Improved diagnostics help to identify clinical features and biomarkers that predict Mycoplasma pneumoniae community-acquired pneumonia in children

BACKGROUND There are no reliable signs or symptoms that differentiate Mycoplasma pneumoniae (Mp) infection in community-acquired pneumonia (CAP) from other etiologies. Additionally, current diagnostic tests do not reliably distinguish between Mp infection and carriage. We previously determined that the measurement of Mp-specific IgM antibody-secreting cells (ASCs) by enzyme-linked immunospot (ELISpot) assay allowed for differentiation between infection and carriage. Using this new diagnostic test, we aimed to identify clinical and laboratory features associated with Mp infection. METHODS This is a prospective cohort study of children, 3-18 years, with CAP from 2016-2017. Clinical features and biomarkers were compared between Mp-positive and -negative groups by Mann-Whitney U test or Fisher's exact test, as appropriate. Area under the receiver operating characteristics curves (AUC) differences and optimal thresholds were determined by using the DeLong's test and Youden's J statistic, respectively. RESULTS Out of 63 CAP patients, there were 29 Mp-positive (46%). Mp-positive was statistically associated with older age (median 8.6 vs. 4.7 years), no underlying disease, family with respiratory symptoms, prior antibiotic treatment, prolonged prodromal respiratory symptoms and fever, and extrapulmonary (skin) manifestations. Lower levels of C-reactive protein, white blood cell count, absolute neutrophil count, and procalcitonin (PCT), specifically PCT 5 years (AUC=0.77), prodromal fever and respiratory symptoms >6 days (AUC=0.79), and PCT <0.25 μg/L (AUC=0.81) improved diagnostic performance (AUC=0.90, p=0.05). CONCLUSIONS A combination of clinical features and biomarkers may aid physicians in identifying patients at high risk for Mp CAP.