OBJECTIVETo reveal changes in clinical manifestations of Mycoplasma pneumoniae (Mp) pneumonia in children older than 3 years of age during 2000 - 2006.

METHODTotally 288 older children with Mp pneumonia hospitalized in the hospital between 2000 and 2006 were enrolled. Clinical manifestation, chest X-ray and clinical outcomes among three time periods (2000 - 2002, 2003 - 2004, 2005 - 2006) were compared.

RESULT(1) Fever and its duration; 281 cases (97.6%) had fever of different duration (median = 7.2 d, 8.5 d, and 11.2 d, respectively) among the time periods, showing statistically significant difference (P < 0.01). (2) Respiratory symptoms: different incidence of wheezing/dyspnea (6.1%, 9.9%, 16.3%), thrilling (6.9%, 11.3%, 19.8%) and chest pain (12.2%, 15.5%, 22.1%) among different time periods had significant difference (χ(2) = 5.87, 11.46, 5.21, P < 0.05). (3) The incidence of extrapulmonary damages (13.0%, 38.0%, 48.8%) among different time periods also had significant difference (χ(2) = 21.27, P < 0.01). (4) Chest X-ray examination showed large area of lesions in most cases; 30.2% of cases seen during 2005 - 2006 were found having pulmonary complications such as pleural effusion or atelectasis. The incidences of pulmonary complications among different time periods had significant difference (P < 0.01). (5) TREATMENT AND OUTCOME: after comparing the efficacy of erythromycin or azithromycin, decline of clinical effectiveness was revealed among different time periods (P < 0.05). The duration of fever after macrolide administration (median = 3.2 d, 4.5 d, 6.2 d, respectively) and hospital stay (median = 7.0 d, 8.7 d, and 11.4 d, respectively) among different time periods showed significant differences (P < 0.05).

CONCLUSIONMore refractory and severe Mp pneumonia cases appeared during 2000 - 2006 in children older than 3 years of age in Hangzhou, with prolonged fever duration, aggravated respiratory symptoms and more complications and extrapulmonary damages.