Reduced lung diffusion capacity after Mycoplasma pneumoniae pneumonia

Mycoplasma pneumoniae is a frequent but underdiagnosed cause of community-acquired pneumonia (CAP) in children, and appropriate macrolide treatment is often given late. The aim of this work was to estimate the frequency of pulmonary involvement in children 6 months after a clinical episode of Mycoplasma CAP.

We measured carbon monoxide diffusion capacity (TLCO) and conducted spirometric tests in 35 children without asthma or chronic lung disease (ages 4.5 to 15 years), 6 months and 1 year after acute CAP caused by M. pneumoniae (23 children), pneumococci (5 children) or viruses (7 children). Only 11 of 23 patients with M. pneumoniae CAP required hospitalization, whereas all the patients with pneumococcal or viral pneumonia were admitted to hospital.

Lung volumes and spirometric tests were normal for all children. TLCO was normal 6 months after pneumococcal or viral pneumonia (87 to 112% of expected values for height and sex). After acute M. pneumoniae CAP, 11 of 23 patients (48%) had TLCO values <80% of the expected value. The extent of change in lung diffusion capacity was correlated with the delay to diagnosis and treatment: TLCO was low in 8 of 11 patients given macrolide treatment 10 days or more after the onset of acute symptoms vs. only 3 of 10 patients given appropriate treatment in the first 10 days. TLCO was low in 7 of 7 who received macrolide therapy for <2 weeks. TLCO had increased slightly after 1 year in the 5 patients retested after a new course of macrolide treatment. TLCO reached the lower normal range in 2 patients controlled after 3 years.

The abnormal TLCO values suggest that some children with Mycoplasma pneumonia have reduced pulmonary gas diffusion after recovery from the illness. The reduction is related to delay and short macrolide therapy.