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1 The clinical characteristics of Mycoplasma pneumoniae pneumonia in children younger than 6 years old Nobue Takeda1,2),Tomomichi Kurosaki1),Naruhiko Ishiwada2),Yoichi Kohno2) 1)Department of Pediatrics,Chiba Municipal Kaihin Hospital 2)Department of Pediatrics,Chiba University Graduate School of Medicine Summary:The characteristics of Mycoplasma pneumoniae pneumonia in adult are nonproductive cough,lack of rales,and the white blood cell counts are<10,000/ƒêl.the aim of this study was to investigate the clinical characteristics of hospitalized cases with M.pneumoniae pneumonia in children younger than 6 years old.a retrospective analysis of 83 children(0-15 years old)at the Chiba Municipal Kaihin Hospital in 2005 was performed.serologic diagnosis was made based on a 4-fold rise or single titers>/=1:640,which were measured by particle aggulutination(pa)test. Children younger than 6 years old accounted for 51.8%(43 cases)of the cases.among the children younger than 6 years old,90.0% had productive cough.rales and altered breath sounds could be heared in 83.7% and white blood cell counts were elevated higher than 10,000/ƒÊL in 31.8% of patients without athma and bacterial infection.37.2% of patients complicated bronchiolitis or infectious asthma.41.9% of patients had found to have mixed bacterial infection and/or viral infection.in conclusion,the clinical characteristics M pneumoniae pneumonia in children younger than 6 years old differ evidently from those of adults because of mixed bacterial infection and/or viral infection, and complicated bronchiolitis or infectious asthma.
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6 H. influenzae Streptococcus S.pneumoniae pneumoniae Haemophilus influenzae S.pneumoniae H. influenzae
7 日本小 児 呼 吸 器疾 患 学会 雑 誌,19(2),2008 感 染2.3%(1例/43例)で はS.pneumoniae, れ ぞ れ1例 あ っ た 6歳 H.influenzaeそ ず つ/40例)で 1 3群 あ った 喀痰 の採取 の 喀痰 が 採 取 され 細 菌 感 染 が 証 以 上 の16例 は14例(87.5%) に抗 菌 薬 の前 投 薬 が み られ た ウ イ ル ス 抗 原 検 査 陽 性 例 は10例 検 に て 認 め,そ れ ぞ れ の ウ イ ル ス の 流 行 期 に一 致 して い た ウ イ の 検 体 で あ っ た り痰 が か ら ま ず 鼻 咽 頭 培 養 で 代 用 し た 症 例 も あ り,Geckler 4,5群 明 さ れ な か っ た6歳 れ ぞ れ2.5%(そ は 入 院 時 に 全 例 に 試 み た も の の,鏡 Geckler Geckler 以上 で ル ス 抗 原 検 査 陽 性 の10例 4, 中9例 が5歳 以下 の 5群 の 評 価 可 能 な 喀 痰 を 採 取 で き た 症 例 は5歳 症 例 で あ っ た(表4) 以 下 で28例(65.1%),6歳 け る 細 菌 や ウ イ ル ス の 混 合 感 染 合 併 率(図5)は, 以 上 で18例(45%) で あ っ た 細 菌 感 染 が 証 明 さ れ た5歳 ら れ,Geckler 4,5群 6歳 以 上 は7.5%(3例/40例)で あ っ た 表4ウ 病 (4)日(図 入 院 時 の マ イ コ プ ラ ズ マ 抗 体 価 が640倍 に み ら の 症 例 は5歳 抗 菌 薬 の 前 投 薬 を 認 め た 図5細 高 率 で あ り, 6) 以上 で喀痰 を の う ち 細 菌 感 染 は2例 認 め ら れ る が, マ イ コ プ ラ ズ マ 抗 体 価(PA法)と は12例(80%)に 抗 菌 薬 の 前 投 薬 が み ら れ た 6歳 れ,1例(50.0%)は 5歳 以 下 で41.9%(18例/43例)と み の喀 痰が 採取 され細菌 感 染 が 証 明 さ れ な か っ た15例 採 取 で き た18例 全 体 で は25.3%(21例/83例)に 以 下13 例 の う ち 抗 菌 薬 の 前 投 薬 は7例(53.8%)に マ イ コ プ ラズ マ 肺 炎 に お 以 下 に 多 く,6歳 イル ス 抗原 検 査 陽性 例 菌,ウ イル スの混 合 感 染 合併 率 143 以上 以 上 と比 較 し て
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10 1) Yamazaki, T, Narita, M., Sakai, T: Comparison of PCR for sputum samples obtained by induced cough and serologic tests for diagnosis of Mycoplasma pneumoniae infection in children. Clin. Vac. Immunol. 13: , 2006.
11 J. Infect. Dis. 157: , ) Nagayama, Y., Sakurai, N., Yamamoto, K., et al: Isolation of Mycoplasma pneumoniae from children with lower respiratory tract infections. 8) Suzuki, S., Yamazaki, T., Narita, M., et al: Clinical evaluation of Macrolide-resistant Mycoplasma pneumoniae. Antimicrob. Agents. Chemother. 50: , 2006.
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