Community-acquired pleuropneumonia in children: Bacteriological and therapeutic challenges.

Background Community-acquired pleuropneumonia (CPP) is a common complication of pneumonia in children. It is serious given its high morbidity and significant mortality. Aim To study clinical and paraclinical features of CPP in children and to establish a common therapeutic strategy. Methods Our retrospective study included patients who were hospitalized for CPP between 2004 and 2012. All data were collected from patients' medical files. Statistical analysis was made by Epi-Info 6. Results One hundred and sixty four patients were registered. The mean age was 32 months (15 days - 14.5 years). The hospital incidence of CPP doubled between 2004 and 2012. The symptomatology was dominated by fever (93.9%), cough (56.7%) and dyspnea (48.1%). The pleural effusion was frequently moderately abundant and loculated. Pleural sample, performed in 53.6% of cases, was the most beneficial bacteriological examination (p=10-6 ). The bacteriological confirmation was attained in 44.5% of cases with the predominance of Staphylococcus aureus (59%) followed by Streptococcus pneumoniae (26%). The S. aureus occurred basically in most young infants (p=0.04) and was responsible for the most severe cases (p=0.01). The CPP management included heterogeneous intravenous antibiotics associated with a pleural drainage in 40% of cases. The quarter of our patients were transferred to an intensive care unit. Six patients died. Conclusion The bacteriological confirmation is difficult. Pleural aspiration is the key tool. S. aureus is the first microorganism followed by S. pneumoniae. A therapeutic strategy is proposed based on large spectrum intravenous antibiotics. The pleural drainage indication is limited.

[Management of the first hour of the pediatric septic shock patient]. / Prise en charge therapeutique du choc septique de l'enfant durant la premiere heure.

BACKGROUND: The pediatric septic shock mortality in Tunisia remains high (50%) and was markedly higher than in western countries (10%). The decrease in septic shock mortality has been obtained with the advent of the early goal directed therapy. AIM: The aim of this paper is to propose to the first line practitioners in Tunisia, during the first hour after establishing the diagnosis of septic shock practical clinical guidelines based on earlier consensus recommendations. METHODS: Literature review. RESULTS: Septic shock must be rapidly suspected and early recognized. Adequate oxygenation and prompt correction of hemodynamic derangements has been shown to improve outcome through aggressive volume resuscitation, early empiric antibiotherapy and early initiation of vasopressor agents. Frequent reassessment has been emphasized to ensure appropriate management. This treatment must take into consideration the resources available in our area. We can reasonably hope to decrease mortality of patients with septic shock if the first line physicians keep in mind specific therapeutic goals.

Community-acquired methicillin-resistant Staphylococcus aureus infections requiring admission to a Tunisian pediatric intensive care unit.

BACKGROUND: There is limited literature describing severe community acquired methicillin-resistant S aureus (CA-MRSA) in children admitted to an intensive care unit. AIM: To review clinical features and outcome of children admitted in a Tunisian pediatric intensive care with CA-MRSA. METHODS: Retrospective chart review of patients coded for CAMRSA over 10 years. RESULTS: There were 14 (0.32% of all admissions) patients identified with severe CA-MRSA. The median age was 3 months (range,0.5-156 months). All patients had pulmonary involvement. Six children (42.8%) developed septic shock. Two (14.3%) patients had multifocal infection with deep venous thrombosis. Two (14.3%) patients died. CONCLUSION: Severe CA-MRSA pneumonia dominated presentation. The mortality of CA-MRSA infection in our series is lower than reported in the literature.

[Neonatal respiratory morbidity after elective cesarean section at term]. / Morbidité respiratoire néonatale après césarienne elective a terme.

