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J Med Microbiol 56 (2007), 1625-1629; DOI: 10.1099/jmm.0.47119-0
© 2007 Society for General Microbiology
ISSN 1473-5644

Clinical features of severe Mycoplasma pneumoniae pneumonia in adults admitted to an intensive care unit

Naoyuki Miyashita1, Yasushi Obase1, Kazunobu Ouchi2, Kozo Kawasaki2, Yasuhiro Kawai2, Yoshihiro Kobashi1 and Mikio Oka1

1 Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Okayama 701-0192, Japan

2 Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan

Correspondence
Naoyuki Miyashita
nao{at}med.kawasaki-m.ac.jp

Received 12 December 2006
Accepted 30 July 2007

Community-acquired pneumonia (CAP) due to Mycoplasma pneumoniae is usually mild, but some cases develop a severe life-threatening pneumonia. To investigate the clinical features of severe M. pneumoniae pneumonia in adults admitted to an intensive care unit, a multi-centre CAP surveillance study was performed. Among all hospitalized CAP cases between January 2000 and December 2004, there were 227 cases with M. pneumoniae pneumonia without the complication of other pathogens. A total of 13 of the cases required admission to an intensive care unit because of acute respiratory failure (ARF), and the remaining 214 cases (non-ARF) were low to moderately severe. The clinical features of ARF cases were compared with those of non-ARF cases. The underlying conditions in both types of case were identical, whereas clinical findings on admission clearly differed between the two groups. A regimen of an antibiotic effective against M. pneumoniae was begun on average at 9.3 days after the onset of symptoms in ARF cases, which was significantly later than for non-ARF cases (P<0.0001). However, two of the ARF cases progressed to respiratory failure despite the fact that adequate antibiotics were initially administered within 3 days after the onset of symptoms. All ARF cases received corticosteroids with adequate antibiotics, and their condition improved promptly. These results indicate that the clinical features, excluding underlying conditions, clearly differed between severe M. pneumoniae pneumonia and low to moderately severe pneumonia. The delayed administration of adequate antibiotics may contribute to the severity of M. pneumoniae pneumonia. Early corticosteroid therapy with adequate antibiotics should be considered.

Abbreviations: ALT, alanine aminotransferase; ARF, acute respiratory failure; AST, aspartate aminotransferase; CAP, community-acquired pneumonia; FiO2, fraction of inspired O2; IL, interleukin; LDH, lactate dehydrogenase; PaO2, partial pressure of O2 in arterial blood; Th1, T-helper type 1; TP, total protein.




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