Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired pneumonia in Istanbul, Turkey

BACKGROUND: To investigate the role of Mycoplasma pneumoniae and Chlamydia pneumoniae infection in pediatric pneumonia, in Istanbul, Turkey, we conducted a prospective study covering all the children between 2 months and 15 years hospitalized for community-acquired pneumonia. METHODS: A total of 140 children (85 males, median age 2.5 years) with community-acquired pneumonia were enrolled. Acute and convalescent sera were tested for IgM and IgG antibodies to M. pneumoniae (enzyme-linked immunosorbent assay, Serion ELISA classic) and for IgM and IgG antibodies to C. pneumoniae (microimmunofluorescence, Savyon, Israel). RESULTS: Mycoplasma pneumoniae infection was diagnosed in 38 patients (27%) and C. pneumoniae infection in 7 (5%). In 2 children M. pneumoniae and C. pneumoniae co infection was observed. The average age of the M. pneumoniae cases was 5.3 years and that of the C. pneumoniae was 1.5 years. The average age of pneumonia cases caused by other pathogens was 3.4 years (p<0.05). No significant difference was observed in clinical onset, signs, symptoms and laboratory parameters in children with M. pneumoniae and C. pneumoniae infection and in those without M. pneumoniae and C. pneumoniae infection. CONCLUSIONS: The results of this study suggest a remarkable role for M. pneumoniae and C. pneumoniae in childhood community-acquired pneumonia, and the knowledge of the true prevalence of these two types of infections discovered in the community might lead to modifications in the present empirical treatment of bacterial pneumonia.     

An epidemic of a pertussis-like illness caused by Chlamydia pneumoniae

BACKGROUND: Between June and July, 1994, we encountered an epidemic of a pertussis-like illness in adolescents in a junior high school located in a rural area of Japan. The purposes of this study were to record the clinical manifestations and to identify an etiology. PATIENTS AND METHODS: We interviewed patients and parents and we performed physical examinations on patients with cough during the epidemic. The chest radiographs were also reviewed by us. To identify an etiology we performed culture and serologic studies for a variety of bacteria, Mycoplasma, chlamydiae and viruses. Polymerase chain reaction (PCR) for Chlamydia pneumoniae was carried out on throat swab specimens. RESULTS: Of a total of 230 students 136 (59%) had severe cough illnesses. One developed pneumonia, 9 had bronchitis and the remaining 126 (93%) presented upper respiratory tract infections (URI). The mean duration of cough in cases with URI was 17.4 days and that in cases with bronchitis and pneumonia was 30.4 days. Serology and/or cultures for Bordetella pertussis, Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia trachomatis, Chlamydia psittaci or viruses were negative. Detection of C. pneumoniae infection was carried out in 46 patients with pneumonia, bronchitis or URI by serology and PCR. The patient with pneumonia, 7 of 7 patients with bronchitis and 32 (84%) of 38 patients with URI were documented to be infected by C. pneumoniae either by serology, PCR or both tests. CONCLUSION: An epidemic of a pertussis-like illness in a junior high school population was caused by C. pneumoniae.     

Frequency of Chlamydia pneumoniae and Mycoplasma pneumoniae infections in children

OBJECTIVE: Chlamydia pneumoniae and Mycoplasma pneumoniae are among the most important pathogens of acute respiratory infections in children between the ages of 5 and 15 years. We aimed to investigate seasonal frequency of respiratory infections caused by C. pneumoniae and M. pneumoniae, frequency of coinfection, clinical findings and to determine relationship between clinical findings and laboratory results. MATERIAL AND METHODS: Total of 284 patients (ranging 5-15 years of age), admitted to out-patient clinic with symptoms of respiratory tract infections between January 2004 and June 2005, were enrolled in the study. IgA, IgG and IgM antibodies against C. pneumoniae were quantitatively detected in all serum samples by using microimmunofluorescence (MIF). For the M. pneumoniae infection an IgM titer in the ELISA test were analyzed. Nasopharyngeal smear samples were collected for PCR detection. RESULTS: Mean age was 8 +/- 2.2 (range 5-14) years. Mycoplasma pneumoniae IgM in 86 (30.2%) cases, C. pneumoniae IgM in one (0.3%) case, IgA in six (2.1%) cases and IgG in 10 (3.5%) cases were found positive. In 10 (3.5%) cases, both C. pneumoniae IgG (a titer of >1/216) and M. pneumoniae IgM were found positive concomitantly. The M. pneumoniae IgM in winter was found significantly higher compared to other seasons. Mycoplasma pneumoniae PCR method was performed on a total of 203 samples in 33 (16.2%) of which M. pneumoniae was found positive. The false positive ratio of PCR technique was found 16.2%. In a total of 217 examined samples by PCR method, the DNA of C. pneumoniae was found positive in two patients. CONCLUSION: Mycoplasma pneumoniae was a common pathogen in respiratory infections. The otherwise C. pneumoniae infections were rarely seen in children. A Comparison of serology diagnostic tests for M. pneumoniae infections was found more sensitive and specific than PCR.     

