Aguilera-Alonso David, López Ruiz Rocío, Centeno Rubiano Jose, Morell García Marta, Valero García Isabel, Ocete Mochón María Dolores, Montesinos Sanchis Elena
Servicio de Pediatría, Hospital General Universitario, Valencia, Spain.
Servicio de Microbiología, Hospital General Universitario, Valencia, Spain.
An Pediatr (Engl Ed). 2019 Jul;91(1):21-29. doi: 10.1016/j.anpede.2019.01.003. Epub 2019 Feb 6.
(MP) is one of the most common etiological agents of community-acquired pneumonia (CAP) in children. We aimed to describe the clinical and epidemiological characteristics, treatment and outcome of children diagnosed with community-acquired MP pneumonia (CAMP) in a tertiary hospital in Valencia, Spain.
Medical records of children <14 years with CAMP were retrospectively reviewed from January 2010 to December 2015. Patients with radiological evidence of pneumonia and microbiological confirmation of MP (PCR from nasopharyngeal swab and/or serum specific IgM) were considered CAMP.
One hundred and sixty two children were diagnosed with CAMP; median age 6 years (IQR: 4-9). The positive MP test rate among children with CAP progressively increased with age as did the empirical use of macrolides. There were two peaks of cases in 2011 and in 2015, being July, August, November and December the seasons with the higher number of cases. The most frequent radiological pattern was segmental infiltrate (62.3%) and 22 (13.6%) children had pleural effusion. It was noteworthy the mild symptomatology and low levels of inflammatory parameters that children with CAMP had. A macrolide was empirically initiated in 68.5% of cases. Hospital admission rate was inversely proportional to patient's age.
According to this study, older, less symptomatic patients and with lower inflammatory parameters had the greatest rate of MP infection among children with CAP and thus they could benefit of empiric macrolide therapy. Therefore, knowing the epidemiology of a geographical area may be important for the management of CAP in children.
肺炎支原体（MP）是儿童社区获得性肺炎（CAP）最常见的病原体之一。我们旨在描述西班牙巴伦西亚一家三级医院中被诊断为社区获得性MP肺炎（CAMP）的儿童的临床和流行病学特征、治疗及转归。
回顾性分析2010年1月至2015年12月期间年龄<14岁的CAMP患儿的病历。有肺炎影像学证据且MP微生物学确诊（鼻咽拭子PCR和/或血清特异性IgM）的患者被视为CAMP。
162例儿童被诊断为CAMP；中位年龄6岁（四分位间距：4 - 9岁）。CAP患儿中MP检测阳性率随年龄增长而逐渐升高，大环内酯类药物的经验性使用情况也是如此。2011年和2015年出现两个病例高峰，7月、8月、11月和12月是病例数较多的季节。最常见的影像学表现为节段性浸润（62.3%），22例（13.6%）儿童有胸腔积液。值得注意的是，CAMP患儿症状较轻且炎症指标水平较低。68.5%的病例经验性使用了大环内酯类药物。住院率与患者年龄成反比。
根据本研究，年龄较大、症状较轻且炎症指标较低的CAP患儿MP感染率最高，因此他们可能从经验性大环内酯类治疗中获益。所以，了解一个地理区域的流行病学情况对于儿童CAP的管理可能很重要。
