Abstract
Respiratory infection with Mycoplasma pneumoniae in children is uniformly considered to be mild and benign. patients with sickle cell disease may have frequent episodes of pulmonary infection and/or infarction and are known to be unusually susceptible to pneumococcal disease including overwhelming sepsis. We recently observed 4 children (ages 4–12 years) with sickle cell disease who had pulmonary infection attended by a severe course of illness. Clinical features included diffuse pneumonia (4 patients), pleural effusion (2), prolonged febrile states (3), respiratory distress (3), moderate to marked leukocytosis (4) and pleuritic pain (3). None of these patients responded to penicillin and/or ampicillin. All 4 patients had significantly elevated cold hemaglutinin titers. M. pneumoniae was isolated from both patients cultured for this organism. In 3 patients serologic evidence of M. pneumoniae infection, as manifested by a rise in the mycoplasma complement fixation (CF) or growth inhibition (GI) titer, was obtained. One patient showed no rise in CF titer but an elevation of the GI titer. The course of this disease was of a severity rarely observed in M. pneumoniae infection. The reason for the unusual severity of this ordinarily benign disease in this group of patients is not clear at present but may be related to concomitant pulmonary infarction or to an underlying immune defect. In addition to pulmonary infarction and pneumococcal infection, the differential diagnosis of pulmonary disease in patients with sickle cell disease and leukocytosis must include mycoplasmal infection, especially when penicillin unresponsiveness is noted.
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Shulman, S., Bartlett, J., Clyde, W. et al. The unusual severity of mycoplasmal pneumonia in children with sickle cell disease. Pediatr Res 5, 405 (1971). https://doi.org/10.1203/00006450-197108000-00142
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DOI: https://doi.org/10.1203/00006450-197108000-00142