Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Meyer Sauteur, Patrick M; Krautter, Selina; Ambroggio, Lilliam; Seiler, Michelle; Paioni, Paolo; Relly, Christa; Capaul, Riccarda; Kellenberger, Christian; Haas, Thorsten; Gysin, Claudine; Bachmann, Lucas M; van Rossum, Annemarie M C; Berger, Christoph

Mycoplasma pneumoniae (Mp) is a common bacterial cause of community-acquired pneumonia (CAP) in children [1, 2] . There are substantial challenges in differentiating infection from carriage for Mp [3, 4] . Current diagnostic tests, including polymerase chain reaction (PCR) of upper respiratory tract (URT) specimens or serology, do not reliably differentiate between Mp infection and carriage [4] . Therefore it is not surprising that previous studies found no signs or symptoms to differentiate Mp infection in CAP from other etiology [5, 6] , potentially because Mp detection was misclassified as infection when in fact it was carriage. Mp carriage is estimated to occur in up to 56% of healthy children [4, 5] . Mp infection is generally mild and self-limiting, and patients with Mp CAP are mostly managed in primary care [7] . The lack of a cell wall makes Mp naturally resistant to first-line empirical β-lactam antibiotics for CAP [5] . Empirical macrolide treatment is extensively used to cover potential Mp infection, which has led to the emergence of macrolide-resistant Mp and a parallel rise in macrolide resistance in other respiratory pathogens [8] . Therefore, with the challenges in diagnostic testing for Mp and its limited use in the primary care setting, it is essential to determine clinical features and biomarkers to aid in the diagnosis of Mp infection in children with CAP.