Mycoplasma pneumoniae: More Testing or More Severe?
K Kelly, D Quinn, J Burns, A Moran, M Sycip, T Leong, L ImmergluckAbstract
Background
Mycoplasma pneumoniae (MP) causes ~2 million infections in the U.S.[1] with increasing rates reported globally in the past few years [2-4]. Rates in children have increased from 1% to 7.2% among 2-4 years and from 3.6% to 7.4% in those 5 -17 years [1]. In Illinois, MP rates are around 5.1%, which is higher than rates of RSV, Flu or Covid [3]. While MP usually presents as “walking pneumonia” in school-aged children, there have been extrapulmonary manifestations, particularly among younger children: Reactive Infection Mucocutaneous Eruptions (RIME), Guillan- Barre Syndrome (GBS), and Stevens-Johnson Syndrome (SJS). Spikes in MP rates may be related to an immunity debt from COVID quarantining, antimicrobial resistance, air pollution and climate change [8].
Methods
This is a retrospective analysis of data collected from network of healthcare systems in Chicago, which are part of NIH-funded Institute of Translational Medicine (University of Chicago Medicine (UCM), Loyola University Health System, Advocate Health and Endeavor Health) during 2014-2024. Data on patient demographics, dates of infection, clinical symptoms, and disease severity will be captured from electronic health records; severity score will be assigned based on diagnoses of complicated pneumonia or evidence of extrapulmonary features requiring hospitalization. Statistical analyses will include χ2 tests or t tests to determine the association between MP and potential risk factors. Multilevel model will include patient level data and area level covariates, which are based on proxies identified as risks factors. We will apply a generalized estimated equations (GEE) model; and crude odds ratios (OR) will be based on conditions determined a priori to be associated with risk of MP and used as estimates of relative risks. All tests for significance is two-tailed, and a p-value of < 0.05 is considered significant.
Results
Since 2014, there have been 67 infections caused by M. pneumoniae recorded at the UCM: 35 of these infections from 1/2024 to 11/2024 compared to zero infections during the COVID19 pandemic (2020-2022). In the last 10 years, there have only been 11 infections in <6 years of age (all in 2024). In 2024, from 269,361 respiratory panel PCR tests, 35 were positive for MP (0.013%) compared to 0.0001% in 2020-2023, when there was 1 infection among 949,013 respiratory panel PCR tests.
Conclusion
More surveillance is needed in the United States to determine how prevalent and severe Mycoplasma pneumoniae is in our pediatric population now and into the future.
Reference
1. Mycoplasma Pneumoniae Infections Have Been Increasing. National Center for Immunization and Respiratory Diseases 2024.