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Clinical Presentation of Pediatric Mycoplasma pneumoniae Before and After the COVID-19 Pandemic
Tehila Haltovsky1, Itai Gross2, Yair Weiss3
1From the Department of Pediatrics.
Objectives:
Mycoplasma pneumoniae (MP) is a prevalent bacterial respiratory pathogen known for cyclic epidemics every 3-5 years, potentially linked to waning immunity. Following the global decline post-coronavirus disease 2019, MP has re-emerged since late 2023. Given the extended interval since the last epidemic, we compared pediatric MP's clinical presentation and outcomes during the recent and previous outbreaks spanning 17 years at a tertiary center in Jerusalem, Israel.
Methods:
We conducted a retrospective cohort study at Hadassah Medical Center, analyzing demographic, clinical and treatment data from pediatric patients (0-17 years) with PCR-confirmed MP. In 2024, daily reports updated physicians on positive cases. We compared 2024 data (221 patients) with cohorts from 2007 to 2017 (352 patients) and initial epidemic years (2012, 2015; 139 patients).
Results:
The 2024 epidemic showed an increased median age (8.0 vs. 5.8 years; P = 0.0002), higher female prevalence (56% vs. 44%; P = 0.007), and altered clinical manifestations: increased cough (78% vs. 63%; P = 0.0002), fever (79% vs. 64%; P = 0.0004), consolidation on radiograph (48% vs. 39%; P = 0.0244) and pleural effusions (5% vs. 0%; P < 0.0001). Rash incidence decreased (8% vs. 16%; P = 0.0031). Significant differences in age, sex, pleural effusions and rash persisted when comparing initial epidemic years. Early emergency department diagnosis rose in 2024 from 43% to 80%. The hospitalization rate decreased from 70% to 30% and was overall lower than 2007-2017 (81%; P < 0.001).
Conclusions:
Pediatric MP presentation in 2024 differed notably from prior epidemics, marked by increased severe pneumonia in older children. Enhanced awareness facilitated rapid diagnostics, reducing hospital admissions, unnecessary tests and inappropriate antibiotic use.
Insights
Pediatric Mycoplasma pneumoniae (MP) infections in 2024 showed more severe pneumonia in older children compared to previous outbreaks. Increased awareness led to faster diagnosis and fewer hospitalizations.
Area of Science:
- Pediatric infectious diseases
- Respiratory pathogens
- Epidemiology
Background:
- Mycoplasma pneumoniae (MP) causes cyclic respiratory epidemics every 3-5 years.
- MP re-emerged in late 2023 after a decline during the COVID-19 pandemic.
- Understanding changes in MP presentation is crucial due to the extended interval since the last major epidemic.
Purpose of the Study:
- To compare the clinical presentation and outcomes of pediatric MP infections during the recent 2024 epidemic with previous outbreaks.
- To analyze demographic and clinical data spanning 17 years at a tertiary care center.
- To identify shifts in MP's epidemiology and clinical impact in children.
Main Methods:
- Retrospective cohort study of pediatric patients (0-17 years) with PCR-confirmed MP.
- Analysis of data from 2024 (221 patients) compared to 2007-2017 (352 patients) and initial epidemic years (2012, 2015; 139 patients).
- Inclusion of demographic, clinical, and treatment data, with daily physician updates in 2024.
Main Results:
- The 2024 epidemic featured older children (median age 8.0 vs. 5.8 years) and more females (56% vs. 44%).
- Increased symptoms included cough (78% vs. 63%), fever (79% vs. 64%), and higher rates of pneumonia consolidation (48% vs. 39%) and pleural effusions (5% vs. 0%).
- Rash incidence decreased (8% vs. 16%), while early emergency department diagnosis rose significantly (43% to 80%) and hospitalization rates dropped (30% vs. 70-81%).
Conclusions:
- Pediatric MP presentation in 2024 significantly differed from prior epidemics, with more severe pneumonia observed in older children.
- Enhanced clinical awareness and rapid diagnostics in 2024 led to reduced hospital admissions.
- These findings highlight evolving MP epidemiology and the impact of improved diagnostic strategies.
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