Robinson Elena, Zellner Michael, Osuna Ester, Seiler Michelle, Theiler Martin, Sidorov Semjon, von Felten Stefanie, Berger Christoph, Meyer Sauteur Patrick M
Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Lenggstrasse 30, CH-8008, Zurich, Switzerland.
Division of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.
Eur J Pediatr. 2025 Aug 7;184(8):535. doi: 10.1007/s00431-025-06326-y.
Since its delayed re-emergence after non-pharmaceutical interventions (NPIs) against the COVID-19 pandemic, Mycoplasma pneumoniae has caused community-acquired pneumonia outbreaks worldwide. In this study, we aimed to investigate how the clinical characteristics and severity of M. pneumoniae infections have changed after COVID-19 pandemic restriction, in order to enable adequate interpretation of clinical features and response to future M. pneumoniae epidemics. This retrospective, comparative cohort study compared clinical features and severity of children with M. pneumoniae detection by PCR during the periods April 1, 2015, to March 31, 2020 (pre-NPI); April 1, 2020, to March 31, 2022 (NPI); and April 1, 2022, to March 31, 2025 (post-NPI). Clinical features were compared between periods by Kruskal-Wallis rank sum test or Fisher's exact test, as appropriate. Moreover, we compared hospitalization and intensive care unit (ICU) admission using generalized linear models. In total, 321 patients were included in the study. Since the first detection of M. pneumoniae after the COVID-19 pandemic in summer 2023, the re-emergence has shown a bimodal curve with two distinct peaks (post-NPI first-year and second-year). The median age of patients was higher in the post-NPI than the pre-NPI period (9.05 vs 8.20 years), particularly during the first-year peak (11.00 years). Obstructive diseases were observed more frequently post-NPI compared to pre-NPI (18.6% vs 9.6%). Moreover, more patients presented with chest pain (8.9% vs 2.4%) and pleural effusions (45.7% vs 28.9%) post-NPI than pre-NPI. Conversely, extrapulmonary manifestations were less frequent post-NPI (18.6% vs 30.1%), particularly dermatological (15.7% vs 25.3%) and neurological (1.3% vs 4.8%) manifestations. Hospitalization rate (38.6% post-NPI vs 43.9% pre-NPI) and length of stay (median, 4 [IQR, 2-5] vs 4 [IQR, 3-6] days) were similar, while generalized linear models showed a trend toward fewer hospitalizations post-NPI (odds ratio [OR], 0.72 [95% CI, 0.42-1.23]; P = 0.22). The same applied to ICU admission rate (5.1% post-NPI vs 4.9% pre-NPI), with a trend toward fewer ICU admissions post-NPI (OR, 0.90 [95% CI, 0.29-3.34]; P = 0.86).
We observed notable changes in the clinical presentation of re-emerging M. pneumoniae infections compared to the pre-COVID-19 pandemic period, particularly an increase in obstructive phenotypes and pleural effusions. However, overall disease severity appeared to remain largely unchanged.
• The delayed re-emergence of M. pneumoniae in late 2023 was substantial in terms of case numbers across many geographical locations. • No statistically increased proportion of severe or worse outcomes of re-emerging M. pneumoniae infections could be observed globally compared with pre-COVID-19 pandemic epidemics.
• Clinical features of M. pneumoniae infections in children partly changed following COVID-19 pandemic restrictions, with new signs like obstructive phenotypes and pleural effusions. • The findings suggest that there has been no overall increase in disease severity; in fact, extrapulmonary manifestations were fewer, with trends toward reduced hospitalizations and ICU admissions.
自针对新冠疫情的非药物干预措施（NPIs）实施后支原体肺炎延迟再现以来，它已在全球范围内引发社区获得性肺炎疫情。在本研究中，我们旨在调查新冠疫情限制措施实施后支原体肺炎感染的临床特征和严重程度如何变化，以便能够充分解读临床特征并应对未来的支原体肺炎流行。这项回顾性、比较队列研究比较了2015年4月1日至2020年3月31日（非NPIs之前）、2020年4月1日至2022年3月31日（NPIs期间）以及2022年4月1日至2025年3月31日（NPIs之后）通过聚合酶链反应（PCR）检测出支原体肺炎的儿童的临床特征和严重程度。根据情况，采用Kruskal - Wallis秩和检验或Fisher精确检验对各时间段的临床特征进行比较。此外，我们使用广义线性模型比较了住院情况和重症监护病房（ICU）收治情况。本研究共纳入321例患者。自2023年夏季新冠疫情后首次检测到支原体肺炎以来，其再现呈现双峰曲线，有两个明显的峰值（NPIs之后的第一年和第二年）。NPIs之后患者的中位年龄高于非NPIs之前（9.05岁对8.20岁），特别是在第一年峰值期间（11.00岁）。与非NPIs之前相比，NPIs之后阻塞性疾病的观察频率更高（18.6%对9.6%）。此外，NPIs之后出现胸痛（8.9%对2.4%）和胸腔积液（45.7%对28.9%）的患者比非NPIs之前更多。相反，NPIs之后肺外表现较少见（18.6%对30.1%），特别是皮肤表现（15.7%对25.3%）和神经表现（1.3%对4.8%）。住院率（NPIs之后为38.6%，非NPIs之前为43.9%）和住院时长（中位数，4[四分位间距，2 - 5]天对4[四分位间距，3 - 6]天）相似，而广义线性模型显示NPIs之后住院人数有减少趋势（比值比[OR]，0.72[95%置信区间，0.42 - 1.23]；P = 0.22）。ICU收治率情况相同（NPIs之后为5.1%，非NPIs之前为4.9%），NPIs之后ICU收治人数有减少趋势（OR，0.90[95%置信区间，0.29 - 3.34]；P = 0.86）。
我们观察到与新冠疫情之前相比，再现的支原体肺炎感染的临床表现有显著变化，特别是阻塞性表型和胸腔积液增加。然而，总体疾病严重程度似乎基本保持不变。
• 2023年末支原体肺炎的延迟再现就许多地理位置的病例数而言规模较大。• 与新冠疫情之前的流行情况相比，全球范围内未观察到再现的支原体肺炎感染的严重或更差结局的比例有统计学意义的增加。
• 新冠疫情限制措施实施后，儿童支原体肺炎感染的临床特征部分发生了变化，出现了阻塞性表型和胸腔积液等新体征。• 研究结果表明疾病严重程度总体没有增加；事实上，肺外表现较少，住院和ICU收治人数有减少趋势。