肺炎支原体耐药基因检测与难治性肺炎支原体肺炎的相关性分析

目的 了解肺炎支原体对大环内酯类耐药基因的检测与临床难治性肺炎支原体肺炎的相关性.方法 (1)对我院血清肺炎支原体抗体及咽试子标本肺炎支原体DNA均阳的97例住院肺炎患儿,行大环内酯类耐药基因DNA测序分析,筛选突变株,比较耐药基因组与无耐药基因突变组的临床表现.(2)将97例肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)患几分为耐药组和非耐药组、普通MPP组和难治性MPP (RMPP)组,回顾性总结分析并比较各组患儿的临床表现、实验室检查及影像学表现的差别,对RMPP的表现行多因素Logistic回归分析,总结耐药基因的突变与RMPP是否具有相关性.结果 (1) 97例MPP中17例无基因突变(17.5％),80例存在耐药基因突变(82.5％).(2)耐药基因突变组中,CRP值更高,发热时间、住院时间、大环内酯类药物应用时间、应用大环内酯类药物后退热时间及咳嗽时间更长,大叶性肺炎发生率更高,经统计学分析具有统计学意义.(3) RMPP组与普通MPP组相比,耐药基因突变率更高,外周血中性粒百分百分比、CRP、降钙素原及乳酸脱氢酶的值更高,发热时间、住院时间、大环内酯类药物应用时间、应用大环内酯类药物后退热时间及咳嗽时间更长,差异有统计学意义(P＜0.05).(4) Logistic回归分析结果大环内酯类药物应用时间以及耐药基因的突变与RMPP具有相关性.结论 MPP中耐药基因普遍存在;耐药基因的突变组临床症状持续时间长、恢复慢,CRP值更高,大叶性肺炎发生率高;RMPP与普通MPP组相比:耐药基因突变率更高,炎性指标及乳酸脱氢酶的值更高,应用大环内酯类药物后退热时间及咳嗽时间更长,其中大环内酯类药物应用时间及耐药基因的突变与RMPP具有相关性,为RMPP的危险因素.     

Prevalence ofMycoplasma pneumoniae andChlamydia pneumoniae in children with community acquired pneumonia

A prospective one year study was performed on 62 children admitted at the Alt India institute of Medical Sciences with community acquired pneumonia (CAP) for the prevalence ofMycoplasma pneumoniae andChlamydia pneumoniae. Diagnosis of infection withM. pneumonias was based on serological tests viz microparticle agglutination test for detection of IgM antibodies and indirect immunofluorescence test for antigen detection from throat swabs (sensitivity 85.7%, specificity 93.3%). The indirect solid-phase enzyme immunoassay for detection of IgG antibodies was used to determine the prevalence ofC. pneumoniae (sensitivity 88.8%, specificity 75.8%). Seventeen patients (27.4%) were found to have serotogical evidence ofM. pneumoniae infection whereas only 4 (6.4%) patients were seropositive forC. pneumoniae. Results of this study indicate thatM. Pneumoniae piays a significant role in CAP in infants and young children. Thus specialized laboratory testing for these agents should be more widely used thereby affecting empiric antibiotic regimens.     

