasma pneumoniae: now in the focus of clinicians and epidemiologists. Euro Surveill. 2012;17(6):20084.
  • Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004;17(4):697-728. doi:10.1128/C MR.17.4.697-728.2004
  • Chalker V, Stocki T, Mentasti M, Fleming D, Harrison T. Increased incidence of Mycoplasma pneumoniae infection in England and Wales in 2010: multiocus variable number tandem repeat analysis typing and macrolide susceptibility. Euro Surveill. 2011;16(19):19865.
  • Lenglet A, Herrador Z, Magiorakos AP, Leitmeyer K, Coulombier D; European Working Group on Mycoplasma pneumoniae surveillance. Surveillance status and recent data for Mycoplasma pneumoniae infections in the European Union and European Economic Area. Euro Surveill. 2012;17(5):20075. doi: 10.2807/ese.17.05.20075-en
  • Principi N, Esposito S. Mycoplasma pneumoniae and Chlamydia pneumoniae cause lower respiratory tract disease in paediatric patients. Curr Opin Infect Dis. 2002;15(3):295-300. doi: 10.1097/00001432-200206 000-00013
  • Cho YJ, Han MS, Kim WS, et al. Correlation between chest radiographic findings and clinical features in hospitalized children with Mycoplasma pneumoniae pneumonia. PLoS One. 2019;14(8):e0219463. doi:10.1371/jo urnal.pone.0219463
  • Youn YS, Lee KY. Mycoplasma pneumoniae pneumonia in children. Korean J Pediatr. 2012;55(2):42-47. doi:10.3345/kjp.2012.55.2.42
  • Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the respiratory tract and beyond. Clin Microbiol Rev. 2017;30(3):747-809. doi: 10.1128/CMR.00114-16
  • Narita M. Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae infection on the basis of possible pathogenesis. Front Microbiol. 2016;7:23. doi: 10.3389/fmicb.2016.00023
  • Irodi A, Leena RV, Prabhu SM, Gibikote S. Role of computed tomography in pediatric chest conditions. Indian J Pediatr. 2016;83(7):675-690. doi: 10.1007/s12098-015-1955-4
  • Kurian J, Levin TL, Han BK, Taragin BH, Weinstein S. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 2009;193(6): 1648-1654. doi: 10.2214/AJR.09.2791
  • Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53 (7):e25-e76. doi: 10.1093/cid/cir531
  • Esposito S, Cohen R, Domingo JD, et al. Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat? Pediatr Infect Dis J. 2012;31(6):e78-e85. doi: 10.1097/INF.0 b013e318255dc5b
  • Williams DJ, Zhu Y, Grijalva CG, et al. Predicting severe pneumonia outcomes in children. Pediatrics. 2016;138(4):e20161019. doi: 10.1542/p eds.2016-1019
  • Jacobs E. Serological diagnosis of Mycoplasma pneumoniae infections: a critical review of current procedures. Clin Infect Dis. 1993;17(1):S79-S82. doi:10.1093/clinids/17.supplement_1.s79
  • Berentsen S, Randen U, Tjønnfjord GE. Cold agglutinin-mediated autoimmune hemolytic anemia. Hematol Oncol Clin North Am. 2015;29 (3):455-471. doi: 10.1016/j.hoc.2015.01.002
  • Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-e1502. doi:10.1542/peds.2014-2742
  • Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017;389(10065): 211-224. doi:10.1016/S0140-6736(16)30951-5
  • Swingler GH, Hussey GD, Zwarenstein M. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet. 1998;351(9100):404-408. doi: 10.1016/S0140-6736(97)07013-X
  • Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66:2:ii1-ii23. doi:10.1136/thoraxjnl-2011-200598
  • Shi T, McAllister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390(10098):946-958. doi:10.1016/S01 40-6736(17)30938-8
There are 26 citations in total.

Details

Primary Language English
Subjects Pediatric Infectious Diseases, Pediatric Chest Diseases
Journal Section Research Article
Authors

Abdullah Akkuş 0000-0002-0642-8759

Sevgi Pekcan 0000-0002-8059-902X

Fatih Ercan 0000-0001-5252-7806

Suat Savaş 0000-0002-2733-7194

Gökhan Gözün 0000-0002-7264-015X

Uğur Saraç 0009-0000-0652-5834

Hasan Çetin 0009-0007-1239-5248

Nefise Betül Ercan 0000-0001-7863-831X

Mustafa Gençeli 0000-0001-9455-2735

Özge Metin Akçan 0000-0002-3465-6994

Mehmet Özdemir 0000-0002-9316-771X

Project Number 23062.R1
Submission Date December 13, 2025
Acceptance Date January 5, 2026
Publication Date January 6, 2026
Published in Issue Year 2026 Volume: 8 Issue: 1

Cite

AMA Akkuş A, Pekcan S, Ercan F, et al. A decade of pediatric Mycoplasma pneumoniae infections: clinical features, extrapulmonary findings, and predictors associated with advanced care markers abstract. Anatolian Curr Med J / ACMJ / acmj. January 2026;8(1):167-173.

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