Significance of mycoplasma infection in the etiopathogenesis of necrotizing pneumonia in pediatric patients

Significance of mycoplasma infection in the etiopathogenesis of necrotizing pneumonia in pediatric patients

M.V. Besedina¹, E.M. Tolstova¹, O.V. Zaytseva¹, N.S. Zaitseva¹, A.A. Aminova¹, S.R. Kuzina¹, M.A. Elkina², S.B. Yatsishina², I.V. Turishchev³, D.V. Khaspekov³, A.S. Sar3, N.V. Tkachenko3, V.N. Morozova3, T.Yu. Belyaeva3

Marina V. Besedina, e-mail: mari-bese@yandex.ru

¹Russian University of Medicine, Moscow

²Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

³St. Vladimir Children’s City Clinical Hospital, Moscow

Background: the specific contribution of Mycoplasma pneumoniae to the development of necrotizing community-acquired pneumonia (CAP) in pediatric patients remains incompletely elucidated.

Aim: to define the clinical relevance of M. pneumoniae in pediatric CAP cases presenting with pulmonary tissue necrosis.

Materials and Methods: this retrospective cohort study analyzed pediatric patients (aged 0–17) hospitalized in the St. Vladimir Children’s City Clinical Hospital between January 1, 2022, and December 31, 2024 with CAP and confirmed M. pneumoniae infection. Diagnostic verification was performed using molecular genetic (PCR) and serological (IgM/IgG) assays. In cases of necrotizing pneumonia, the etiological profile was investigated in greater detail.

Results: M. pneumoniae markers were identified in 308 (24.2%) of the 1,271 patients: 160 female (51,9%) and 148 male (48,1%) patients. Pleuropulmonary complications were recorded in 65 (22.3%) patients, with necrotizing pneumonia diagnosed in 14 cases (4.5%). Diagnostic verification revealed M. pneumoniae DNA via PCR in 25.3% of nasopharyngeal swabs and IgM antibodies in 87.9% of the cohort. Within the necrotizing pneumonia subgroup, M. pneumoniae infection was confirmed in all instances, consistently presenting as a mixed infection with other pathogens. This subgroup demonstrated the most severe clinical trajectory, including a higher incidence of dyspnea (p=0.013), significant hypoxemia (p=0.037), and markedly elevated C-reactive protein levels (p<0.0001). Notably, M. pneumoniae IgM titers in patients with necrotizing pneumonia were lower than in other subgroups (p>0.05). Although specific antimycoplasmal therapy was administered to only 3 of the 14 patients with necrotizing disease, clinical recovery was achieved across the entire study population.

Conclusion: evidence of M. pneumoniae was confirmed in 75% of pediatric patients hospitalized for CAP during the study period. Complications were observed in 20% of cases, and a definitive association with M. pneumoniae was present in all recorded instances of necrotizing pneumonia. These results suggest that M. pneumoniae likely serves as a critical trigger in the etiopathogenesis of necrotizing pulmonary processes.

Keywords: pediatric community-acquired pneumonia, Mycoplasma pneumoniae, pulmonary complications, necrotizing pneumonia, co-infection, mixed infection.

For citation: Besedina M.V., Tolstova E.M., Zaytseva O.V., Zaitseva N.S., Aminova A.A., Kuzina S.R., Elkina M.A., Yatsishina S.B., Turishchev I.V., Khaspekov D.V., Sar A.S., Tkachenko N.V., Morozova V.N., Belyaeva T.Yu. Significance of mycoplasma infection in the etiopathogenesis of necrotizing pneumonia in pediatric patients. RMJ. 2026;1:18–22. DOI: 10.32364/2225-2282-2026-1-4