Reduced lung diffusion capacity after Mycoplasma pneumoniae pneumonia

BACKGROUND: Mycoplasma pneumoniae is a frequent but underdiagnosed cause of community-acquired pneumonia (CAP) in children, and appropriate macrolide treatment is often given late. The aim of this work was to estimate the frequency of pulmonary involvement in children 6 months after a clinical episode of Mycoplasma CAP. METHODS: We measured carbon monoxide diffusion capacity (TLCO) and conducted spirometric tests in 35 children without asthma or chronic lung disease (ages 4.5 to 15 years), 6 months and 1 year after acute CAP caused by M. pneumoniae (23 children), pneumococci (5 children) or viruses (7 children). Only 11 of 23 patients with M. pneumoniae CAP required hospitalization, whereas all the patients with pneumococcal or viral pneumonia were admitted to hospital. RESULTS: Lung volumes and spirometric tests were normal for all children. TLCO was normal 6 months after pneumococcal or viral pneumonia (87 to 112% of expected values for height and sex). After acute M. pneumoniae CAP, 11 of 23 patients (48%) had TLCO values <80% of the expected value. The extent of change in lung diffusion capacity was correlated with the delay to diagnosis and treatment: TLCO was low in 8 of 11 patients given macrolide treatment 10 days or more after the onset of acute symptoms vs. only 3 of 10 patients given appropriate treatment in the first 10 days. TLCO was low in 7 of 7 who received macrolide therapy for <2 weeks. TLCO had increased slightly after 1 year in the 5 patients retested after a new course of macrolide treatment. TLCO reached the lower normal range in 2 patients controlled after 3 years. CONCLUSIONS: The abnormal TLCO values suggest that some children with Mycoplasma pneumonia have reduced pulmonary gas diffusion after recovery from the illness. The reduction is related to delay and short macrolide therapy.     

Rising rates of macrolide-resistant Mycoplasma pneumoniae in the central United States

Macrolide-resistant Mycoplasma pneumoniae is widespread in Asia, and severe cases of pneumonia have been described in children. Little information is available about the resistance pattern in the United States. We collected respiratory samples from 49 patients with Mycoplasma infection in the central United States between 2007 and 2010. We found a macrolide resistance rate of 8.2%. Resistance should be considered when patients with M. pneumoniae infection do not have a satisfactory response to macrolides. Alternative antibiotics include tetracyclines or fluoroquinolones.     

24例23SrRNA A2063G基因突变肺炎支原体肺炎临床分析

目的 分析23SrRNA A2063G基因突变引起肺炎支原体肺炎(MPP)的临床特征,从而提高对该疾病的诊治能力.方法 对36例MPP患儿痰标本进行MP-DNA及23SrRNA基因测序,检测耐药基因,在此基础上分为24例大环内酯类耐药组与12例大环内酯类敏感组.比较两组患儿的临床表现、实验室检查、影像学、治疗等资料.结果 36例MPP患儿中24例检出大环内酯类抗生素耐药基因,均为23SrRNA V区A2063G突变,12例为大环内酯类敏感组.大环内酯类耐药组患儿在住院时间(P=0.025),总咳嗽时间(P=0.035),总发热时间(P=0.008),抗生素治疗后发热时间(P=0.010)及病程(P=0.048)方面均高于大环内酯类敏感组.大环内酯类耐药组患儿白细胞计数及CRP较大环内酯类敏感组更高.大环内酯类耐药组12例患儿仅应用大环内酯类治疗5d内体温消退,3例需改用喹诺酮类抗感染;另10例联合激素,6例加用静脉丙种球蛋白,所有患儿预后良好.大环内酯类敏感组8例患儿在大环内酯类治疗后12h~3d体温消退.结论 相比大环内酯类敏感组,23SrRNA A2063G基因突变引起的耐药MPP患儿在住院时间、总咳嗽时间、总发热时间和抗生素治疗后发热时间、病程上更长,白细胞计数及CRP更高.大环内酯类抗生素对部分耐药MPP治疗有效,病情严重者需联合糖皮质激素和静脉丙种球蛋白或根据病情酌情更改抗生素.     

Mycoplasma pneumoniae pneumonia in a four-year-old child with transient abscess in the right lower lobe]

The frequency of Mycoplasma pneumoniae infection among community-acquired pneumonia, underestimated for a long time, is now better known. Severe evolution is yet uncommon. Differential diagnosis with Streptococcus pneumoniae is often difficult. CASE REPORT: A 4-year-old child was admitted for a right lower lobe pneumonia, with very high values of white blood cell count and CRP, worsening despite a treatment with high doses of amoxicillin, then with cefotaxime and vancomycin. Diagnosis of M. pneumoniae infection was considered only on the tenth day after admission and confirmed on the thirteenth day. Clinical outcome rapidly improved with macrolide antibiotherapy. Radiologic outcome consisted, two months after the beginning of the pneumonia, in abscess of the right lower lobe, which recovered in one month with continuing oral antibiotherapy. CONCLUSION: Lung abscess is very rare in M. pneumoniae pneumonia, as only two other cases were described in the literature. In all three cases, macrolide therapy was delayed. Those cases highlight the importance of considering M. pneumoniae infection in a beta-lactams-resistant community-acquired pneumonia, whatever its severity may be, and to start macrolide antibiotherapy. Our case also shows the possibility of a conservative treatment in case of pulmonary abscess, if clinical tolerance is good.     

