Mycoplasma pneumoniae Pneumonia Requiring Hospitalization, With Emphasis on Infection in the Elderly

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Abstract
Purpose: To determine the frequency and the clinical characteristics ofMycoplasma pneumoniaepneumonia in the elderly. Methods: Analysis of cases ofM pneumoniaepneumonia accumulated as part of a prospective study of communityacquired pneumonia. Results: Sixty-four (4.9%) of 1300 patients had pneumonia due toM pneumoniae. Six (9.3%) of the 64 were 65 years of age or older. None of the elderly patients had a discharge diagnosis ofM pneumoniaecompared with 21 of those 64 years of age or younger (36%). Sixty-four percent of the patients withM pneumoniaereceived erythromycin therapy compared with 45% of 1118 of the patients with community-acquired pneumonia. The clinical features of the six elderly patients withM pneumoniaedid not allow distinction from other causes of pneumonia. One patient presented with normal pressure pulmonary edema due to infection with bothM pneumoniaeand respiratory syncytial virus; a second patient had hisSalmonellacarrier state converted to bacteremia during his episode ofM pneumoniae. Three presented as nonspecific pneumonia in the elderly, while one patient had a slowly resolving infection due to a narrowed bronchus. The 58 patients who were 64 years of age or younger demonstrated four previously unrecognized or underemphasized features ofM pneumoniaeinfection—prolonged thrombocytopenia, one patient; recurrent pulmonary hemorrhage, one patient; thrombocytosis, 45% of the patients; and prolonged hospital stay, eight (13.7%) of the 58 patients. Only one patient died (1.5%) and this was a result of Shy-Drager syndrome. Conclusions: Mycoplasma pneumoniaeaccounts for 4.9% of community-acquired pneumonia requiring hospitalization, and 9% of these patients were 65 years of age or older. There are no clinical features that distinguish this form of pneumonia from that due to other agents. The mortality rate from this infection is low even in the elderly. (Arch Intern Med. 1993;153:488-494)