Mucocutaneous disease is common in pediatric M pneumoniae CAP

  • Meyer Sauteur PM & al.
  • JAMA Dermatol
  • 18.12.2019

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In children with Mycoplasma pneumoniae community-acquired pneumonia (CAP), mucocutaneous disease is common and associated with worse long-term outcomes.
  • Findings suggest the need for caution in saddling children with a lifelong label of “medication allergy” and support an assumption of M pneumoniae CAP in mucocutaneous disease presentations.

Why this matters

  • Editorial: These findings can guide intermediate- and long-term management, including surveilling for sequelae and precluding an incorrect labeling of severe medication allergy.

Key results

  • 22.7% of the 44 children who were PCR-positive for M pneumoniae developed mucocutaneous lesions.
  • 100% of that group tested positive for specific IgM-secreting cells.
  • Skin manifestations included rash, mucositis, itching, maculopapular skin eruptions.
  • In 2 patients, ocular symptoms were the only feature.
  • In 3 cases of PCR-negative M pneumoniae CAP, mucocutaneous skin manifestations were also detected.
  • Vs non-M pneumoniae CAP, with M pneumoniae positivity, the children had:
    • Longer prodromal fever (P=.02).
    • Higher C-reactive protein levels (P=.04).
    • Greater likelihood of needing oxygen: OR, 17.6 (95% CI, 1.5-984.1; P=.007).
    • Increased hospitalization: OR, 9.0 (95% CI, 1.4-81.4; P=.01).
    • Greater rates of long-term sequelae (30% vs 0%; P=.03).

Study design

  • Prospective, longitudinal cohort study in Zurich, 152 children ages 3-18 (median, 5.7) years, enrolled from May 1, 2016 to April 30, 2017.
  • Funding: Not specified.

Limitations

  • Bias toward severe disease possible in a tertiary care center.
  • Small numbers.