Five children with sickle-cell disease had severe mycoplasma pneumonia. The severity was greater than that noted with M. pneumoniae infection in otherwise normal persons. Clinical features included pneumonia involving more than one lobe, white-cell counts over 25,000, prolonged febrile state, respiratory distress and pleuritic pain; pleural effusion occurred in two of the five patients. Serologic data in all patients and bacteriologic isolation in three patients implicated M. pneumoniae as the causative agent. Erythromycin may be the initial antibiotic of choice for patients with sickle-cell and pneumonia in whom the diagnosis of pneumococcal infection cannot be established firmly, or the first alternative antibiotic in those failing to respond to penicillin.
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