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Multiplex Polymerase Chain Reaction Panel for Suspected Pertussis: What About a Positive Mycoplasma pneumoniae
Michaël Desjardins1, Paméla Doyon-Plourde1,2, Sarah Mousseau3
1From the Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Background:
The use of bacterial multiplex polymerase chain reaction (PCR) in children with suspected pertussis sometimes yields unexpected positive results for Mycoplasma pneumoniae. We aimed to evaluate the clinical significance of positive M. pneumoniae results in this population.
Methods:
Retrospective cohort of consecutive patients with suspected pertussis tested with a bacterial multiplex PCR (including Bordetella pertussis and M. pneumoniae) between June 2015 and March 2017. Medical records were reviewed to compare demographics, clinical presentations and outcomes of patients positive for M. pneumoniae with those positive for B. pertussis and those with negative results, using multivariable logistic regression.
Results:
A total of 1244 patients were included as follows: 56 (4.5%) with M. pneumoniae, 116 (9.3%) with B. pertussis and 1029 (82.7%) with negative results. Mean age was respectively 4.8 years, 6.5 years and 2.8 years (P < 0.05). Children with M. pneumoniae were less likely to present with cardinal symptoms of pertussis such as paroxysmal cough [adjusted odds ratio (OR): 0.19, 95% confidence interval (CI): 0.08-0.40) but were more likely to have fever (adjusted OR: 10.53, 95% CI: 3.54-39.49) and other nonspecific respiratory symptoms compared with children with B. pertussis. Children with M. pneumoniae had very similar clinical presentations to those with a negative PCR, but were more likely to have radiologically confirmed pneumonia (adjusted OR: 5.48, 95% CI: 2.96-9.99) and were less likely to be diagnosed with a concomitant viral infection (adjusted OR: 0.32, 95% CI: 0.07-0.99).
Conclusions:
In children with suspected pertussis, the detection of M. pneumoniae is clinically relevant. However, the impact of this finding on patients' outcome is still unclear.
Insights
In children suspected of pertussis, Mycoplasma pneumoniae detection is clinically significant. This finding is associated with different symptoms and higher pneumonia rates compared to Bordetella pertussis.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Pathogen Diagnostics
- Clinical Microbiology
Background:
- Bacterial multiplex polymerase chain reaction (PCR) for pertussis can yield unexpected Mycoplasma pneumoniae results in children.
- The clinical significance of co-detection requires evaluation.
Purpose of the Study:
- To assess the clinical relevance of positive Mycoplasma pneumoniae results in children with suspected pertussis.
- To compare clinical presentations and outcomes between M. pneumoniae, Bordetella pertussis, and negative PCR results.
Main Methods:
- Retrospective cohort study of 1244 children tested via multiplex PCR for B. pertussis and M. pneumoniae.
- Comparison of demographics, clinical symptoms, and outcomes using multivariable logistic regression.
Main Results:
- M. pneumoniae was detected in 4.5% of patients, B. pertussis in 9.3%, and 82.7% were negative.
- M. pneumoniae cases showed fewer pertussis symptoms but more fever, nonspecific respiratory issues, and higher rates of radiologically confirmed pneumonia.
- Clinical presentation for M. pneumoniae cases resembled those with negative PCR results more than B. pertussis cases.
Conclusions:
- Detection of M. pneumoniae in children with suspected pertussis is clinically relevant.
- M. pneumoniae infections present differently from pertussis and are associated with pneumonia.
- Further research is needed to clarify the impact on patient outcomes.
