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Cochrane Corner

Diagnosing Mycoplasma pneumoniae in Children and Adolescents with Community-Acquired Pneumonia

Christie, Janice PhD, RN

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AJN, American Journal of Nursing: May 2013 - Volume 113 - Issue 5 - p 65
doi: 10.1097/01.NAJ.0000430240.42261.16
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Abstract

REVIEW QUESTION

What is the diagnostic accuracy of signs and symptoms in the clinical recognition of Mycoplasma pneumoniae as the cause of community-acquired pneumonia in children and adolescents?

TYPE OF REVIEW

This is a Cochrane diagnostic test accuracy systematic review containing meta-analyses of data from seven studies.

RELEVANCE FOR NURSING

Up to 40% of children over five years of age who develop community-acquired pneumonia are infected by M. pneumoniae. Currently, there is no universally agreed-upon gold standard laboratory test for M. pneumoniae, which is typically treated with macrolide antibiotics. Serology, the most widely available test, can require both acute and convalescent serum samples taken two to four weeks apart. Because of the lack of a quick, reliable method for diagnosing suspected M. pneumoniae infections, clinicians mostly rely on clinical signs and symptoms. These include cough, wheeze, nasal symptoms, crepitations (crackles heard during chest examination), fever, rhonchi (wheeze heard during chest examination), shortness of breath, chest pain, diarrhea, myalgia, and headache. The purpose of this review was to assess the value of each of these 11 signs and symptoms in diagnosing M. pneumoniae in children and adolescents with community-acquired pneumonia.

CHARACTERISTICS OF THE EVIDENCE

This systematic review considered peer-reviewed studies that prospectively and consecutively recruited from any health care setting children ages 18 years or younger with community-acquired pneumonia who had no serious comorbidity and weren't immunocompromised. Participants were required to have a diagnosis of M. pneumoniae using serology as the reference standard test (with or without any other laboratory confirmation).

Seven studies, all conducted in hospital settings, and reporting data on 1,491 children, met the inclusion criteria. Meta-analyses (where possible) were conducted of pooled specificity and sensitivity data for each sign and symptom, although not every sign or symptom was measured in every study. The findings of two studies indicated that the presence of chest pain more than doubled the probability of M. pneumoniae infection, but these findings were based on a small number of children. Coryza and cough were not good indicators of M. pneumoniae infection. Wheeze was 12% more likely to be absent in children with M. pneumoniae infection. A sensitivity analysis showed that crepitations were associated with M. pneumoniae with borderline statistical significance.

BEST PRACTICE RECOMMENDATIONS

There is insufficient evidence that clinical signs and symptoms can reliably diagnose M. pneumoniae in children and adolescents. Although the absence of wheeze is a statistically significant indicator, it does not have enough diagnostic validity to guide antibiotic treatment.

RESEARCH RECOMMENDATIONS

More high-quality large-scale studies are required in primary care settings to investigate a wide range of signs and symptoms, including headache, diarrhea, and myalgia. More research is also required to determine if the presence of chest pain can be an accurate diagnostic indicator of M. pneumoniae.

SOURCE DOCUMENT

Wang K, et al. Clinical symptoms and signs for the diagnosis of Mycoplasma pneumoniae in children and adolescents with community-acquired pneumonia Cochrane Database Syst Rev. 2012;10:CD009174
    © 2013 Lippincott Williams & Wilkins, Inc.