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Differentiationbetweenmycoplasma
andviralcommunity-acquired
pneumoniainchildrenwithlobeor
multifociin
ltration:aretrospective
casestudy
Wan-liangGuo,
1JianWang,
2Li-yuanZhu,
3Chuang-liHao
3Tocite:
GuoW-liang,
WangJ,ZhuL-yuan,
etal
.Differentiationbetween
mycoplasmaandviral
community-acquired
pneumoniainchildrenwith
lobeormultifociinfiltration:
aretrospectivecasestudy.
BMJOpen
2015;5:e006766.doi:10.1136/bmjopen-2014-
006766Prepublicationhistoryfor
thispaperisavailableonline.
Toviewthesefilesplease
visitthejournalonline
bmjopen-2014-006766).
WGandJWcontributed
equally.
Received1October2014
Revised23December2014
Accepted29December2014
1RadiologyDepartment,the
Children
™sHospitalAffiliated
toSoochowUniversity,
Suzhou,China
2GeneralSurgery
Department,theChildren
™sHospitalAffiliatedto
SoochowUniversity,Suzhou,
China3RespiratoryDepartment,the
Children
™sHospitalAffiliated
toSoochowUniversity,
Suzhou,China
Correspondenceto
DrChuang-liHao;
clhaosuzhou@163.com
ABSTRACT
Objectives:
Toanalysetheclinicalfeatures,
inflammatorymarkersandradiographsofcommunity-
acquiredpneumonia(CAP)caseswithlobeormulti
fociinfiltration;withaspecialfocusonfactorswhich
allowthedifferentialdiagnosisofviraland
mycoplasmapneumonia.
Setting:RetrospectivechartreviewofCAPcasesina
largeuniversityteachinghospital.
Participants:
126paediatricCAPcases,withlobeor
multifociinfiltration,presentingbetweenMay2012
andApril2013.Demographicdata,clinicalpresentation
onadmissionorreferral,laboratorytests,priorhistory,
andradiographywerecollectedforeachcaseif
available.
Primaryandsecondaryoutcomemeasures:
Weusedunivariateandmultivariatelogisticregressionto
determinethesignificantfactorswhichallowthe
differentialdiagnosisofviralandmycoplasmaCAP
withlobeormultifociinfiltration.
Results:
Therewere71(56%)maleand55(44%)
femaleCAPcaseswithlobarormultifociinfiltration.
70pneumoniacaseswerecausedby
Mycoplasmapneumoniaeand18byviruses.Univariateanalysisof
themycoplasmaandviralcausesoftheCAPrevealed
thatincreasedrespiratoryrate,wheeze,malegender
andlymphocytepercentagewerethefactorsassociated
withthedifferentiationofmycoplasmaandviral
aetiologiesofpneumonia(p<0.05).Astepwiselogistic
regressionanalysiswasperformedtoassess
independentfactorswhichallowthedifferential
diagnosisofviralandmycoplasmapneumonia.
Increasedrespiratoryrate,wheeze,andlymphocyte
percentagewerereliableindependentfactorswhich
allowthedifferentialdiagnosisofviraland
mycoplasmaCAPwithlobarormultifociinfiltration.
Conclusions:
WhethertheCAPwithlobarormulti
fociinfiltrationwascausedbymycoplasmaspeciesor
virusescouldnotbeinferredfromtheradiological
patterns.Wheeze,lymphocytepercentageand
respiratoryratewereindependentfactorswhichallowed
thedifferentialdiagnosisofviralandmycoplasmaCAP
withlobarormultifociinfiltration.
INTRODUCTION
Forthepaediatricpopulation,community-
acquiredpneumonia(CAP)isamongthemost
frequentcausesofhospitaladmission.CAP
remainsamajorcauseofmorbidityandmortal-
ityworldwide,especiallyregardingchildrenless
than5yearsofage.MostchildrenwithCAPlive
inthedevelopingcountries.
1Virusesandmyco-
plasmaspeciesaretwomainofthemanypatho-
genicagentswhichcancauseCAP.
2Œ4ThesymptomsofCAPvaryconsiderably
dependingonitsaetiology,infectionpattern,
andunderlyingmedicalconditions.Inclin-
icalpractice,mostCAPdiagnosesarebased
onradiographyandclinicalsymptoms.Some
caseshavebeenreportedinwhichthe
Strengthsandlimitationsofthisstudy
Overaperiodof1year,aretrospectivestudy
wascarriedoutinourhospital.Astepwiselogis-
ticregressionanalysisof88caseswasper-
formedtoassessindependentpredictorswhich
allowedthedifferentialdiagnosisofviraland
mycoplasmacommunity-acquiredpneumonia
(CAP).
Increasedrespiratoryrate,wheezeandlympho-
cytepercentageweresignificantlypredictive
regardingthedifferentiationbetweenviraland
mycoplasmaCAPwithlobarormultifociinfiltra-
tion,aswasviralaetiologyofCAPwithlobaror
multifociinfiltration,increasedrespiratoryrate,
wheezeandincreasedlymphocytepercentage.
Thisstudyhasseverallimitations.First,itwasa
retrospectivestudy,andthereforetheremayhave
beensomeselectionbias.Second,viralpneumo-
niacouldbemissedduetothesensitivityof
immunofluorescenceandthelimitednumberof
viruseswedetected.Third,theremaybesome
casesinwhichthepatienthadaviralaswellas
bacterialoracombinedbacterialandmyco-
plasmainfectionwhichcannotbedetected.
GuoW-liang,
etal
.BMJOpen
2015;5:e006766.doi:10.1136/bmjopen-2014-006766
1OpenAccess
Research
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