Mycoplasma pneumoniae is back! Is it the next pandemic?

Characteristics of the 2023-2024 Mycoplasma pneumoniae epidemic in adults, Southeast France

Objectives

Analysis of current 2023-2024 Mycoplasma pneumoniae (Mp) infection characteristics in adults.

Methods

A retrospective case series analysis was performed on Mp polymerase chain reaction-positive adult patients admitted to the University Hospital of Marseille from April 2017 to June 2024. Clinical presentations, treatments, and outcomes were assessed. We compared the epidemiological and clinical characteristics of Mp infections between 2017 and 2022 with the current epidemic.

Results

Clinical and radiological characteristics and outcomes of patients with Mp infection did not differ significantly between the current epidemic (N = 108) and the 5 previous years (N = 94), except that patients in the current epidemic required less supplemental oxygen (odds ratio [95% confidence interval] = 0.48 [0.29-0.78]) and were less likely to present with fever on admission (odds ratio [95% confidence interval] = 0.22 [0.10-0.47]). In both periods, more than half of the patients hospitalized with Mp infection required supportive oxygen therapy.

Conclusions

During the current 2023-2024 epidemic, more hospital admissions for Mp infection in adults were observed at the University Hospital of Marseille than in the previous 5 years. The clinical characteristics and outcomes of patients with Mp infection did not differ significantly. In our cohort, Mp infection was often severe, regardless of the study period.

A 5-transcript signature for discriminating viral and bacterial etiology in pediatric pneumonia

Pneumonia stands as the primary cause of death among children under five, yet current diagnosis methods often result in inadequate or unnecessary treatments. Our research seeks to address this gap by identifying host transcriptomic biomarkers in the blood of children with definitive viral and bacterial pneumonia. We performed RNA sequencing on 192 prospectively collected whole blood samples, including 38 controls and 154 pneumonia cases, uncovering a 5-transcript signature (genes FAM20A, BAG3, TDRD9, MXRA7, and KLF14) that effectively distinguishes bacterial from viral pneumonia (area under the curve (AUC): 0.95 [0.88-1.00]). Initial validation using combined definitive and probable cases yielded an AUC of 0.87 [0.77-0.97], while full validation in a new prospective cohort of 32 patients achieved an AUC of 0.92 [0.83-1.00]. This robust signature holds significant potential to enhance diagnostics accuracy for pediatric pneumonia, reducing diagnostic delays and unnecessary treatments and potentially transforming clinical practice.

Characteristics of lower respiratory microbiota in children's refractory Mycoplasma pneumoniae pneumonia pre- and post-COVID-19 era

Introduction

Little was known about the characteristics of low respiratory tract (LRT) microbiota of refractory M. pneumoniae pneumonia (RMPP) in children before and after the COVID-19 pandemic.

Methods

Forty-two children diagnosed with RMPP in 2019 (Y2019 group) and 33 children diagnosed with RMPP in 2023 (Y2023 group), entered into the study. The characteristics of the clinical findings were examined, and the LRT microbiota was analyzed by metagenomic next generation sequencing.

Results

The ratio of consolidate, atelectasis, lung necrosis, and erythema multiforme in Y2023 group was significantly higher than that in Y2019 (P<0.05). Mycoplasmoides pneumoniae was the top species of the LRT microbiota in both groups. The rate of macrolide resistance MP in Y2023 was significantly higher than that in Y2019 (P<0.05), and the mutant site was all 23S rRNA A2063G. There were no significant differences in α-diversity and β-diversity of LRT microbiota between Y2019 and Y2023 group. Trichoderma citrinoviride, Canine mastadenovirus A, Ralstonia pickettii, Lactococcus lactis, Pseudomonas aeruginosa were the biomarkers of LRT microbiota in children with RMPP of Y2023. The abundance of Mycoplasmoides pneumoniae positively correlated with the levels of D-dimer and LDH, negatively correlated with the counts of CD3+ T cells, CD8+ T cells, CD19+ B cells and CD16+CD56+ NK cells.

