Clinical Investigation of Mycoplasma Pneumoniae Infection in Pediatrics

• Main Authors: Tzu-Yu Ho, 何慈育
• Other Authors: Ying-Chun Li
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/48432943487401567867

碩士 === 國立中山大學 === 醫務管理研究所 === 101 === Background Mycoplasma pneumoniae (M. pneumoniae) is a major cause of pediatric community‐acquired pneumonia (CAP), accounting for approximately 15% of all CAP cases. Treatment with macrolide antibiotics is recommended. However, diagnosis of M. pneumoniae infection based on clinical symptoms is difficult. Diagnostic uncertainty can lead to the prescription of inappropriate antibiotics, which may worsen patients’ clinical prognosis, increase their antibiotic resistance, and generate medical waste. Any information that can contribute to achieving an effective diagnosis is extremely valuable. Thus, this study investigates the clinical features and laboratory and radiographic findings of patients with lower respiratory tract infections to facilitate diagnosis of M. pneumoniae infection. Design A retrospective review of medical records was conducted to obtain patient data, including their sex, age, and duration of hospitalization (Appendix 3). All lower respiratory tract infection patients admitted to the pediatric ward at the Zuoying branch of the Kaohsiung Armed Forces General Hospital (a local teaching hospital) between January 2009 and August 2012 were included in this study. Patients who were over 18 years of age, diagnosed with critical illnesses, discharged against medical advice, or had a hospitalization duration of less than 24 hours were excluded. The remaining patients were divided into two groups according to whether their indirect hemagglutination test (IHT) results showed values below or above 1:320. Data were analyzed using Statistical Packages for Social Sciences (SPSS) software for Windows, version 19.0. A p value of < 0.05 was considered significant. Results The total number of cases examined was 283. Of these, 67 had titer values equal to or greater than 1:320 (infection group), and 216 had values below 1:320 (non-infection group). The patients’ mean age and average hospitalization duration for the infection group were 5.87 + 2.88 years and 4.13 + 2.04 days, and 5.13 + 2.86 years and 4.20 + 1.86 days for the non-infection group. Between the 2 groups, 3 variables achieved statistical significance (p < 0.05), namely, chest X-ray film patches (p = 0.000), eosinophil percentage (p = 0.009), and platelet count (p = 0.039). Conclusion The results for patients’ eosinophil percentage and platelet count in routine blood tests showed statistical significance for M. pneumoniae infection. Furthermore, the results could be obtained more rapidly using routine blood tests compared to IHT, specifically, less than 1 hour versus at least 3 hours. In addition, the performance of IHT is not suitable for emergency purposes. Physicians can use the eosinophil percentage identified in routine blood tests to rapidly and adequately diagnose patients with lower respiratory tract infections in not only outpatient and inpatient departments, but also in emergency departments. Consequently, more appropriate antibiotics can be administered, thereby reducing medical waste.