65ª Reunião Anual da SBPC

D. Ciências da Saúde - 2. Medicina - 8. Medicina

MYCOPLASMA PNEUMONIAE ACUTE INFECTION AMONG CHILDREN WITH NON-SEVERE PNEUMONIA TREATED WITH AMOXICILLIN

Cristiana Maria Costa Nascimento de Carvalho - Departamento de Pediatria, Faculdade de Medicina da UFBA Aldina Maria Prado Barral - Departamento de Patologia, Faculdade de Medicina da UFBA Gabriel Xavier Pereira de Souza - Departamento de Pediatria, Faculdade de Medicina da UFBA Maria do Socorro Heitz Fontoura - Departamento de Pediatria, Faculdade de Medicina da UFBA Ana Luisa Vilas Boas - Departamento de Pediatria, Faculdade de Medicina da UFBA César Araújo Neto - Departamento de Diagnóstico por Imagem, Faculdade de Medicina da UFBA

INTRODUÇÃO:

Acute lower respiratory infections are still the leading cause of death in children under 5-years of age in developing countries, accounting for 1.5 million deaths per year, and pneumonia is the most serious acute lower respiratory infection. Mycoplasma pneumoniae is one of the treatable causative agents of childhood pneumonia, and it has been identified among 14% of hospitalized patients. On the other hand, among those under 5-years old, M. pneumoniae accounts for around 9% of the overall childhood pneumonia cases. There is an on-going debate on the empirical use of macrolides to treat childhood pneumonia cases. There is a lack of recent information about the failure rates of pneumonia cases with M. pneumoniae infection treated with beta-lactams.

OBJETIVO DO TRABALHO:

We aimed to assess association between clinical failure and acute M. pneumoniae infection in children with non-severe pneumonia receiving amoxicillin.

MÉTODOS:

Patients aged 2-59 months were prospectively followed-up. The finally diagnosed pneumonia was based on agreed detection of pulmonary infiltrate/pleural effusion by 2 independent radiologists. Amoxicillin (50mg/kg/day) was given. Demographic data and clinical findings on admission, daily evolution and 2-4 weeks after enrollment were collected. Acute and convalescent blood samples were collected. Clinical failure included persistence of fever, difficulty breathing or tachypnea >first 48h of treatment or of cough >first 96h of treatment or sign of severe/very severe disease up to the fifth day of treatment. IgM antibodies to M. pneumoniae were searched for to detect acute M. pneumonia infection.

RESULTADOS E DISCUSSÃO:

Out of 382 patients studied, 372(97.4%) had concordant radiographic diagnosis which was pneumonia(n=192;52%), normal chest radiograph(n=152;41%) and others(n=28;7%). Overall, IgM against M. pneumoniae was detected in 53(14%) and clinical failure occurred in 10(2.6%) cases. No difference was found between children with or without IgM against M. pneumoniae when clinical failure rates were compared (3.8%vs.2.6%,p=0.6) Acute M. pneumoniae infection was significantly more frequent among pneumonia cases in comparison with the others (21%vs.7%,p<0.001). For the 192 radiographically diagnosed pneumonia cases, no difference was identified when children with or without acute M. pneumoniae infection were compared (5.3%vs.2.1%,p=0.3).

CONCLUSÕES:

Clinical failures were rare and not associated with acute M. pneumoniae infection. Clinical failure was not associated with acute M. pneumoniae infection among children with non-severe community-acquired pneumonia receiving amoxicillin

Palavras-chave: acute respiratory infection, amoxicillin, lower respiratory tract disease.