Evidence map›Paper›PMID 40770147›Full record

ArticleEuropean journal of pediatrics2025

Evolving clinical features of Mycoplasma pneumoniae infections following COVID-19 pandemic restrictions: a retrospective, comparative cohort study.

Elena Robinson, Michael Zellner, Ester Osuna, Michelle Seiler, Martin Theiler, Semjon Sidorov, Stefanie von Felten, Christoph Berger, Patrick M Meyer Sauteur

Abstract readComparative Study
In one paragraph

Article in European journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Open forum infectious diseases · 2026
    Review
  2. Review
  3. Early prediction of plastic bronchitis in pediatric patients withFrontiers in cellular and infection microbiology · 2026
    Article
  4. Article
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Elena RobinsonDivision of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Lenggstrasse 30, CH-8008, Zurich, Switzerland.ORCID http://orcid.org/0009-0000-0077-4311
Michael ZellnerDivision of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.ORCID http://orcid.org/0000-0002-9118-7266
Ester OsunaDivision of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Lenggstrasse 30, CH-8008, Zurich, Switzerland.ORCID http://orcid.org/0000-0001-7706-6102
Michelle SeilerEmergency Department, University Children's Hospital Zurich, Zurich, Switzerland.ORCID http://orcid.org/0000-0002-1263-5818
Martin TheilerPediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.ORCID http://orcid.org/0000-0001-7160-3958
Semjon SidorovDivision of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Lenggstrasse 30, CH-8008, Zurich, Switzerland.ORCID http://orcid.org/0000-0001-5300-664X
Stefanie von FeltenDepartment of Biostatistics at Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.ORCID http://orcid.org/0000-0002-5264-6394
Christoph BergerDivision of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Lenggstrasse 30, CH-8008, Zurich, Switzerland.ORCID http://orcid.org/0000-0002-2373-8804
Patrick M Meyer SauteurDivision of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Lenggstrasse 30, CH-8008, Zurich, Switzerland. patrick.meyersauteur@kispi.uzh.ch.ORCID http://orcid.org/0000-0002-4312-9803

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Since its delayed re-emergence after non-pharmaceutical interventions (NPIs) against the COVID-19 pandemic, Mycoplasma pneumoniae has caused community-acquired pneumonia outbreaks worldwide. In this study, we aimed to investigate how the clinical characteristics and severity of M. pneumoniae infections have changed after COVID-19 pandemic restriction, in order to enable adequate interpretation of clinical features and response to future M. pneumoniae epidemics. This retrospective, comparative cohort study compared clinical features and severity of children with M. pneumoniae detection by PCR during the periods April 1, 2015, to March 31, 2020 (pre-NPI); April 1, 2020, to March 31, 2022 (NPI); and April 1, 2022, to March 31, 2025 (post-NPI). Clinical features were compared between periods by Kruskal-Wallis rank sum test or Fisher's exact test, as appropriate. Moreover, we compared hospitalization and intensive care unit (ICU) admission using generalized linear models. In total, 321 patients were included in the study. Since the first detection of M. pneumoniae after the COVID-19 pandemic in summer 2023, the re-emergence has shown a bimodal curve with two distinct peaks (post-NPI first-year and second-year). The median age of patients was higher in the post-NPI than the pre-NPI period (9.05 vs 8.20 years), particularly during the first-year peak (11.00 years). Obstructive diseases were observed more frequently post-NPI compared to pre-NPI (18.6% vs 9.6%). Moreover, more patients presented with chest pain (8.9% vs 2.4%) and pleural effusions (45.7% vs 28.9%) post-NPI than pre-NPI. Conversely, extrapulmonary manifestations were less frequent post-NPI (18.6% vs 30.1%), particularly dermatological (15.7% vs 25.3%) and neurological (1.3% vs 4.8%) manifestations. Hospitalization rate (38.6% post-NPI vs 43.9% pre-NPI) and length of stay (median, 4 [IQR, 2-5] vs 4 [IQR, 3-6] days) were similar, while generalized linear models showed a trend toward fewer hospitalizations post-NPI (odds ratio [OR], 0.72 [95% CI, 0.42-1.23]; P = 0.22). The same applied to ICU admission rate (5.1% post-NPI vs 4.9% pre-NPI), with a trend toward fewer ICU admissions post-NPI (OR, 0.90 [95% CI, 0.29-3.34]; P = 0.86).

conclusionWe observed notable changes in the clinical presentation of re-emerging M. pneumoniae infections compared to the pre-COVID-19 pandemic period, particularly an increase in obstructive phenotypes and pleural effusions. However, overall disease severity appeared to remain largely unchanged. WHAT IS KNOWN: • The delayed re-emergence of M. pneumoniae in late 2023 was substantial in terms of case numbers across many geographical locations. • No statistically increased proportion of severe or worse outcomes of re-emerging M. pneumoniae infections could be observed globally compared with pre-COVID-19 pandemic epidemics. WHAT IS NEW: • Clinical features of M. pneumoniae infections in children partly changed following COVID-19 pandemic restrictions, with new signs like obstructive phenotypes and pleural effusions. • The findings suggest that there has been no overall increase in disease severity; in fact, extrapulmonary manifestations were fewer, with trends toward reduced hospitalizations and ICU admissions.

Indexed as

COVID-19Pneumonia, MycoplasmaAdolescentChildChild, PreschoolFemaleHospitalizationHumansInfantMaleMycoplasma pneumoniaePandemicsRetrospective StudiesSARS-CoV-2Severity of Illness IndexCommunity-acquired pneumoniaEpidemiologyExtrapulmonary manifestationsNon-pharmaceutical interventions (NPIs)Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Identifiers

PMID40770147
PMCPMC12328521

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.