Mycoplasma Pneumoniae Pneumonia: Walking Pneumonia Can Cripple the Susceptible

Mycoplasma pneumoniae pneumonia (MPP), or "walking pneumonia," is an atypical mild disease with varied clinical findings. Specifically, diagnosis is often controversial and understanding of disease presentation is limited. The goal of the study was to evaluate presentation, clinical associations and outcomes of MPP patients admitted to an inner-city hospital.

This was a retrospective analysis of adult patients diagnosed with MPP from January 2010 to January 2017. Primary outcomes were need for intensive care unit (ICU) care, ICU and hospital length of stay (LOS), presence of shock and need for mechanical ventilation (MV). Predictors of mortality were analyzed.

Of the 203 patients analyzed, 16 (8%) died. Relative to survivors, non-survivors were older (65 ± 21 versus 53 ± 18, P = 0.009) and less frequently had obstructive airway disease (OAD; P = 0.003). Non-survivors also had significantly higher serum levels of lactic dehydrogenase (LDH), blood urea nitrogen (BUN), creatinine, transaminases and troponins. Finally, non-survivors more commonly exhibited shock, need for MV and bilateral lung infiltrates. There were no group differences in patient comorbidities, symptoms, antibiotic use or LOS. Predictors of mortality included age, OAD, low CD4⁺ T-cell counts in human immunodeficiency virus-infected patients and elevated serum levels of LDH, creatinine, BUN, leukocytes, transaminases and troponins.

Despite the availability of appropriate antibiotics, MPP incurs significant mortality and morbidity. Our study indicated that the recommended treatment includes prompt serological diagnosis, aggressive supportive care and presumptive antibiotics, especially in patients with poor prognosis.