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Letters to the Editor Indian Pediatrics 2002; 39:1061-1062 |
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We thank Prof. Jacob John for his interest in our article. We agree with the comments that in clinical practice, we must aim to detect the etiological agent causing pneumonia rather than classifying it into typical and atypical. However, in community practice when microbiological investigations are not available, clinical pointers towards atypical pneumonia may guide the choice of initial antimicrobial treatment. Moreover if a particular patient does not behave like a typical pneumonia i.e bacterial pneumonia, one must keep other organisms in mind. Main difference between respiratory syncytial virus and mycoplasma pneumonia is that age group for the later is different and course is usually subacute unlike a viral pneumonia. Other features like otitis media, rash, anemia are pointers in favour of mycoplasma pneumonia. We agree that primary atypical pneumonia should be a preferred term. We will also like to clarify about the "bed side test" available for Mycoplasma pneumoniae. This is performed by adding 4 drops of blood to a tube containing sodium citrate or other anticoagulant. The tube is placed in icewater(0ºC to 4ºC) in a freezer for about 30 seconds and immediately observed for coarse agglutination by tilting the tube on one side. On rewarming the tube to 37ºC, the agglutination should resolve, and it can be reproduced again by repeating the ice water cooling procedure. A positive bed side agglutinin test is equivalent to a laboratory titre of >1:64(1,2,3). This test is practically possible when performed close to the place where sampling is done. This could be a side lab or bed side if freezing equipment such as cold box be taken to the ward. Non specific and insensitive were used in terms of diagnostic value to the tests as derived from terms specificity and sensitivity. We thank Prof Jacob John for clarifying these terms and providing a case illustration. Manju Salaria, Meenu Singh, Advanced Pediatric Centre Post Graduate Institute of Medical Sciences and Research, Chandigarh 160 012. |
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