1763. Mycoplasma pneumoniae as a cause of severe bronchiolitis-like syndrome among children under two years of age
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 10, 2015
Room: Poster Hall

.

Background: Mycoplasma pneumoniae (Mp) is a common cause of pneumonia among school-aged children and is increasingly being recognized as a pathogen among younger children.  Current literature includes conflicting descriptions of the severity of Mp disease at young ages. Multiplex PCR testing of respiratory samples facilitates identification of Mp even among children initially suspected to have viral illness.

Methods: Retrospective review of children under age 2 presenting with acute illness to a pediatric hospital who were found to be Mp-positive by multiplex PCR of nasopharyngeal sample from August 2013-May 2015.  Data collected included patient demographics, presenting symptoms, medical history, medications and respiratory support, length of stay (LOS), and results of laboratory and radiologic testing.

Results: During the study period, 45 Mp-positive children were identified.  Demographic and clinical characteristics (Table 1), presenting signs and symptoms (Table 2) and maximum respiratory support and ICU requirement (Figure) are shown below.   The majority of subjects presented with respiratory distress, and 58% required ICU admission for respiratory support.

Table 1. Patient Characteristics

Age in months: median (range)

15 (1, 24)

Male

58%

Premature (<37 weeks gestation)

16%

History of wheezing

13%

Chronic medical condition (not wheezing)

20%

Daycare attendance

11%

Admitted to hospital

87%

LOS in days: median (range)

4 (1, 27)

Home oxygen at discharge

36%

Table 2. Clinical Signs and Symptoms

Fever

91%

Cough

96%

Congestion

84%

Tachypnea

74%

Increased work of breathing

70%

SpO2 87%

67%

Coarse breath sounds

67%

Vomiting

41%

Crackles

33%

Wheeze

29%

78% of patients had respiratory viral co-infections detected on multiplex PCR testing, of which rhino/enterovirus was the most common (22/35, 63%).  Of the 87% of patients who had a chest x-ray, 46% had airways disease, 46% consolidation, 5% atelectasis, and 3% no abnormality. Most patients (84%) received azithromycin and 58% received additional antibiotics for other clinical indications. 44% received albuterol and 24% received steroids. There were no deaths.

Conclusion: Mycoplasma pneumoniae may represent a treatable cause of potentially severe bronchiolitis-like syndrome among infants and toddlers.

Jessica Cataldi, MD1, Daniel Olson, MD2, Kevin Messacar, MD1, Christine C. Robinson, PhD3, Samuel R. Dominguez, MD, PhD1 and James Gaensbauer, MD, MScPH4,5, (1)Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (2)Pediatric Infectious Diseases, University of Colorado - Denver, Aurora, CO, (3)Children's Hospital Colorado, Denver, CO, (4)Pediatric Infectious Disease, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, (5)Pediatric Infectious Disease, Denver Health and Hospital Authority, Denver, CO

Disclosures:

J. Cataldi, None

D. Olson, None

K. Messacar, None

C. C. Robinson, Biofire: Scientific Advisor , Consulting fee

S. R. Dominguez, None

J. Gaensbauer, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.