1762. Comparison of ESR and CRP among Children with Mycoplasma-associated Pneumonia versus Viral and Bacterial Pneumonia
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 10, 2015
Room: Poster Hall

Background: Previous studies among adults have shown that pneumonia due to Mycoplasma pneumoniae can be associated with a prolonged incubation and the formation of cold agglutinins, possibly predisposing to a significantly elevated erythrocyte sedimentation rate (ESR). Elevated ESR among children with Mycoplasma pneumonia is not well-described. If shown to correlate with M. pneumoniae disease, disproportionately elevated ESR, compared to c-reactive protein (CRP), could be useful as a biomarker for a potentially treatable illness.

Methods: Using an electronic database at our tertiary children's hospital from 2008-2015, we queried all children with a discharge ICD-9 diagnosis code for Mycoplasma-associated pneumonia and positive polymerase chain reaction (PCR) testing for M. pneumoniae from a respiratory source (nasopharyngeal, oropharyngeal or bronchoalveolar lavage). We compared ESR and CRP among this Mycoplasma pneumonia group to children diagnosed with viral or bacterial pneumonia.

Results: The 3 pneumonia groups (viral, bacterial, Mycoplasma) varied by age, with the Mycoplasma group being the oldest (Table 1). CRP did not vary significantly by pneumonia group. The Mycoplasma pneumonia group was significantly more likely to have an elevated ESR than both the viral pneumonia (p<0.0001) and bacterial pneumonia (p<0.0001) groups.   

Table 1: Age, ESR, and CRP Among Children Admitted to CHCO for Pneumonia

Age (years), all subjects

CRP (mg/dL)

ESR (mm/hr)

Type of Pneumonia

Sample size

Mean (Range)

Sample size

Mean (SD)

Sample size

Mean (SD)

Viral

706

5.0 (0.01-34.0)

698

5.2 (11.5)

257

32.0 (31.0)

Bacterial

659

6.0 (0.01-32.0)

651

7.5 (16.4)

287

44.1 (37.6)

M. pneumoniae

61

9.1 (0.2-17.0)

61

6.0 (6.9)

42

80.2 (34.5)*#

*p<0.0001 vs viral pneumonia

#p<0.0001 vs bacterial pneumonia

Conclusion: Among patients admitted to CHCO from 2008-2015, children with Mycoplasma-associated pneumonia had a significantly higher ESR than children diagnosed with viral or bacterial pneumonia, while CRP testing was similar between groups. Though a prospective study is needed, this finding supports the hypothesis that disproportionately elevated ESR compared to CRP could act as a biomarker for Mycoplasma pneumonia. We recommend that children with symptoms of pneumonia and a disproportionately elevated ESR be considered for testing and treatment for M. pneumoniae.  

Daniel Olson, MD, Pediatric Infectious Diseases, University of Colorado - Denver, Aurora, CO, Molly Lamb, PhD, Epidemiology, University of Colorado School of Public Health, Aurora, CO and James Todd, MD, FIDSA, Epidemiology, Children's Hospital Colorado, Aurora, CO

Disclosures:

D. Olson, None

M. Lamb, None

J. Todd, None

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