Pneumococcal endocarditis in a previously healthy 17-month-old boy

Invasive pneumococcal infection is a severe disease and its incidence may be increasing. Endocarditis due to Streptococcus pneumoniae is uncommon, particularly in children without risk factors. Etiologic diagnosis is difficult when cultures are negative. We report the case of a previously healthy, 17-month-old boy not vaccinated against pneumococcus who, during the course of pneumonia treated with beta-lactam antibiotics, developed cardiorespiratory deterioration and heart murmur. Mitral valve vegetation was identified by transthoracic echocardiography. Endocarditis was diagnosed and new antibiotics were given for 6 weeks (cefotaxime, gentamycin and vancomycin). Cultures were negative. Because of lack of improvement, prosthetic mitral replacement was indicated. S. pneumoniae was identified by polymerase chain reaction (PCR) in the pathological specimen. Outcome was favorable, and the patient remained symptom-free after 6 months of follow-up. The possibility of endocarditis as an invasive pneumococcal infection should be considered in children without risk factors. PCR is a useful technique to establish the etiology when cultures are negative.     

儿童哮喘急性发作与肺炎衣原体感染的临床研究

目的：对儿童哮喘急性发作病例与肺炎衣原体(CP)感染相关性进行临床研究。方法：采用固相酶联免疫吸附(ELISA)方法,检测120例儿童哮喘急性发作期的肺炎衣原体血清特异性CP-IgM,CP-IgG抗体,探讨哮喘患儿急性发作及临床控制与肺炎衣原体感染的关系。以健康体检者作为对照。结果：120例儿童哮喘急性发作病例中,检测出CP-IgM阳性22例,阳性率18.3%,CP-IgG阳性32例,阳性率26.7%,与健康对照组比较差异有显著性(P<0.01)。CP感染的32例哮喘病人中有15例(46.9%)单纯给予吸入治疗获良好哮喘控制;有17例(53.1%)给予阿奇霉素足疗程治疗,配合吸入治疗,哮喘急性发作方得以完全控制。结论：儿童哮喘急性发作与肺炎衣原体感染有关,应作肺炎衣原体相关特异性抗体检测,并须配合大环内酯类药物治疗及规范吸入激素治疗,以早日达到哮喘的完全控制。     

耐大环内酯类药物的肺炎支原体肺炎患儿临床特征及治疗

目的 分析大环内酯类药物耐药的肺炎支原体肺炎患儿的临床特征,并探讨其治疗方案。方法 采集136例肺炎支原体肺炎患儿的咽拭子或支气管肺泡灌洗液标本,实时荧光定量PCR检测23s rRNA编码基因2063/2064 A：G突变情况,依结果分为突变耐药组（耐药组,n=81）和野生型敏感组（敏感组,n=55）,分析两组患儿的年龄构成、呼吸道症状、肺外并发症、实验室检查指标、影像学改变、治疗方式及住院天数。结果 耐药组较敏感组发热时间、高热时间延长,有血氧饱和度降低的例数多（P < 0.05）;耐药组谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）水平高于敏感组（P < 0.05）。常规使用阿奇霉素治疗对敏感组疗效好,而耐药组更多需要加用激素治疗。结论 耐大环内酯类药物的肺炎支原体感染单从某一项临床特征无法鉴别,但发热和高热时间延长、血氧饱和度降低,以及ALT、LDH升高有一定提示作用。对于耐药肺炎支原体肺炎患儿,阿奇霉素配合激素可能是更佳的治疗模式。     