BACKGROUND: Incidence of elective caesareans at term is increasing these last decades with an associated increase of neonatal respiratory morbidity. AIM: To analyse the influence of elective Caesarean delivery at term on the incidence of neonatal respiratory distress in order to propose an effective strategy of prevention. METHODS: It is an analytical study compiling all births resulting from elective Caesarean at term (gestational age ranging between 37 and 41+6 GA), reported over two years period at the Charles Nicolle hospital (Tunis-Tunisia). We compared 250 live births, without maternal risk factors, delivered by elective Caesarean to 250 births delivered by vaginal way. RESULTS: Frequency of the elective Caesarean at term was of 3.6% live births; it was mainly indicated in the presence of a cicatricial uterus. The incidence of respiratory morbidity was 6% (15/250) in the group exposed to the elective caesarean versus 1.6% (4/250 cas) in the reference group, OR=3.9; 95%CI: [1, 28-11, 99] p<0.01. Before the term of 39 GA, OR=5.22; 95%CI: [1.14-23.87] p=0.01. After 39 GA, the risk of respiratory distress decreased: OR=1.86 95%CI: [0.30, 11.35] NS. The principal etiology of respiratory distress in the exposed group was the transitory tachypnea of the newborn. CONCLUSION: Incidence of respiratory distress was higher at newborn babies born from elective Caesarean with a significant reduction in this incidence after the term of 39 GA.

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 246 intensive units of 83 hospitals in 52 cities of 14 countries of Middle East: Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates-International Nosocomial Infection Control Consortium (INICC) findings.

BACKGROUND: Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied, and data on their incidence by number of device-days is not available. METHODS: Prospective, surveillance study on PVCR-BSI conducted from September 1st, 2013 to 31st Mays, 2019 in 246 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 83 hospitals in 52 cities of 14 countries in the Middle East (Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates). We applied U.S. RESULTS: We followed 31,083 ICU patients for 189,834 bed-days and 202,375 short term peripheral venous catheter (PVC)-days. We identified 470 PVCR-BSIs, amounting to a rate of 2.32/1000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 10.38%, and 29.36% in patients with PVC and PVCR-BSI. The mean length of stay in patients with PVC but without PVCR-BSI was 5.94 days, and 16.84 days in patients with PVC and PVCR-BSI. The microorganism profile showed 55.2 % of gram-positive bacteria, with Coagulase-negative Staphylococci (31%) and Staphylococcus aureus (14%) being the predominant ones. Gram-negative bacteria accounted for 39% of cases, and included: Escherichia coli (7%), Klebsiella pneumoniae (8%), Pseudomonas aeruginosa (5%), Enterobacter spp. (3%), and others (29.9%), such as Serratia marcescens. CONCLUSIONS: PVCR-BSI rates found in our ICUs were much higher than rates published from USA, Australia, and Italy. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module.

BACKGROUND: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS: During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied. RESULTS: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher. CONCLUSIONS: Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings.

BACKGROUND: Short-term peripheral venous catheter-related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available. METHODS: Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS: We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%). CONCLUSIONS: PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.

Sternal cleft, a rare congenital anomaly. Report of the first Tunisian case.

BACKGROUND: Sternal cleft is an uncommon visually dramatic congenital anomaly of the chest wall. It is resulting of failure of the two lateral mesodermal sternal bars fusion by the eight weeks of gestation. Superior defects are the commonest forms, usually isolated. AIM: Clinical and surgical aspects of sternal cleft are presented. The advantages of early surgery in the neonatal period are developed. CASE REPORT: We report the first Tunisian case of a superior sternal cleft associated to haemangioma in a newborn boy. Scanning shows non-appearance of manubrium at the upper part of sternum. Sternal bars showing a U-shaped incomplete sternal cleft. Surgical repair consisted of reconstructing a new sternum from sternal bars and resection of haemangioma. The patient had good aesthetic and functional results. CONCLUSION: The appearance of a child with its heart bulging through its chest wall is very disturbing to parents. Early surgery is most easy and most comforting.

[Management of purpura fulminans apropos of 21 cases: diagnostic delay and therapeutic problems]. / Prise en charge du purpura fulminans a propos de 21 cas: retard diagnostique et problemes therapeutiques.

