Clinical implications of human rhino-/enterovirus co-detection in children with Mycoplasma pneumoniae infection

By
Elena Robinson
Stefanie von Felten
Patrick M. Meyer Sauteur
October 14, 2026

Infection

Overview

In a reanalysis of 236 children with PCR-detected Mycoplasma pneumoniae in a post-NPI cohort, demographic characteristics, clinical presentation, and inflammatory markers did not differ meaningfully by human rhino-/enterovirus co-detection status. The findings were unchanged when analysis was restricted to children with M. pneumoniae alone or M. pneumoniae plus human rhino-/enterovirus alone.

Background

The clinical relevance of respiratory-pathogen co-detection in children with M. pneumoniae infection remains uncertain. A positive upper-respiratory PCR for human rhino-/enterovirus may reflect active infection, prolonged shedding, or asymptomatic detection; the virus has been detected in 14–50% of asymptomatic children. During the post-COVID-19 re-emergence of M. pneumoniae, human rhino-/enterovirus was a common viral co-detection. A prior study reported differences in fever, inflammatory markers, and blood counts by co-detection status, prompting evaluation in a larger independent pediatric cohort.

Data Highlights

Measure	M. pneumoniae alone (n=170)	With human rhino-/enterovirus co-detection (n=66)
Female	47.1%	37.9%
Fever	27.9%	29.0%
Median CRP	25 mg/L	15 mg/L
Median leukocyte count	9.28 G/L	8.90 G/L
Median neutrophil count	6.27 G/L	4.59 G/L
Restricted comparison	M. pneumoniae alone (n=146)	M. pneumoniae plus human rhino-/enterovirus alone (n=44)
Female	46.6%	36.4%
Fever	27.3%	27.9%
Median CRP	23 mg/L	22 mg/L
Median leukocyte count	8.82 G/L	9.20 G/L
Median neutrophil count	6.21 G/L	5.89 G/L

Key Findings

The post-NPI cohort included 236 children aged 0 to under 18 years with M. pneumoniae detected by multiplex PCR between April 1, 2022, and March 31, 2025.
In the initial comparison, 170 children had no human rhino-/enterovirus co-detection and 66 had respiratory-tract co-detection.
The investigators reported no statistically significant or clinically meaningful differences in demographic characteristics, clinical presentation, or inflammatory markers between the groups.
After excluding other viral and bacterial co-detections, the comparison of M. pneumoniae alone (n=146) with M. pneumoniae plus human rhino-/enterovirus alone (n=44) likewise showed no differences persisting in the reported measures.
In the cited Brandlmeier et al. cohort, human rhino-/enterovirus was detected in 27 of 87 children (31%) during 2023–2024, compared with 0 of 10 (0%) in the pre-COVID-19 period; co-detected children were more often male, less often febrile, had lower CRP, and had higher rates of leukopenia and neutropenia.
The source notes that human rhino-/enterovirus PCR positivity in the upper respiratory tract may represent prolonged shedding or asymptomatic infection, and reports detection in 14–50% of asymptomatic children.