title: Early Additional Immune-Modulators for Mycoplasma pneumoniae Pneumonia in Children: An Observation Study.
abstract: BACKGROUND
  Mycoplasma pneumoniae (MP) pneumonia is a self-limiting disease, but some patients complain of progressive pneumonia, despite of appropriate antibiotic treatment. We aimed to introduce the role of immune-modulators (corticosteroid and/or intravenous immunoglobulin, IVIG) treatment for childhood MP pneumonia based on previous our experiences.
  
  
  METHODS
  A retrospective case series analysis for 183 children with MP pneumonia was performed. MP pneumonia patients were diagnosed by two Immunoglobulin M (IgM) tests: the micro-particle agglutination method (≥1:40) and the cold agglutination test (≥1:4), and were examined twice at the initial admission and at discharge. Among 183 MP pneumonia patients, 90 patients with persistent fever for over 48 hours after admission or those with severe respiratory symptoms and signs received additional prednisolone (82 patients, 1 mg/kg/day) or intravenous methylprednisolone (8 patients, 5-10 mg/kg/day) with antibiotics. Four patients with aggravated clinical symptoms and chest radiographic findings after corticosteroid treatment received IVIG (1 g/kg/day, 1-2 doses).
  
  
  RESULTS
  Mean age of 183 patients was 5.5 ± 3.2 years (6 months-15 years), and the male: female ratio was 1.1:1 (96:87). Fifty-seven patients (31%) were seroconverters and 126 seropositive patients showed increased diagnostic IgM antibody titres during admission (over 4 folds). The majority of the patients who received corticosteroids (86/90 cases) showed rapid defervescence within 48 hours with improved clinical symptoms, regardless of the used antibiotics. Also, 4 patients who received additional IVIG improved both clinically and radiographically within 2 days without adverse reaction.
  
  
  CONCLUSIONS
  In the era of macrolide-resistant MP strains, early additional immune-modulator therapy with antibiotics might prevent from the disease progression and reduce the disease morbidity without adverse reaction.
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Pediatrics, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors.forename: You-Sook
authors.initials: YS
authors.lastname: Youn
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung-Churl
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Pediatrics, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors.forename: Jung-Woo
authors.initials: JW
authors.lastname: Rhim
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Pediatrics, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors.forename: Myung-Seok
authors.initials: MS
authors.lastname: Shin
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jin-Han
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Pediatrics, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors.forename: Kyung-Yil
authors.initials: KY
authors.lastname: Lee
keywords: Children; Corticosteroid; Immunoglobulin; Intravenous; Mycoplasma; Pneumonia