Frequency and Clinical Presentation of Mucocutaneous Disease Due to Mycoplasma pneumoniae Infection in Children With Community-Acquired Pneumonia

Importance

The diagnosis ofMycoplasma pneumoniaeinfection as the cause of mucocutaneous disease is challenging because current diagnostic tests are not able to differentiateM pneumoniaeinfection from carriage.

Objective

To examine the frequency and clinical presentation ofM pneumoniae–induced mucocutaneous disease in children with community-acquired pneumonia (CAP) using improved diagnostics.

Design, Setting, and Participants

This prospective, longitudinal cohort study included 152 children aged 3 to 18 years with CAP enrolled in a CAP study from May 1, 2016, to April 30, 2017, at the University Children’s Hospital Zurich. Children were inpatients or outpatients with clinically defined CAP according to the British Thoracic Society guidelines. Data analysis was performed from July 10, 2017, to June 29, 2018.

Main Outcomes and Measures

Frequency and clinical presentation ofM pneumoniae–induced mucocutaneous disease in childhood CAP.Mycoplasma pneumoniaeinfection was diagnosed by polymerase chain reaction (PCR) of oropharyngeal samples and confirmed with the measurement of specific peripheral blood IgM antibody-secreting cells by enzyme-linked immunospot assay to differentiateM pneumoniae–infected patients from carriers with CAP caused by other pathogens. Mucocutaneous disease was defined as any eruptive lesion that involved skin and/or mucous membranes occurring during the CAP episode.

Results

Among 152 enrolled children with CAP (median [interquartile range] age, 5.7 [4.3–8.9] years; 84 [55.3%] male), 44 (28.9%) tested positive forM pneumoniaeby PCR; of these, 10 children (22.7%) developed mucocutaneous lesions. All 10 patients with mucocutaneous eruptions tested positive for specific IgM antibody–secreting cells. Skin manifestations were found in 3 cases (2.8%) ofM pneumoniaePCR-negative CAP (P < .001). The spectrum ofM pneumoniae–induced mucocutaneous disease includedM pneumoniae–induced rash and mucositis (3 cases [6.8%]), urticaria (2 cases [4.5%]), and maculopapular skin eruptions (5 cases [11.4%]). Two patients had ocular involvement as the sole mucosal manifestation (bilateral anterior uveitis and nonpurulent conjunctivitis). Patients withM pneumoniae–induced mucocutaneous disease had longer duration of prodromal fever (median [interquartile range], 10.5 [8.3-11.8] vs 7.0 [5.5-9.5] days;P = .02) and higher C-reactive protein levels (median [interquartile range], 31 [22-59] vs 16 [7-23] mg/L;P = .04) than patients with CAP due toM pneumoniaewithout mucocutaneous manifestations. They were also more likely to require oxygen (5 [50%] vs 1 [5%];P = .007), to require hospitalization (7 [70%] vs 4 [19%];P = .01), and to develop long-term sequelae (3 [30%] vs 0;P = .03).

Conclusions and Relevance

Mucocutaneous disease occurred significantly more frequently in children with CAP due toM pneumoniaethan in children with CAP of other origins.Mycoplasma pneumoniae–induced mucocutaneous disease was associated with increased systemic inflammation, morbidity, and a higher risk of long-term sequelae.