Searching Mycoplasma pneumonia by serology & PCR in children with adenoid hypertrophy and rhinosinusitis: A case control study, Tehran, Iran

BACKGROUND AND OBJECTIVES: Chronic infection in childhood is a leading cause of adeno-tonsillectomy. The aim of this study was to determine the role of M. pneumoniae in children with rhino sinusitis and adenoid hypertrophy. METHOD AND MATERIAL: This case - control study was carried out in the pediatric and ENT wards of Hazrat Rasul Hospital, Tehran, Iran (2007-2009). In this trial, we investigated 40 cases with adenoid surgery and 32 controls.We looked for M. pneumoniae -DNA (PCR) in adenoid tissues resected from cases and 31 nasopharyngeal swabs in controls and IgM & IgG antibodies (ELISA) were compared between the 2 groups, P < 0.05 was considered to show a significant value. RESULTS: Positive PCR results were observed in 35% of cases and none of controls, positive-IgG was seen in 20% of cases and 6.4% of controls (P = 0.71) which was higher in older cases (6 vs. 4 years, p < 0.05). Positive –IgM was seen in 10% of cases vs. 9.7% of controls, (P= 0.74); without any difference for age (6.2/ 5.3 years, p = 0.1). A positive PCR result was not related to positive IgG (p = 0.014), but to a positive IgM (p= 0.1). CONCLUSION: M. pneumoniae infection was found serologically (IgM & IgG) in10% and 20% of cases, respectively. These numbers along with positive PCR in adenoid tissue of cases (30%) indicates the prominent role for M. pneumoniae in adenoid hypertrophy. We concluded that children in Iran will have been infected with M. pneumoniae and would have obtained immunity between the ages of 6 and 8. Adenoid tissue might act as a reservoir for M. pneumoniae and cause rhino sinusitis concomitant with adenoid hypertrophy in infected children. Theoretically, suitable M. pneumoniae eradicating antibiotics before adenoid surgery (with rhino sinusitis or chronic ear infection) might be helpful treatment, but it needs future RCT studies to be proven.