Methods: A retrospective study was performed in patients 0-18 years old with positive MPP RVP from 1/1/2013 to 6/30/2017. Clinical cases of patients hospitalized with positive MPP testing by RVP PCR were reviewed for clinical, radiologic and laboratory data.
Results: A total of 3,621 RVPs were tested with 49 positive for MPP. In regard to age of patients, 27/49 (incidence 2.7%) positive for MPP were under 5 years old as compared to 22/49 (incidence 1%) between 5-18 years old. 75% of RVPs obtained were in patients under 5 years of age. Cough and fever were present for a mean of 8.3 and 7.6 days, respectively prior to RVP. Of the MPP positive patients, 21/49 patients (43%) were treated with scheduled although only 16 had a history of wheezing. Of the MPP positive patients, 38/48 patients had radiological findings of a pulmonary infiltrate (not perihilar) with 30/38 patients (79%) had bilateral infiltrates. Admission antimicrobial therapy was the following: 8 on no antibiotic, 21 on non-macrolide, 11 macrolide and non-macrolide, and 9 on macrolide therapy alone. Pediatric intensive care unit (PICU) admission occurred in 8 patients: 4 direct PICU admissions and 4 patients transferred from wards to PICU. All four PICU transfers had initially non‑macrolide therapy; 3 of 4 were under 5 years of age.
Conclusion: Over half of Pediatric MPP was diagnosed by rapid molecular diagnostics in patients under 5 years of age. Bilateral pulmonary infiltrates and new onset wheezing responsive to beta agonists were commonly noted in patients who had MPP. A small subset of those younger patients required higher level of care after initial therapy with non-macrolide therapy. While MPP has a lower incidence among younger children, the infection is not rare and can have a significant clinical impact. MPP should be considered in all patients, especially younger patients who are non-responsive to treatment of community acquired pneumonia.