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[Mycoplasma pneumoniae pulmonitis: delayed diagnosis and empirical therapy]
1Divisione di Pneumologia, IRCCS Policlinico S. Matteo, Pavia.
Unlabelled:
MYCOPLASMA PNEUMONIAE: Delayed diagnosis and empiric therapy.
Background:
To evaluate the consistency of IHA test to the initial diagnosis and therapy in suspected cases of Mycoplasma pneumoniae pneumonia (MP).
Design:
retrospective-descriptive.
Environment:
Division of Pneumology, IRCCS Policlinico S. Matteo, Pavia from November 1991 to October 1993.
Patients:
235 pts inpatients.
Variables:
age, sex, clinical diagnosis, microbiology, serological investigations for MP by indirect hemagglutination test (IHA); therapy, monitoring and evaluation; considered as positive IHA titres > or = 1:40.
Results:
Clinical presentation not different from other "atypical" pneumonia. Macrolides, aminoglycosides, quinolones or cephalosporins were the usual treatment; patients recovered within 1 to 2 weeks consistently to the severity of disease. Sixty-five cases were IHA-positive (28%). Serological outcomes were usually known after 7 to 10 days or more, when most of patients resulted discharged. Mean age in IHA-positive pts was younger than in IHA-negative (31.3 vs 51.6 yrs; p < 0.0001). IHA test was repeated after 3 weeks in 23/235: 2 (9%) remained negative and 15 (65%) positive; 5 (22%) turned from positive to negative; 1 (4%) from negative to positive.
Conclusions:
Clinical and roentgenological presentation similar to other "atypical" pneumonia; late etiological diagnosis and only in 28%, including those monitored distally; significantly young age among IHA-positives; empiric therapy, effective even on the remaining 72% IHA-negative. IHA, commonly used test with good specificity and sensitivity, is of late support to the clinician in short course and uncomplicated disease.