Discussion

Our study showed that high abundance of MP was correlated with the severity of RMPP and decrease of immune cells. Trichoderma citrinoviride, Canine mastadenovirus A, Ralstonia pickettii, Lactococcus lactis, Pseudomonas aeruginosa were the biomarkers in microbiota of LRT in children with RMPP post COVID-19 era.

New Insights into the Epidemiological Characteristics of Mycoplasma pneumoniae Infection before and after the COVID-19 Pandemic

Mycoplasma pneumoniae (M. pneumoniae), a prevalent respiratory pathogen affecting children and adolescents, is known to trigger periodic global epidemics. The most recent significant outbreak commenced in the first half of 2023 and reached its peak globally during the autumn and winter months. Considering the worldwide repercussions of the COVID-19 pandemic, it has become increasingly essential to delve into the epidemiological characteristics of M. pneumoniae both before and after the pandemic. This review aims to provide a comprehensive analysis of the key features of M. pneumoniae epidemics in the pre-and post-COVID-19 contexts, including but not limited to shifts in the susceptible population, the molecular genotypes of the pathogen, the clinical manifestations, and potential new trends in drug resistance. Additionally, we will introduce the latest advancements in the diagnosis of M. pneumoniae.

Predominance of A2063G mutant strains in the Mycoplasma pneumoniae epidemic in children: A clinical and epidemiological study in 2023 in Wuhan, China

OBJECTIVES

The prevalence of respiratory infectious diseases has changed in the post-COVID-19 epidemic era, and mycoplasma pneumoniae (MP) infection in children has attracted wide attention.

METHODS

Children hospitalized for pneumonia in Wuhan, China, in 2023 were enrolled. Respiratory secretions were obtained for the targeted next-generation sequencing (tNGS) including mutation of MP. Pulmonary inflammation was divided into bronchopneumonia and pulmonary consolidation/atelectasis according to lung computed tomography imaging.

RESULTS

Of the 667 pediatric pneumonia, 478 were MP positive (72%). The positive rate of MP detected by tNGS increased from April, and MP had become the primary pathogen of pneumonia in children in 2023. The 23S rRNA mutations were all A2063G, accounting for 85% of detected MP. The clinical symptoms of the mutant and wild-type strains were similar, with half of them experiencing atelectasis and lung consolidation. Early bronchoscopic lavage combined with azithromycin in pediatric pulmonary consolidation was an effective therapy strategy, which could be an alternative selection to MP pneumonia treatment.

CONCLUSIONS

A2063G mutant strain MP was the primary pathogen of mycoplasma pneumoniae in children recently, which was often complicated by extra-pulmonary symptoms and complications.

Macrolide-resistant mycoplasma pneumoniae infection in children observed during a period of high incidence in Henan, China

Objective

Mycoplasma pneumoniae (Mp) is one of the major pathogens that causes respiratory tract infections, and macrolide resistance has increased rapidly in recent years due to the inappropriate use of macrolides in northeastern Asia. In the present study, we aimed to investigate Mp infection and macrolide resistance during a period of high incidence of Mp infection in Henan, China.

Methods

A total of 29473 suspected children with Mp infection were enrolled in the study from July to December 2023. Throat swab specimens were collected from all the study subjects, and real-time PCR was performed to detect the Mp-DNA and macrolide resistance-associated A2063G or A2064G mutations.

Results

The overall percentage of Mp-DNA-positive patients was 51.1 %, and the percentage of macrolide-resistant strains was 91 %. The rate of macrolide resistance remained stable from July to December. The Mp-DNA positivity rates among the different age groups from low to high were 0-1, 1-3, 3-6, 10-18 and 6-10 years. The macrolide resistance rate was the lowest in the 0-1 age group and highest in the 6-10 age group. No difference in the rate of macrolide resistance was observed between male and female children.