Etiology of community-acquired pneumonia in 254 hospitalized children

BACKGROUND: Childhood community-acquired pneumonia is a common illness, but there have been relatively few comprehensive studies of the viral and bacterial etiology in developed countries. The aim of the present investigation was to determine the etiology of community-acquired pneumonia in hospitalized children by several laboratory methods. METHODS: In a 3-year prospective study a nasopharyngeal aspirate for viral studies and acute and convalescent serum samples for viral and bacterial serology were taken from 254 children with symptoms of acute infection and infiltrates compatible with pneumonia in the chest radiograph. The role of 17 microbes was investigated. RESULTS: A potential causative agent was detected in 215 (85%) of the 254 patients. Sixty-two percent of the patients had viral infection, 53% had bacterial infection and 30% had evidence of concomitant viral-bacterial infection. Streptococcus pneumoniae (37%), respiratory syncytial virus (29%) and rhinovirus (24%) were the most common agents associated with community-acquired pneumonia. Only one patient had a positive blood culture (S. pneumoniae) of 125 cultured. A dual viral infection was detected in 35 patients, and a dual bacterial infection was detected in 19 patients. CONCLUSIONS: The possible causative agent of childhood community-acquired pneumonia can be detected in most cases. Further studies are warranted to determine what etiologic investigations would aid in the management of pneumonia. With effective immunization for S. pneumoniae and respiratory syncytial virus infections, more than one-half of the pneumonia cases in this study could have been prevented.     

Lung abscess due to Mycoplasma pneumoniae in an adolescent]

Pulmonary abscess is an uncommon complication of pneumonia in children. Pyogenes, in particular Staphylococcus aureus or Streptococcus pneumoniae are the principal responsible bacteria. Mycoplasma pneumoniae is rarely the cause. CASE REPORT: A 14-year-old child was hospitalized with right thoracic pain. The patient was non-febrile and had a recent history of moderate infection. He was receiving antibiotic (macrolide) and non-steroidal anti-inflammatory therapy. CT scan confirmed a mid-lobe abscess in the right lung. Interruption of therapy resulted in fever and increase in C-reactive level with hyperleucocytosis, suggesting that the abscess was caused by a bacterial infection. The child's general condition and the radiographic picture improved with combined antibiotic therapy with amoxycillin and clavulanic acid, aminoglycosides and macrolides. The suspected diagnostic of M. pneumoniae was confirmed by increased IgM antibodies for M. pneumoniae. Recovery was complete two months later without sequelae. COMMENT: Pulmonary abscess is a rare complication of M. pneumoniae infection in children. This complication should be considered when the general condition does not improve despite appropriate early treatment of a pneumonia, as in the case of our patient.     

Etiology of Childhood Pneumonia: What We Know,and What We Need to Know!

Childhood community acquired pneumonia continues to be an important clinical problem at the individual, institutional and community levels. Determination of microbial etiology is critical to develop evidence-based management (therapeutic and prophylactic) decisions. For decades, the approach to this relied on culture of lung aspirate specimens obtained from children with radiographically confirmed pneumonia, before administering antibiotics. Such studies revealed the major bacteria associated with pneumonia, prompting the World Health Organization to develop a highly sensitive clinical definition of pneumonia and advocate empiric antibiotic therapy; in order to save lives (focusing on community settings lacking resources for diagnostic tests). However, it spawned research studies conducted in/from/by institutions enrolling children with the relatively non-specific WHO definition of pneumonia. Specificity got further compromised by abandoning lung aspiration and using naso/oro pharyngeal specimens; even in children who had received antibiotics. This led to the recovery of viruses more often than bacteria. The use of highly sensitive molecular based diagnostics (especially PCR) facilitated the detection of multiple organisms (bacteria, viruses, atypical organisms and even fungal species); making it difficult to attribute etiology in individual cases. This challenge was sought to be addressed through the multi-site PERCH Study (Pneumonia Etiology Research for Child Health), designed as a case-control study to conclusively determine the etiology of pneumonia. However, despite a slew of publications, the answer to the central question of etiology has not emerged so far. Since none of the PERCH Study sites was located in India, the Community Acquired Pneumonia Etiology Study (CAPES) was conducted at Chandigarh. This turned out to be the largest single-centre pneumonia etiology study, and generated a wealth of data. This article summarizes the current challenges in pneumonia etiology research; outlines the key observations from the PERCH and CAPES projects, as well as other important studies; and suggests a way forward for pneumonia etiology research in the current era.     

Comparison of polymerase chain reaction and the indirect particle agglutination antibody test for the diagnosis of Mycoplasma pneumoniae pneumonia in children during two outbreaks