AIM: To evaluate the diagnostic delay and therapeutic insufficiencies delay before the transfer in ICU of the children admitted in the ICU of the children's hospital of Tunis with a purpura fulminans (PF). METHODS: A retrospective, descriptive study, of children with PF referred between January 2000 and January 2006 to a the paediatric intensive care unit (PICU) of the children's hospital of Tunis. The PF diagnosis was retained in any child presenting a feverish purpura and circulatory insufficiency signs. The optimal diagnostic and therapeutic charge taking was defined in three levels: parental, the first line doctors, and the hospital doctors. The symptoms' duration and the various treatments which were lavished to the patients were taken from the medical observations of the patients transferred in our PICU. RESULTS: Twenty one observations were collected. Twelve patients (57.1%) were addressed by a doctor exerting in a dispensary or by a free practicing doctor, 5 patients (23.8%) were transferred from a regional hospital and 4 children (19.1%) directly consulted the children hospital of Tunis urgencies delayed parental recognition occured in 11 children. The PF diagnosis was not evoked by the first line doctor in 62%. Eleven (52.4%) of the children with meningococcal disease were seen but not admitted by a doctor in the 48 hours before admission. Apart from 2 patients (9.5%) who were hospitalized in reanimation directly of the urgencies, all the other patients forwarded by a general pediatry service. In general pediatry, the PF diagnosis was not evoked in 3 cases (15.8%), 31.6% of patients had unnecessary a lumbar punctures and shock was not recognised or treated in 26.3%. Twelve patients (52.2%) died. The duration of hospitalization in general pediatry is significantly higher among deceased patients (5.5 +/- 6.6 hours) than among the surviving patients (2.6 +/- 1.5 hours); p < 0.05. CONCLUSION: Suboptimal treatement in PF is due to failure of parents, general practioners and hospital doctors to recognise specific features of the illness. Improvement in outcome could be achieved by public education and better training of clinicians in recognition, resuscitation, and stabilisation of seriously ill children.

[Current management of acute bronchiolitis in Tunisia]. / Prise en charge de la bronchiolite aiguë en Tunisie.

AIM: The purpose of this study was to assess the current management practices of acute bronchiolitis by tunisian paediatricians. METHODS: A questionnaire was sent by mail to all tunisian paediatricians, about the most widely used drugs during the first stage of acute bronchiolitis. The answers were sent to us by mail in pre-stamped envelopes. RESULTS: Out of total of 420 questionnaires sent, 180 (42.8%) were returned, out of which 177 (42%) were analysed. Of the respondents, 117 (66%) were working in hospitals and, 60 (34%) were working in the private sector. Bronchodilatators were used by 93.3% of peadiatricians either routinely (35.6%) or occasionally (44.1%). Steroids were used by 88.7% of pediatricians either routinely (28.8%) or occasionally (43.5%) Nasal drops, were prescribed routinely by 80.2% of the pediatricians. Physiotherapy was performed routinely or occasionally in 91.5% of the cases. Oygen and antibiotics were respectively used by 92% and 70% of the paediatricians. A comparaison between the practices of the hospital paediatricians and their private sector conterparts showed that private practitioners, statistically, prescribe more bronchodilatators (42.7% vs 21.7%) (p < 0.05) and corticosteroids (36.8% vs. 13.3%) (p < 0.05) than their hospital colleagues. Hospital physicians, more than the private sector ones, tend to never prescribe bronchodilatators ,2 (15% vs. 2.6%) (p < 0.05) and steroids (25% vs. 4.3) (p < 0.05). CONCLUSIONS: Despite the absence of the scientific evidence showing a beneficial effect of the pharmaceutical agents, most paediatricians, during the initial phase of acute bronchiolitis, resort to prescribing bronchodilators (93.3%) and corticosteroids (88.7%). There is a great variety of therapeutic practices among hospital paediatricians and private practitioners. National guidelines could be helpful in reducing this disparity.

[Acute respiratory distress syndrome in infants at term and near term about 23 cases]. / Le syndrome de détresse respiratoire aigue du nouveau-né à terme et proche du terme: à propos de 23 observations.

