EMERGING ROLE OF ATYPICAL BACTERIA IN CHILDREN
WITH RECURRENT RESPIRATORY TRACT INFECTIONS
Esposito S, Blasi F*, Ferranti R, Guidotti P, Faelli
N, Grugnola A*, Allegra L*, Principi N
Pediatric Department
I, and *Institute of Respiratory Diseases, University of Milan, Milan,
Italy
Objective: Recurrent respiratory tract infections (RRTI)
in infants and children are among the most common causes of physician
visits and hospitalization. Few data are available on the role of atypical
bacteria in RRTI. Aim of this study was to evaluate the role of Mycoplasma
pneumoniae (Mp) and Chlamydia pneumoniae (Cp) in the etiology of
RRTI in pediatric patients.
Methods: A total of 237 children aged 0-14 yrs (130
males, median age 3.6 yrs) with an acute respiratory infection and a
history of RRTI (> 6 episodes per year if age was > 3 yrs, and > 8
episodes per year if age was < 3 yrs) and 208 age- and sex-matched
healthy controls were studied. Patients were classified as having acute
bronchitis (N=68), pharyngitis (N=54), wheezing (N=40), sinusitis (N=38),
pneumonia (N=19), and laryngotracheitis (N=18). On admission and after 4-6
weeks, sera for determination of specific antibodies and nasopharyngeal
aspirates for Mp and Cp DNA detection were obtained from each child.
Results: The incidence of atypical bacteria infections
was significantly higher in children with RRTI (109/237, 45.9%) than in
controls (8/208, 4.1%; p<0.0001), unregardless of age group or site of
infection. Mp infection was diagnosed in 76 (32.1%), Cp infection in 23
(9.7%), and Mp-Cp coinfection in 10 (4.2%) subjects. Considering age
groups, atypical bacteria infections were detected in 23.1% of children
< 2 yrs, 42.2% of those aged 2 - 5 yrs, and 75.4% of those aged > 5
yrs. Considering clinical diagnosis, the incidence of atypical bacteria
infections was 55.5% in children with pharyngitis, 55.0% in those with
wheezing, 45.6% in those with acute bronchitis, 39.5% in those with
sinusistis, 36.8% in those with pneumonia, and 22.2% in those with
laryngotracheitis.
Conclusions: Our data suggest that Mp and Cp are a
significant cause of both upper and lower respiratory tract infections in
children with a history of RRTI. The spectrum of diseases ranges from
asymptomatic infection to serious disease, including severe pneumonia and
exacerbations of asthma. Also children younger than 5 years appear to be
significantly affected by infection due to atypical bacteria.