Conclusions

The macrolide resistance rate of Mp did not change during the investigated period of high incidence of infection, and no sex difference existed. The macrolide resistance rate of Mp was the lowest in children under 1 year old.

Increased Severity of Mycoplasma pneumoniae Infections in Spanish Children

BACKGROUND

Since the end of 2023, an elevated incidence and severity of Mycoplasma pneumoniae infections among children in Asia has been noted. Subsequently, this trend was observed in several European countries although limited data are currently available. We conducted a national study to delineate the ongoing M. pneumoniae outbreak in our country.

METHODS

A multicenter retrospective observational study was conducted across 32 hospitals in Spain, encompassing patients under 18 years old hospitalized for M. pneumoniae infection from January 2023 to March 2024. Infection was confirmed by positive polymerase chain reaction and/or by 2 serological tests.

RESULTS

A total of 623 children were included, with 79% of cases diagnosed in the final 3 months of the study period. Pneumonia was the most common diagnosis (87%). Respiratory symptoms were present in 97% of cases, with 62% requiring oxygen supplementation and 14% requiring admission to the pediatric intensive care unit (PICU). Risk factors for PICU admission included the presence of neurological symptoms, hypoxemia and a history of prematurity. Children admitted to the PICU exhibited significantly higher neutrophil counts upon admission.

CONCLUSIONS

We have observed a notable increase in hospital admissions, including PICU support by up to 14%, due to M. pneumoniae infection in our country since November 2023, indicative of a more severe clinical course associated with this pathogen.

Post COVID-19 Pandemic Increased Detection of Mycoplasma Pneumoniae in Adults Admitted to the Intensive Care

Background: Mycoplasma pneumoniae (M. pneumoniae) infections can progress to severe respiratory complications, necessitating intensive care treatment. Recent post COVID-19 pandemic surges underscore the need for timely diagnosis, given potential diagnostic method limitations. Methods: A retrospective case series analysis was conducted on M. pneumonia PCR-positive patients admitted to two Dutch secondary hospitals' ICUs between January 2023 and February 2024. Clinical presentations, treatments, outcomes, and mechanical ventilation data were assessed. Results: Seventeen ICU-admitted patients were identified, with a median age of 44 years, primarily due to hypoxia. Non-invasive ventilation was effective for most, while five required invasive mechanical ventilation. None of the patients required extracorporeal membrane oxygenation. No fatalities occurred. Post-PCR, treatment was adjusted to doxycycline or azithromycin; seven received steroid treatment. Discussion: Increased ICU admissions for M. pneumoniae infection were observed. Diverse clinical and radiological findings emphasize heightened clinical awareness. Early molecular diagnostics and tailored antibiotic regimens are crucial since beta-lactam antibiotics are ineffective. Conclusion: This study highlights the escalating challenge of severe M. pneumoniae infections in ICUs, necessitating a multifaceted approach involving accurate diagnostics, vigilant monitoring, and adaptable treatment strategies for optimal patient outcomes.

Outbreak of Mycoplasma pneumoniae pneumonia in hospitalized patients: Who is concerned? Nord Franche-Comté Hospital, France, 2023-2024

We report an outbreak of confirmed Mycoplasma pneumoniae community-acquired pneumonia (CAP) in Nord Franche-Comté Hospital, France, from 14 November 2023 to 31 January 2024. All 13 inpatients (11 adults with a mean age of 45.5 years and 2 children) were diagnosed with positive serology and/or positive reverse transcription polymerase chain reaction (RT-PCR) on respiratory specimens. All patients were immunocompetent and required oxygen support with a mean duration of oxygen support of 6.2 days. Two patients were transferred to the intensive care unit (ICU) but were not mechanically ventilated. Patients were treated with macrolides (n = 12, 92.3%) with recovery in all cases. No significant epidemiological link was reported in these patients.