AIM: to precise the incidence of acute respiratory distress syndrome in infants at term and near term and the clinical characteristics of this disease not yet well recognised. METHODS: Retrospective study of the medical records of infants admitted in the paediatric intensive care unit for ARDS along a period of 4 years. Diagnosis of ARDS was based on the following criterias: (1) Gestational age > or =35 weeks of gestation; (2) Severe and immediate respiratory distress requiring mechanical ventilation with PEEP > or =4 cmH2O and FiO2 > or = 0.5 during at least 6 hours; (3) Dependence on oxygen > or =48 hours ; (4) Diffuse alveolar damage in the chest radiograph; (5) PaO2 < or =60 mmHg under FiO2 > or = 0.5. RESULTS: During the period of the study, 23 infants (gestational age = 36 +/- 1.1 weeks of gestation; birth weight = 2756 +/- 453 gr) were included in the study. Their mean age at admission was 16.5 +/- 14.6 hours. The majority of infants (91.3%) were born by caesarean section before the onset of labour in 78.3% cases. All infants had a severe acute hypoxemic respiratory failure (D(A -a)O2 = 468 +/- 165; OI = 19 +/- 8.4). Five infants (21.7 %) improved their oxygenation parameters under conventional mechanical ventilation (CMV) (p < 0.001; p = 0.002 et p = 0.003 respectively for D(A - a)O2, OI and PaO2/FiO2). Eighteen infants (78.2%) required high frequency oscillatory ventilation (HFOV)with a rapid and persistant improvement of oxygenation parameters. Five patients (21.7%) developed pulmonary air leak. One infant died. CONCLUSION: ARDS represents 6.8% of etiology of respiratory distress in infants at term and near term. Caesarean section before the onset of labour seems to be a triggering factor. The outcome seems to be favourable (rate of survival = 95.7%) if the management is suitable.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module.

BACKGROUND: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. RESULTS: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. CONCLUSIONS: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

[Pulmonary alveolar proteinosis in two siblings. A case report]. / La protéinose alvéolaire pulmonaire de l'enfant. A propos d'une observation familiale.

Pulmonary alveolar proteinosis (PAP) is a rare disorder in children. This report describes two siblings in whom PAP developed during infancy (three years for the boy and four years two months for the girl). The girl was admitted for chronic respiratory distress. Chest x-ray showed a reticulonodular pattern. Her brother was asymptomatic. The diagnosis of PAP was confirmed by open lung biopsy for the boy and broncho-alveolar lavage for the girl. Therapeutic broncho-alveolar lavages were performed (six for the girl and two for the boy), the girl lost dependence on oxygen therapy. 6 years later, the brother is still asymptomatic. The sister had two episodes of respiratory distress, after two and four years, that required therapeutic lavages. The last therapeutic bronch-oalveolar lavage was performed for the first time by a Tunisian team.

Prevalence of Bordetella pertussis and Bordetella parapertussis infections in Tunisian hospitalized infants: results of a 4-year prospective study.