BACKGROUND: Diagnosis of Mycoplasma pneumoniae pneumonia is challenging because of the lack of standardized rapid tests. Many serologic tests and polymerase chain reaction (PCR) based methods are used with different diagnostic criteria. METHODS: This retrospective study was conducted to compare the diagnostic values of the indirect particle agglutination test and nested PCR of nasopharyngeal aspirates for the diagnosis of M. pneumoniae pneumonia in children. These assays were evaluated in 234 hospitalized children with community-acquired lower respiratory tract infections during 2 outbreaks of M. pneumoniae pneumonia in 2000 and 2003. RESULTS: The cumulative PCR positive rate was 26.7% in patients with maximum antibody titers of < or =1:320 and 78.2% in those with titers of > or =1:640. Based on these data, a positive PCR, a 4-fold increase in antibody titer, or a single titer > or =1:640 were considered to indicate acute M. pneumoniae infection. Overall, 152 children were diagnosed to have M. pneumoniae pneumonia; 27 (18%) by serology only, 26 (17%) by PCR only, and 99 (65%) by both methods. Children who were diagnosed by PCR only were significantly younger (P = 0.003) and were more often immunocompromised (P = 0.019) than those that were PCR negative. Duration of cough before PCR diagnosis was shorter in cases diagnosed by PCR only than those that were PCR negative (P = 0.045). CONCLUSIONS: In conclusion, during the 2 outbreaks of M. pneumoniae infection, we found that the PCR test may be useful for the rapid diagnosis of M. pneumoniae pneumonia, particularly in young children and in immunocompromised patients and in early stage disease.     

氯霉素、利福平对肺炎支原体的抗菌活性分析

目的探讨氯霉素、利福平对肺炎支原体(MP)的抗菌活性。方法对370例咽拭子标本进行MP分离培养,应用套式聚合酶链式反应(PCR)扩增MP种特异16SrRNA基因对临床分离株进行分子鉴定;通过药物敏感试验测定MP分离株的红霉素的最小抑菌质量浓度(MIC),应用套式扩增红霉素作用靶位23SrRNA基因,以鉴别敏感株和耐药株;应用药物敏感试验测定MP分离株的氯霉素、利福平的MIC。结果临床标本370例中分离MP50株。其中红霉素敏感株4株,耐药株46株。46株耐药株的红霉素作用靶位23SrRNA基因发生点突变,4株敏感株无点突变。所有MP分离株对氯霉素敏感,对利福平耐药。结论利福平对MP无效,氯霉素对MP红霉素敏感株及耐药株均有效。     

重症肺炎支原体肺炎危险因素分析及临床意义

肺炎支原体肺炎在儿童中较为常见.近年来难治性肺炎支原体肺炎日趋增多,其中部分重症患几虽经大环内酯类抗生素治疗仍难见效.然而糖皮质激素治疗有意想不到的效果.对重症肺炎支原体肺炎危险因素的识别,可能有助于早期予以激素干预,改善预后.临床研究发现,临床表现、影像学表现及实验室检查等多种指标与重症肺炎支原体肺炎的发生相关.该文对目前国内外研究所涉及的、可能与重症肺炎支原体肺炎发生相关的因素进行综述.     

Is there any relationship between asthma and asthma attack in children and atypical bacterial infections; Chlamydia pneumoniae, Mycoplasma pneumoniae and Helicobacter pylori

Asthma is a chronic inflammatory airway disease characterized by variable airway obstruction and bronchial hyperresponsiveness. There are many factors affecting the development and severity of childhood asthma such as genetic predisposition, atopy, environmental factors, obesity, diet, socioeconomic status, and infectious triggers. In the present study we aimed to investigate the frequency of Mycdoplasma pneumoniae, Chlamydia pneumoniae, and Helicobacter pylori infections in asthmatic children. We investigated also whether there is a relationship between these agents and asthma attacks. MATERIAL AND METHODS: Seventy-nine asthmatic children (46 males, aged 5-15 years) were included in study. The study group was divided into two groups: group 1 consisted of 37 children with asthma attacks and group 2 consisted of 42 children with stable asthma. As a control group we studied 36 healthy children. Pulmonary function tests, skin prick tests for common allergens were performed; serum total IgE, phadiatop, specific IgM and IgG antibody levels (ELISA) for M. pneumoniae, C. pneumoniae and H. pylori were measured in all patients. RESULTS: Mycoplasma IgM and Chlamidia IgM were positive in 8.1% (3 patients) and 18.9% (7 patients) of group 1 patients, respectively. There was a statistically significant difference for Mycoplasma IgM (p = 0.031) and Chlamidia IgM (p = 0.03) between group1 and other two groups. We have not found significant difference for M. pneumoniae IgG, C. pneumoniae IgG and H. pylori IgM and IgG among groups. CONCLUSION: M. Pneumoniae and C. Pneumoniae may play a role in development of asthma exacerbations in childhood. We could not find a relationship between H. Pylori and asthma.