Comparison of real-time polymerase chain reaction and serological tests for the confirmation of Mycoplasma pneumoniae infection in children with clinical diagnosis of atypical pneumonia
Comparison of real-time polymerase chain reaction and serological tests for the confirmation of Mycoplasma pneumoniae infection in children with clinical diagnosis of atypical pneumonia
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DOI：
10.1016/j.jmii.2013.03.015
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发表时间：
2014-04-01
影响因子：
7.4
通讯作者：
Huang, Li-Min
中科院分区：
文献类型：
--
作者：
Chang, Hsin-Yu;Chang, Luan-Yin;Huang, Li-Min
背景资料：肺炎支原体是小儿呼吸道感染的常见病原体，其正确、快速的诊断是临床上的一个挑战。实时聚合酶链反应（RT-PCR）已被频繁用于检测这种病原体。材料和方法：从所有儿童的临床诊断支原体肺炎和呼吸道标本进行支原体检测的医疗记录。肺炎（使用RI-PCR）在2011年进行了回顾性审查。我们比较了血清学试验和RT-PCR诊断M。肺炎感染。我们还回顾性分析了有实验室证据的儿童M的临床特征、实验室和影像学表现。结果：2011年，有290名儿童被临床诊断出患有支原体肺炎，并对其呼吸道样本进行了支原体检测。pneumoniae进行RT-PCR。54名儿童（19%）有阳性结果。同时，63%（182/290）的儿童还接受了血清学检查，其中44例（24%）发现免疫球蛋白M（IgM）阳性。以PCR为金标准，M.肺炎IgM检测的敏感性为62.2%，特异性为85.5%。IgM阳性预测值为52.3%，阴性预测值为89.9%。In M.肺炎IgM阳性的儿童，PCR阴性结果与更多的其他病原体合并感染和住院前发热持续时间较长有关。M.结论：临床诊断的肺炎支原体肺炎绝大多数未经确诊。肺炎支原体IgM敏感性差，阳性预测值低。应谨慎判读肺炎支原体IgM。Copyright（C）2013，Taiwan Society of Microbiology.出版社：Elsevier Taiwan LLC All rights reserved.
Background: Mycoplasma pneumoniae is a common pathogen of respiratory tract infection in children, and its correct and rapid diagnosis is a clinical challenge. Real-time polymerase chain reaction (RT-PCR) has been used frequently for the detection of this pathogen.Materials and methods: Medical records from all children with a clinical diagnosis of mycoplasma pneumonia and whose respiratory samples were tested for M. pneumoniae (using RI-PCR) during 2011 were reviewed retrospectively. We compared the sensitivity and specificity of serological assays versus those of RT-PCR for diagnosis of M. pneumoniae infections. We also reviewed retrospectively clinical characteristics, and laboratory and imaging findings of children with laboratory evidence of M. pneumoniae infection.Results: In 2011, 290 children were diagnosed to have mycoplasma pneumonia clinically and had their respiratory samples tested for M. pneumoniae by RT-PCR. Fifty-four children (19%) had a positive result. Meanwhile, 63% (182/290) of these children also underwent serological tests, out of whom 44 (24%) were found to be positive for immunoglobulin M (IgM). Using PCR as a gold standard, M. pneumoniae IgM assay was found to show a sensitivity of 62.2% and a specificity of 85.5%. Positive and negative predictive values of IgM were 52.3% and 89.9%, respectively. In M. pneumoniae IgM-positive children, a negative PCR result was associated with more coinfection by other pathogens and longer duration of prehospitalization fever. Bacterial loads of M. pneumoniae were not correlated with clinical outcomes.Conclusion: The majority of clinically diagnosed mycoplasma pneumonia was unconfirmed. Mycoplasma pneumoniae IgM has poor sensitivity and a positive predictive value. Interpretation of Mycoplasma pneumoniae IgM should be done with caution. Copyright (C) 2013, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights reserved.