The prevalence of pertussis in Tunisia remains undetermined essentially because of the unavailability of a basic laboratory diagnostic service. Specific diagnostic tools were applied for the first time in a Tunisian prospective study in order to get a first estimation of the prevalence of Bordetella pertussis/parapertussis infections and to evaluate their use to determine the epidemiologic characteristics of these infections in Tunisian infants. Between 2007 and 2011, a total of 626 samples from 599 infants aged <1 year with and without pertussoid cough were investigated for the presence of B. pertussis/parapertussis using culture and real-time polymerase chain reaction (PCR). The real-time PCR (RT-PCR) targets include IS481 commonly found in B. pertussis, B. bronchiseptica, and B. holmesii; IS1001 specific of B. parapertussis, in combination with the pertussis toxin promoter region gene (ptx) of B. pertussis; and the recA gene specific of B. holmesii. When possible, patients' household contacts provided nasopharyngeal aspirates (NPAs) for RT-PCR detection of B. pertussis/parapertussis or single-serum samples for anti-PT IgG quantification. All except 1 NPAs were negative by conventional culture, whereas PCR gave positive signals for 126 specimens (21%): B. pertussis, B. parapertussis, and Bordetella spp. were detected in 82%, 6%, and 4% of the samples, respectively. The simultaneous presence of B. pertussis and B. parapertussis was noted in 8% of the cases. Pertussis was reported throughout the year with a peak during the summer of the year 2009. The prevalence of Bordetella infection was 20% between 2007 and 2011. Most of these cases corresponded to patients younger than 6 months who received <3 doses of pertussis vaccine. Among the household contacts enrolled in the study, mothers seemed to be the likely source of infection. This study showed that pertussis is still prevalent in Tunisia and that the disease remains a public health problem affecting not only infants but also adults. Given this situation, sensitive and specific laboratory tests are needed to improve the accuracy of pertussis diagnosis.

The new health legacy: when pertussis becomes a heritage transmitted from mothers to infants.

Despite high vaccination coverage rates, there has been a gradual increase in reported pertussis cases. Although whooping cough affects all ages, young infants continue to suffer the greatest pertussis disease burden. Adolescents and adults are the primary source of infection for young babies. In this paper, we report two cases involving the likely transmission of pertussis from mothers to infants in Tunisia.

Community-associated methicillin-resistant Staphylococcus aureus infections in a pediatric intensive care unit.

INTRODUCTION: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is an increasing problem worldwide. In developing countries, there is little data on CA-MRSA infection in children. This study reviewed the clinical features and outcomes of children admitted in a Tunisian pediatric intensive care unit with severe CA-MRSA infections. METHODOLOGY: Retrospective chart review of patients coded for CA-MRSA over 10 years. RESULTS: There were 14 (0.32% of all admissions) patients identified with severe CA-MRSA infections. The median age was three months (range, 0.5-156 months). All patients had pulmonary involvement. Six children (42.8%) developed septic shock. Two (14.3%) patients had multifocal infection with deep venous thrombosis. Two (14.3%) patients died. CONCLUSIONS: Severe CA-MRSA pneumonia dominated presentation. The mortality of CA-MRSA infection in our series is lower than that previously reported.

Prevalence of Mycoplasma pneumoniae-associated respiratory tract infections in hospitalized children: results of a 4-year prospective study in Tunis.

Specific microbiologic, molecular, and serologic assays are hardly available in Tunis to confirm a suspected infection of Mycoplasma pneumoniae (MP). These diagnosis methods were used for the first time in a Tunisian prospective study to estimate the prevalence of MP infection in children and to evaluate their usefulness for diagnosis. A total of 540 children hospitalized in Tunis for lower respiratory tract infections (LRTIs) between 2005 and 2009 and 580 clinical specimens were investigated for the presence of MP by culture and by end-point polymerase chain reaction (PCR) targeting the P1 and the 16S rRNA genes. Real-time PCR was also used for MP detection on 158 respiratory samples. A total of 525 serum samples were tested for detection of MP-specific IgM and IgG. The P1 adhesin type and the antibiotic susceptibility testing were determined for the 9 clinical strains isolated during the study period. MP was detected in 33 (5.7%) clinical samples. Specific MP seropositivity was confirmed in 54 serum samples (10.3%), among which 19 (3.6%) were indicative of acute MP infection. MP infection was confirmed in 39 (7.2%) patients: 24 positive by PCR and/or culture, 10 serologically positive only, and 5 confirmed positive by both methods. MP infections occurred throughout the year with a slight decrease in autumn. The 9 MP isolates were susceptible to erythromycin, tetracycline, and ciprofloxacin, and all belonged to type I. The prevalence of MP infection in children with LRTI was 7.2% between 2005 and 2009, in Tunisia. Combination of direct detection and serology was required to enhance the clinical sensitivity of MP detection in clinical specimens.