title: Clinical features of severe Mycoplasma pneumoniae pneumonia in adults admitted to an intensive care unit.
abstract: Community-acquired pneumonia (CAP) due to Mycoplasma pneumoniae is usually mild, but some cases develop a severe life-threatening pneumonia. To investigate the clinical features of severe M. pneumoniae pneumonia in adults admitted to an intensive care unit, a multi-centre CAP surveillance study was performed. Among all hospitalized CAP cases between January 2000 and December 2004, there were 227 cases with M. pneumoniae pneumonia without the complication of other pathogens. A total of 13 of the cases required admission to an intensive care unit because of acute respiratory failure (ARF), and the remaining 214 cases (non-ARF) were low to moderately severe. The clinical features of ARF cases were compared with those of non-ARF cases. The underlying conditions in both types of case were identical, whereas clinical findings on admission clearly differed between the two groups. A regimen of an antibiotic effective against M. pneumoniae was begun on average at 9.3 days after the onset of symptoms in ARF cases, which was significantly later than for non-ARF cases (P<0.0001). However, two of the ARF cases progressed to respiratory failure despite the fact that adequate antibiotics were initially administered within 3 days after the onset of symptoms. All ARF cases received corticosteroids with adequate antibiotics, and their condition improved promptly. These results indicate that the clinical features, excluding underlying conditions, clearly differed between severe M. pneumoniae pneumonia and low to moderately severe pneumonia. The delayed administration of adequate antibiotics may contribute to the severity of M. pneumoniae pneumonia. Early corticosteroid therapy with adequate antibiotics should be considered.
authors.affiliation: Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Okayama 701-0192, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miyashita
authors.affiliation: Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Okayama 701-0192, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Obase
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Ouchi
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Kawasaki
authors.affiliation: Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Okayama 701-0192, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kobashi
authors.affiliation: Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Okayama 701-0192, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Oka
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007157:Immunologic Surveillance; D007362:Intensive Care Units / Q000706:statistics & numerical data* / Q000639:trends; D009177:Mycoplasma pneumoniae / Q000187:drug effects / Q000472:pathogenicity*; D011019:Pneumonia, Mycoplasma / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents