Typical or atypical pneumonia and severe acute respiratory symptoms in PICU.
OBJECTIVE
Mycoplasma pneumoniae (MP) is a common childhood pathogen associated with atypical pneumonia (AP). It is often a mild disease and seldom results in paediatric intensive care (PICU) admission. In 2003, World Health Organization (WHO) coined the word SARS (severe acute respiratory syndrome) in patients with severe acute respiratory symptoms (sars) for an outbreak of AP in Hong Kong due to a novel coronavirus. In 2012, another outbreak of coronavirus AP occurred in the Middle East. Confusing case definitions such as MERS (Middle East respiratory syndrome) and SARI (severe acute respiratory infections) were coined. This paper aims to present a case of MP with sars, ARDS, pneumonia and pleural effusion during the MERS epidemics, and review the incidence and mortality of severe AP with MP.


METHODS
We presented a case of MP with sars, acute respiratory distress syndrome (ARDS), pneumonia and pleural effusion during the MERS epidemics, and performed a literature review on the incidence and mortality of severe AP with MP requiring PICU care.


RESULTS
In early 2013, an 11-year-old girl presented with sars, ARDS (acute respiratory distress syndrome), right-sided pneumonia and pleural effusion. She was treated with multiple antibiotics. Streptococcus pneumoniae was not isolated in this girl with 'typical' pneumonia by symptomatology and chest radiography, but tracheal aspirate identified MP instead. The respiratory equations are computed with PaO2 /FiO2 consistent with severe lung injury. Literature on the incidence and mortality of severe AP with MP requiring PICU care is reviewed. Six, 165 and 293 articles were found when PubMed (a service of the U.S. National Library of Medicine) was searched for the terms 'mycoplasma' and 'ICU', 'mycoplasma' and 'mortality', and 'mycoplasma' and 'severe'. Mortality and PICU admission associated with MP is general low and rarely reported. Experimental and clinical studies have suggested that the pathogenesis of lung injuries in MP infection is associated with a cell-mediated immune reaction, and high responsiveness to corticosteroid therapy has been reported especially for severe disease. Management of severe mycoplasma infection in the PICU includes general cardiopulmonary support and specific antimicrobial treatment. Macrolide resistance genotypes have been detected.


CONCLUSIONS
We urge health organizations to refrain from the temptation of coining unnecessary new terminology to describe essentially the same conditions each and every time when outbreaks of AP occur.
Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Kam Lun
KL
Hon
Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Agnes S Y
AS
Leung
Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Kam Lau
KL
Cheung
Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Antony C
AC
Fu
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Winnie Chiu Wing
WC
Chu
Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Margaret
M
Ip
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Paul K S
PK
Chan
D002648:Child; D003422:Critical Care; D005260:Female; D006801:Humans; D009177:Mycoplasma pneumoniae; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011019:Pneumonia, Mycoplasma / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D045169:Severe Acute Respiratory Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
MERS; Mycoplasma pneumoniae; atypical pneumonia; immuniztions; pleural effusion; pneumococcus; severe acute respiratory syndrome