title: Mycoplasma pneumoniae as a causative agent of community-acquired pneumonia in children: clinical features and laboratory diagnosis.
abstract: BACKGROUND
  Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in children. The aim of this study was to assess the prevalence of Mycoplasma pneumoniae infection in children with CAP and find clinical, radiological and laboratory features helpful to diagnose Mycoplasma pneumoniae pneumonia. Furthermore, we evaluated the value of serology, real-time PCR (RT-PCR) and culture for the accurate diagnosis of Mycoplasma pneumoniae pneumonia.
  
  
  METHODS
  The study included 166 children aged between 1 and 15 years with radiologically confirmed pneumonia. Throat swab specimens were cultured and assessed by RT-PCR for the presence of Mycoplasma pneumoniae. Mycoplasma pneumoniae-specific IgM and IgG antibodies were determined using ELISA in paired sera.
  
  
  RESULTS
  Mycoplasma pneumoniae pneumonia was diagnosed in 14.5% CAP cases. Cough (p=0.029), headache (p=0.001) and wheezing (p=0.036) were more frequent in children with Mycoplasma pneumoniae pneumonia compared to children with pneumonia caused by other pathogens. Logistic regression analysis showed that headache (odds ratio [OR] =36.077, p=0.001) and wheezing (OR=5.681, p=0.003) were significantly associated with MP pneumonia. Neither radiological findings, nor common laboratory parameters distinguished Mycoplasma pneumoniae infection in children with CAP. Using IgG serology in paired sera as the gold standard, we found that sensitivity of IgM serology, RT-PCR and culture was equal (81.82%), while specificity values were 100%, 98.6% and 100% respectively. We observed that combination of IgM detection in acute-phase serum and RT-PCR was positive for 91.7% of cases with Mycoplasma pneumoniae infection.
  
  
  CONCLUSIONS
  There are no characteristic radiological findings, or routine laboratory tests that would distinguish CAP caused by Mycoplasma pneumoniae from other CAP. It was found that clinical features such as headache and wheezing are indicative for Mycoplasma pneumoniae infection. Furthermore, it was found that during the acute phase of disease, detection of IgM antibodies in combination with RT-PCR allows for precise and reliable diagnosis of Mycoplasma pneumoniae infections in children.
authors.affiliation: Medical Faculty, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia. medjo.biljana@gmail.com.|University Children's Hospital, Tirsova 10, Belgrade, Serbia. medjo.biljana@gmail.com.
authors.forename: Biljana
authors.initials: B
authors.lastname: Medjo
authors.affiliation: Medical Faculty, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia. marinaa@eunet.rs.|University Children's Hospital, Tirsova 10, Belgrade, Serbia. marinaa@eunet.rs.
authors.forename: Marina
authors.initials: M
authors.lastname: Atanaskovic-Markovic
authors.affiliation: Children's Hospital for Respiratory Diseases and TB, Clinical Health Center "Dr Dragisa Misovic - Dedinje", Jovana Marinovica 4, 11 000, Belgrade, Serbia. snezana_radic@hotmail.com.
authors.forename: Snezana
authors.initials: S
authors.lastname: Radic
authors.affiliation: Medical Faculty, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia. dimitrije.nikolic@gmail.com.|University Children's Hospital, Tirsova 10, Belgrade, Serbia. dimitrije.nikolic@gmail.com.
authors.forename: Dimitrije
authors.initials: D
authors.lastname: Nikolic
authors.affiliation: Medical Faculty, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia. marija.lukac@udk.bg.ac.rs.|University Children's Hospital, Tirsova 10, Belgrade, Serbia. marija.lukac@udk.bg.ac.rs.
authors.forename: Marija
authors.initials: M
authors.lastname: Lukac
authors.affiliation: Institute of Microbiology, Medical Faculty, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia. bobadi@orion.rs.
authors.forename: Slobodanka
authors.initials: S
authors.lastname: Djukic
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009177:Mycoplasma pneumoniae / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial