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Kim A, Kim M, Baek JY, Lee JY, Kim SH, Kang JM, Ahn JG, Kang HC. Aetiology and Prognosis of Encephalitis in Korean Children: A Retrospective Single-Centre Study, 2005-2020. Yonsei Med J 2024; 65:78-88. [PMID: 38288648 PMCID: PMC10827636 DOI: 10.3349/ymj.2023.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Encephalitis is a heterogeneous syndrome that occurs in childhood and is not rare. However, epidemiological studies of encephalitis based on the International Encephalitis Consortium (ICS) and expert recommendations are lacking. We investigated the aetiology and prognosis of encephalitis in Korean children. MATERIALS AND METHODS This retrospective study included children aged <19 years hospitalised for encephalitis at Severance Children's Hospital between 2005 and 2020. The 2013 ICS criteria were used to diagnose encephalitis, and causality was classified according to the site from which the specimen was obtained. Neurological sequelae were categorised using the modified Rankin Scale (mRS) score. RESULTS In total, 551 children were included, with 7% classified as possible, 77% as probable, and 15% as proven cases. A cause was identified in 42% of the cases (n=222), with viruses being the most common (42%), followed by bacteria (38%) and autoimmune encephalitis (12%). In cases of proven/probable encephalitis (n=65), bacteria accounted for 52%, followed by viruses (25%) and autoimmune encephalitis (22%). In cases with a single pathogen, the anti-N-methyl-D-aspartate receptor autoantibody (n=14) was the most common, followed by Group B streptococcus (n=13), herpes simplex virus (n=11), enterovirus (n=4), and others. Approximately 37% of patients had severe sequelae (mRS score ≥3) at discharge, which decreased to 31% 6 months after discharge. CONCLUSION This large-scale study showed that autoimmune and infectious causes accounted for a significant proportion of encephalitis in Korean children. Further studies are needed to determine whether early targeted treatment following early diagnosis leads to a favourable prognosis in these populations.
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Affiliation(s)
- Ahra Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoung Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Yeon Baek
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hee Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Seoul, Korea.
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea.
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Seoul, Korea
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Peng QY, Zhang L, Deng H, Ye YM, Huang RL, Liang YQ, Feng SS, Li J, Luo XQ, Peng YL. Poor accuracy of single serological IgM tests in children with suspected acute Mycoplasma pneumoniae infection in Guangzhou, China. J Med Microbiol 2023; 72. [PMID: 36920846 DOI: 10.1099/jmm.0.001673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Introduction. Early and accurate diagnosis of Mycoplasma pneumoniae (MP) infection of children with pneumonia is at the core of treatment in clinical practice.Gap Statement. Serological immunoglobulin M (IgM) tests for MP infection of children in south China have been rarely described.Aim. To assess the diagnostic performance and clinical application of serodiagnosis of MP infection in paediatric pneumonia patients.Methodology. Serum samples from 144 children diagnosed with MP pneumonia were subjected to a particle agglutination (PA)-based IgM assay. Meanwhile, we used an established suspension array as the reference standard method for the detection of MP DNA in bronchoalveolar lavage fluid (BALF) from all patients to assess the reliability of serological assays.Results. When running immunological testing in single serum samples, 80.6 %(79/98) of cases were diagnosed with MP infection, whereas only 55 (56.1 %) cases were positive in MP DNA analysis. Furthermore, single serum tests for IgM during acute MP infection resulted in 85.5 % (47/55) sensitivity and 25.6 % (11/43) specificity. Nevertheless, immunological testing and MP DNA analysis yielded the same results when paired sera were available for MP IgM antibody testing.Conclusion. Paired serological IgM assays are necessary for the determination of an acute MP infection, whereas single serological IgM testing is unreliable. Moreover, even a short interval of two MP serological tests works well.
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Affiliation(s)
- Qiu-Ying Peng
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Liang Zhang
- Maternal and Child Health Research Institute, Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, PR China
| | - Hua Deng
- Maternal and Child Health Research Institute, Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, PR China
| | - Yu-Ming Ye
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Rui-Lin Huang
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Yao-Qiong Liang
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Su-Shi Feng
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Juan Li
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Xue-Qun Luo
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Yan-Li Peng
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
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Garin N, Marti C, Skali Lami A, Prendki V. Atypical Pathogens in Adult Community-Acquired Pneumonia and Implications for Empiric Antibiotic Treatment: A Narrative Review. Microorganisms 2022; 10:microorganisms10122326. [PMID: 36557579 PMCID: PMC9783917 DOI: 10.3390/microorganisms10122326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Atypical pathogens are intracellular bacteria causing community-acquired pneumonia (CAP) in a significant minority of patients. Legionella spp., Chlamydia pneumoniae and psittaci, Mycoplasma pneumoniae, and Coxiella burnetii are commonly included in this category. M. pneumoniae is present in 5-8% of CAP, being the second most frequent pathogen after Streptococcus pneumoniae. Legionella pneumophila is found in 3-5% of inpatients. Chlamydia spp. and Coxiella burnetii are present in less than 1% of patients. Legionella longbeachae is relatively frequent in New Zealand and Australia and might also be present in other parts of the world. Uncertainty remains on the prevalence of atypical pathogens, due to limitations in diagnostic means and methodological issues in epidemiological studies. Despite differences between CAP caused by typical and atypical pathogens, the clinical presentation alone does not allow accurate discrimination. Hence, antibiotics active against atypical pathogens (macrolides, tetracyclines and fluoroquinolones) should be included in the empiric antibiotic treatment of all patients with severe CAP. For patients with milder disease, evidence is lacking and recommendations differ between guidelines. Use of clinical prediction rules to identify patients most likely to be infected with atypical pathogens, and strategies of narrowing the antibiotic spectrum according to initial microbiologic investigations, should be the focus of future investigations.
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Affiliation(s)
- Nicolas Garin
- Division of Internal Medicine, Riviera Chablais Hospital, 1847 Rennaz, Switzerland
- Division of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Correspondence: ; Tel.: +41-79-900-54-74
| | - Christophe Marti
- Division of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Aicha Skali Lami
- Division of Internal Medicine, Riviera Chablais Hospital, 1847 Rennaz, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Division of Infectious Disease, Geneva University Hospital, 1211 Geneva, Switzerland
- Division of Internal Medicine for the Aged, Geneva University Hospital, 1211 Geneva, Switzerland
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Choo S, Kim SH, Lee E. Clinical significance of Mycoplasma pneumoniae specific IgM titer in children hospitalized with Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2022; 22:470. [PMID: 35578177 PMCID: PMC9109195 DOI: 10.1186/s12879-022-07456-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The present study aimed to identify the clinical significance of Mycoplasma pneumoniae (MP)-specific immunoglobulin M (IgM) titer, in addition to a diagnosis of MP infection, in children with MP pneumonia. METHODS This study was performed in 155 children hospitalized with MP pneumonia. The clinical features and laboratory and radiographic findings on admission in children with positive or negative MP-specific IgM titers were retrospectively reviewed from the electronic medical records. RESULTS The mean age of the included children was 6.0 years, and 118 (76.1%) of the children were positive for MP-specific IgM. A longer duration between symptom onset and admission (adjusted odds ratio [aOR] 1.47, 95% confidence interval [CI] 1.24-1.75), longer duration of symptoms during the illness (aOR 1.15, 95% CI 1.02-1.30), and development of extra-pulmonary manifestations (aOR 9.16, 95% CI 1.96-42.81) were significantly associated with a positive MP-specific IgM titer. Serum lactate dehydrogenase levels (aOR 1.00, 95% CI 1.00-1.01) and pneumonic infiltration involving > 50% of the total lung volume on chest radiography (aOR 4.68, 95% CI 1.12-19.55) were associated with positive MP-specific IgM in children with MP pneumonia. A poor response to stepwise treatment for MP pneumonia was more common in children with a positive MP-specific IgM titer than those with a negative MP-specific IgM titer on admission. CONCLUSIONS A positive MP-specific IgM titer at diagnosis of MP pneumonia may partially suggest an exaggerated immune response with a higher disease burden compared to children with MP pneumonia with a negative MP-specific IgM titer.
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Affiliation(s)
- Soojeong Choo
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Seo-Hee Kim
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Darabi Z, Niakan M, Khaledi M, Afkhami H, Soltanimoghadam F, Darabi Z. The investigation of P1 gene in Mycoplasma pneumonia isolated from atypic pneumonia by molecular methods, determine IgG antibody and MIC to ciprofloxacin antibiotic. New Microbes New Infect 2022; 46:100954. [PMID: 35251667 PMCID: PMC8889415 DOI: 10.1016/j.nmni.2022.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022] Open
Abstract
Mycoplasma pneumoniae, which causes atypical pneumonia, is a well-established pathogen of the respiratory tract. This bacterium is intrinsically susceptible to fluoroquinolones. But recently, drug-resistant forms of this bacterium have been reported. This study aims to determine the prevalence of this bacterium by ELISA and PCR and MIC to ciprofloxacin. The clinical samples (blood and nasopharyngeal swab) were collected from 100 patients, who were referred to selective hospitals in Tehran with respiratory complaints, were enrolled in 2017. Nasopharyngeal swab sample collections were cultured on PPLO broth and PPLO agar. After culturing and DNA extraction, PCR was performed by specific P1 genes primers. Ciprofloxacin's MIC of Mycoplasma pneumonia isolated was determined by the Micro-broth dilution method. The serum of IgG antibody titers was also measured by ELISA Mycoplasma pneumonia. In this study, out of 100 samples, 12 bacteria were isolated on PPLO agar. Using specific primers, 7 samples of Mycoplasma speciesism-specific were positive for the presence of M.pneumoniae and 2 Ciprofloxacin resistant isolates were evaluated. ELISA results show that IgG titer antibody is existent in 19 samples and 5 samples are intermediate as well. IgG antibody titer average in the whole sample is 27/66 U/ml, but it is in Positive samples by P1 PCR is 45/75 U/ml. This study showed that PCR is a sensitive and reliable method for rapid detection of M. pneumoniae bacteria in respiratory infectious samples, but the results of this method are different from the ELISA method. Additionally, it seems that the resistance to ciprofloxacin is relatively common among M. pneumoniae.
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Mycoplasma pneumoniae and Chlamydia pneumoniae Coinfection with Acute Respiratory Distress Syndrome: A Case Report. Diagnostics (Basel) 2021; 12:diagnostics12010048. [PMID: 35054214 PMCID: PMC8775183 DOI: 10.3390/diagnostics12010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
Community-acquired pneumonia caused by Mycoplasma pneumoniae or Chlamydia pneumoniae is usually mild. Mycoplasma pneumoniae-related and C. pneumoniae-related acute respiratory distress syndromes (ARDSs) are rare. Moreover, to our knowledge, there are no published reports on ARDS caused by M. pneumoniae and C. pneumoniae coinfection. Here, we report a case of an immunocompetent young woman who was co-infected with M. pneumoniae and C. pneumoniae and was started on treatment with piperacillin and clarithromycin. Two days later, she developed ARDS. She recovered rapidly following a change of antibiotic treatment to levofloxacin and was discharged on day 12. We conducted exome sequencing followed by alternative filtering to search for candidate ARDS-related genes. We identified an intronic variant of unknown significance within leucine-rich repeat-containing 16A (LRRC16A), a gene previously identified as a significant locus for platelet count with a possible role in ARDS. This is a rare case of ARDS in a young adult caused by M. pneumoniae and C. pneumoniae coinfection. This case suggests that ARDS in young adults may be correlated with variants in LRRC16A. This requires confirmation by further case reports.
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KC O, Dahal PH, Koirala M, NtemMensah AD. Rhabdomyolysis and Neurological Manifestation With Progressive Weakness in a Young Adult: A Rare Extrapulmonary Presentation of Mycoplasma Pneumoniae. Cureus 2021; 13:e20552. [PMID: 35103132 PMCID: PMC8770897 DOI: 10.7759/cureus.20552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is a common cause of community-acquired pneumonia. It has been associated with many extrapulmonary manifestations that can present even in the absence of pulmonary signs and symptoms. Rhabdomyolysis and central nervous system (CNS) manifestations are rare extrapulmonary manifestations. These are infrequently reported in adults. We present a case of a healthy 32-year-old male who initially presented with signs and symptoms of community-acquired pneumonia and was treated with antibiotics. However, he continued to have generalized malaise, night sweats, diffuse joint pain, and myalgias and was subsequently noted to have rhabdomyolysis with elevated creatine kinase (CK) and myoglobin levels. Rhabdomyolysis was attributed to M. pneumoniae based on the recent history of upper respiratory tract infection and M. pneumoniae immunoglobulin M (IgM) serology positivity along with high M. pneumoniae IgG titer. The other causes of rhabdomyolysis were diligently excluded based on patient history and laboratory and clinical data. This immune-mediated rhabdomyolysis improved with intravenous hydration, doxycycline, and prednisone therapy. However, the patient developed progressive weakness with neuropathy, which required treatment with intravenous immune globulin (IVIG). This case highlights the need to maintain a high index of suspicion for rare extrapulmonary manifestations of mycoplasma infection, which could be life-threatening or cause significant morbidity; and in cases of severe extrapulmonary manifestations, the appropriate use of immunosuppressive/immunomodulatory therapy may lead to a better outcome.
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Lai WC, Hsieh YC, Chen YC, Kuo CY, Chen CJ, Huang YC, Chiu CH, Lin TY, Huang KYA. A potent antibody-secreting B cell response to Mycoplasma pneumoniae in children with pneumonia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:413-420. [PMID: 34503921 DOI: 10.1016/j.jmii.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/09/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae is a major pathogen for community-acquired pneumonia and frequently causes outbreaks in children. M. pneumoniae-specific antibody response is detected upon acute infection and the serology is widely used in the clinical setting. Nevertheless, the cellular basis for antigen-specific antibody response to acute M. pneumoniae infection is largely undetermined in children. METHODS Hospitalized children with community-acquired pneumonia were enrolled and the infection with M. pneumoniae was confirmed with positive PCR result and negative findings for other pathogens. The M. pneumoniae P1-specific antibody-secreting B cell (ASC) response was examined with the ex vivo enzyme-linked immunosorbent spot assay and the relationships between the ASC frequency and serological level and clinical parameters within M. pneumoniae patients were studied. RESULTS A robust M. pneumoniae P1-specific ASC response was detected in the peripheral blood among M. pneumoniae-positive patients. By contrast, no M. pneumoniae-specific ASCs were detected among M. pneumoniae-negative patients. The IgM-secreting B cells are the predominant class and account for over 60% of total circulating M. pneumoniae-specific ASCs in the acute phase of illness. The M. pneumoniae P1-specific ASC frequency significantly correlated with the fever duration, and the IgG ASC frequency significantly correlated with serological titer among patients. CONCLUSION A rapid and potent elicitation of peripheral M. pneumoniae-specific ASC response to acute infection provides the cellular basis of antigen-specific humoral response and indicates the potential of cell-based diagnostic tool for acute M. pneumoniae infection. Our findings warrant further investigations into functional and molecular aspects of antibody immunity to M. pneumoniae.
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Affiliation(s)
- Wan-Chun Lai
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chia Hsieh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Yi-Ching Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Yen Kuo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Ying A Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Severe Pediatric Mycoplasma pneumoniae Infection Requiring Veno-venous Extracorporeal Membrane Oxygenation. Pediatr Infect Dis J 2021; 40:e154-e156. [PMID: 33427801 DOI: 10.1097/inf.0000000000003051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mycoplasma pneumoniae (MP) is an atypical bacterial pathogen that typically causes mild respiratory symptoms. Rarely, MP is associated with acute respiratory distress syndrome, a condition marked by widespread inflammation in the lungs that often requires invasive support. We report a case of severe acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation in an otherwise healthy adolescent because of MP.
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Early Confirmation of Mycoplasma pneumoniae Infection by Two Short-Term Serologic IgM Examination. Diagnostics (Basel) 2021; 11:diagnostics11020353. [PMID: 33672480 PMCID: PMC7923409 DOI: 10.3390/diagnostics11020353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study is to re-evaluate the clinical application of two-times serologic immunoglobulin M (IgM) tests using microparticle agglutination assay (MAA), an enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR) assay in diagnosing Mycoplasma pneumoniae (MP) infection. A retrospective analysis of 62 children with MP pneumonia during a recent epidemic (2019–2020) was conducted. The MAA and ELISA immunoglobulin M (IgM) and IgG measurements were conducted twice at admission and around discharge, and MP PCR once at presentation. Diagnostic rates in each test were calculated at presentation and at discharge. The seroconverters were 39% (24/62) of patients tested by MAA and 29% (18/62) by ELISA. At presentation, the diagnostic positive rates of MAA, ELISA, and PCR tests were 61%, 71%, and 52%, respectively. After the second examination, the rates were 100% in both serologic tests. There were positive correlations between the titers of MAA and the IgM values of ELISA. The single serologic IgM or PCR tests had limitations to select patients infected with MP in the early stage. The short-term, paired IgM serologic tests during hospitalization can reduce patient-selection bias in MP infection studies.
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Tang M, Wang D, Tong X, Wu Y, Zhang J, Zhang L, Yin Y, Cao Q. Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia. BMC Pediatr 2021; 21:90. [PMID: 33607971 PMCID: PMC7893926 DOI: 10.1186/s12887-021-02523-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Due to the lack of a sensitive, specific and rapid detection method, aetiological diagnosis of pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae, MP) is a constantly challenging issue. This retrospective study aimed to compare the diagnostic methods for Mycoplasma pneumoniae in children and evaluate their values. METHODS From November 2018 to June 2019, 830 children with community-acquired pneumonia were selected from the Department of Respiratory Medicine, Shanghai Children's Medical Center. On the first day of hospitalization, sputum, throat swab and venous blood samples were collected to analyse MP-IgM (particle agglutination, PA), MP-IgM (immune colloidal gold technique, GICT), MP-DNA, MP-RNA (simultaneous amplification and testing, SAT) and MP-DNA (real-time polymerase chain reaction, RT-PCR). RESULTS Among these 830 children, RT-PCR showed that the positive rate was 36.6% (304/830), in which the positive rate of macrolide resistance (A2063G mutation) accounted for 86.2% of cases (262/304). Using RT-PCR as the standard, MP-RNA (SAT) had the highest specificity (97.5%), and MP-IgM (PA) had the highest sensitivity (74.0%) and Youden index (53.7%). If MP-RNA (SAT) was combined with MP-IgM (PA), its Kappa value (0.602), sensitivity (84.2%), specificity (78.7%) and Youden index (62.9%) were higher than those of single M. pneumoniae detection. CONCLUSIONS Our research indicated that a combination of MP-RNA (SAT) plus MP-IgM (PA) might lead to reliable results as an early diagnostic method for children with clinical manifestations of Mycoplasma pneumoniae pneumonia.
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Affiliation(s)
- Mingyu Tang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China
| | - Dong Wang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China
| | - Xing Tong
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China
| | - Yufen Wu
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China.
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Lee HY, Sul S, Lee JY, Kim MN, Yu J, Sung H. Comparison of Nucleic Acid Amplification and IgM Tests for the Diagnosis of Mycoplasma pneumoniae Infection in Children During a Recent Korean Outbreak. Lab Med 2020; 52:181-187. [PMID: 32882711 DOI: 10.1093/labmed/lmaa048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In the absence of standardized methods for Mycoplasma pneumoniae detection, we evaluated the diagnostic value of polymerase chain reaction (PCR) and IgM assays for detecting M. pneumoniae infection in children during a recent Korean outbreak. METHODS The diagnostic performances of PCR and IgM assays for M. pneumoniae in 1,109 clinical specimens were evaluated by the Japanese Respiratory Society (JRS) scoring system as an interim reference standard. RESULTS The level of agreement between both tests was fair. As analyzed by the JRS scoring system, the sensitivity of PCR was 45.2% in the group aged <5 years, 86.8% in the group aged 5 years to 10 years group, and 72.2% in the group aged 10 years to 18 years; the sensitivity of the IgM assay was 66.8%, 71.4%, and 55.6% in each group, respectively. CONCLUSION The sensitivity of PCR is relatively low but is superior to that of IgM assays such that diagnostic performance can be improved by both test methods in patients aged <5 years.
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Affiliation(s)
- Hye-Young Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.,Department of Laboratory Medicine, U2Bio Laboratories, Seoul, Republic of Korea
| | - Seunghwan Sul
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jeong Young Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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Mycoplasma pneumoniae in Children With and Without Community-acquired Pneumonia. What do PCR and Serology Say? Pediatr Infect Dis J 2020; 39:e104-e108. [PMID: 32118860 DOI: 10.1097/inf.0000000000002636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND IgM titers of Mycoplasma pneumoniae can remain high for months or years, and specific DNA can be detected in asymptomatic people. METHODS We compared the performance of serology and PCR in children with and without community-acquired pneumonia (CAP) for the diagnosis of M. pneumoniae. RESULTS In children with CAP, a positive test by M. pneumoniae (PCR and/or paired serology or both) were found in 13.9%. Of these, 10.3% were positive by multiplex PCR (Seeplex-Seegen), and 6.7% exhibited quadrupled titers (22 for IgG, 6 for IgM and 5 for both). Both tests were positive in 2.8% of cases. In the group without CAP, 3.3% were positive by PCR. Thirty-two percent of children with CAP and 38.3% of healthy children had IgM titers >11 in the acute phase. CONCLUSIONS The detection of IgM is not useful for diagnosing acute M. pneumoniae infection, and a positive PCR result can be due to colonization and not infection. New and better diagnostic techniques are required.
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14
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Acute saddle pulmonary embolism: A rare complication of mycoplasma pneumonia. Respir Med Case Rep 2020; 30:101033. [PMID: 32368484 PMCID: PMC7190873 DOI: 10.1016/j.rmcr.2020.101033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background/Introduction Mycoplasma pneumonia affects 1% of the population in the United States. The majority of patients infected with Mycoplasma experience upper respiratory tract infection symptoms, and about 10% of patients infected with Mycoplasma develop pneumonia. A rare complication is a pulmonary embolism (PE), which may be life-threatening if not diagnosed early and treated promptly. Our case explores the presentation of Mycoplasma pneumonia complicated by acute saddle PE, an association only reported in the form of case reports globally. Case presentation A 75-year-old previously healthy female presented to the emergency department with shortness of breath. The patient was found to be in acute hypoxic respiratory failure secondary to community acquired pneumonia and antibiotics were started. During hospitalization, her respiratory failure worsened and had to be escalated to a non-rebreather mask. Repeat chest X-ray showed a possible developing infiltrate on the left side. Antibiotic coverage was escalated and broadened. Serology was positive for mycoplasma pneumoniae. Telemetry monitoring showed non-sustained episodes of Atrial Fibrillation and Electrocardiogram showed the presence of new-onset SIQIIITIII. Computer Tomography Angiography of the chest showed acute saddle PE. The patient was subsequently upgraded to the ICU, where she was intubated and started on catheter-directed thrombolysis to decrease clot burden. Conclusion To our knowledge, this is the first case of acute saddle PE in a live patient with mycoplasma pneumonia. This entity is important in order to ensure early diagnosis of PE in association with mycoplasma pneumonia and the initiation of early treatment to improve patient outcomes.
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15
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Li QL, Dong HT, Sun HM, Zhang XX, Gu WJ, Huang L, Wang YQ, Yan YD, Ji W, Hao CL, Zhu CH, Chen ZR. The diagnostic value of serological tests and real-time polymerase chain reaction in children with acute Mycoplasma pneumoniae infection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:386. [PMID: 32355830 PMCID: PMC7186703 DOI: 10.21037/atm.2020.03.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study set out to evaluate the clinical significance and diagnostic effectiveness of serological tests and real-time polymerase chain reactions (RT-PCR) in children of different age groups and disease durations infected with Mycoplasma pneumoniae (MP). Methods Pediatric patients with lower respiratory tract infection (LRTI) confirmed by polymerase chain reaction (PCR) were enrolled and subjected to bronchoalveolar lavage fluid PCR (BALF-PCR) for MP infection. The diagnostic values of the serum immunoglobulin M (IgM) test, paired sera immunoglobulin G (IgG) test, RT PCR applied to nasopharyngeal aspirates (NPA-PCR), and combined IgM and NPA-PCR test were evaluated. Results When BALF PCR was used as the gold standard, the MP positivity rate of combined IgM and NPA PCR was 78.85%in children aged 3–5 years. The positivity rates of IgM, NPA PCR, and combined IgM and NPA PCR in children older than 5 years were 71.21%, 72.72%, and 84.85%, respectively. The detection rate of combined IgM and NPA PCR was consistent with BALF PCR (Kappa =0.727). The MP positivity rates of combined IgM and NPA PCR at 1–2 weeks was as high as 91.11%, and was consistent with the BALF PCR (Kappa =0.756). Moreover, the positivity rates of IgM or NPA PCR at 2-3 weeks were 63.16%, and were consistent with each other (Kappa =0.771). Conclusions Combined IgM and NPA PCR is the optimal test to confirm MP infection among children aged 3–5 years in cases with a disease duration of less than2 weeks, and either NPA PCR or IgM is recommended for children older than 5 years with a disease duration of 2–3 weeks. Keywords Mycoplasma pneumoniae pneumonia (MPP); diagnosis; children; age; disease duration
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Affiliation(s)
- Qing-Ling Li
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China.,The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China
| | - He-Ting Dong
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Hui-Ming Sun
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Xin-Xing Zhang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Wen-Jing Gu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Li Huang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Yu-Qing Wang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Yong-Dong Yan
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Wei Ji
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Chuang-Li Hao
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Can-Hong Zhu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Zheng-Rong Chen
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
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Affiliation(s)
| | - Cynthia Christy
- Division of Pediatric Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, NY.,Rochester General Hospital, Rochester, NY
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17
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Goyal A, Hook K. Two pediatric cases of influenza B-induced rash and mucositis: Stevens-Johnson syndrome or expansion of the Mycoplasma pneumoniae-induced rash with mucositis (MIRM) spectrum? Pediatr Dermatol 2019; 36:929-931. [PMID: 31576583 DOI: 10.1111/pde.13921] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We present two pediatric cases of recurrent mucositis associated with influenza B infection, both in patients with prior episodes of Stevens-Johnson syndrome (SJS) due to Mycoplasma. Influenza B is an uncommon cause of both rash and mucosistis and SJS.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Kristen Hook
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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18
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Ranjbar R, Halaji M. Epidemiology of Mycoplasma pneumoniae prevalence in Iranian patients: a systematic review and meta-analysis. J Med Microbiol 2019; 68:1614-1621. [PMID: 31524582 DOI: 10.1099/jmm.0.001079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Mycoplasma pneumoniae is regarded as the important infectious agent of acute respiratory infections (ARIs) in the world. However, there is little knowledge about the prevalence of M. pneumoniae in Iran. Therefore, the aim of this study was to investigate the prevalence of M. pneumoniae in Iran through a meta-analysis of included studies.Methods. A systematic search was done by using electronic databases from papers that were published by Iranian authors to the end of February 2019. Then, 12 publications, which met our inclusion criteria, were enrolled for data extraction and analysis by using the 'metaprop program' in stata version 14.0.Results. The pooled prevalence of M. pneumoniae was 9 % (95 % confidence intervals: 5-16 %) ranging from 1 to 26 %. There was a significant heterogeneity among the 12 studies (X2=128.29; P<0.001; I 2=91.43 %). The funnel plot for publication bias showed no evidence of asymmetry.Conclusions. The frequency of M. pneumoniae in Iran is comparable with other parts of the world. Although the overall prevalence of M. pneumoniae was low, awareness about the distribution of these agent is very important because of higher infection rates in susceptible groups. In addition, these results showed the rates of M. pneumoniae had variation based on location, type of infection and sample, gender and detection rate and there was evidence of publication bias.
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Affiliation(s)
- Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mehrdad Halaji
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Elkolaly RM, Shams Eldeen MA. Easy and rapid diagnosis of Mycoplasma pneumonia: is it possible? THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_46_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Matsumoto M, Nagaoka K, Suzuki M, Konno S, Takahashi K, Takashina T, Ishiguro N, Nishimura M. An adult case of severe life-threatening Mycoplasma pneumoniae pneumonia due to a macrolide-resistant strain, Japan: a case report. BMC Infect Dis 2019; 19:204. [PMID: 30819124 PMCID: PMC6396484 DOI: 10.1186/s12879-019-3846-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/22/2019] [Indexed: 11/16/2022] Open
Abstract
Background Until now, the prevalence of macrolide-resistant Mycoplasma pneumoniae (MP) infection among adult patients has been low, and severe MP pneumonia due to a macrolide-resistant strain has seldom been reported. Here, we describe a rare case of severe life-threatening MP pneumonia due to a macrolide-resistant strain in an adult, which was finally treated with fluoroquinolone and tetracycline after failed treatment with macrolide and corticosteroid. Case presentation A 39-year-old apparently healthy woman complained of fever and productive cough. Three days after onset, she was admitted to a local general hospital. On admission, her vital signs were stable except for high-grade fever. The patient’s chest X-ray and chest computed tomography images revealed subsegmental consolidation in her right lower lobe. Treatment with ampicillin/sulbactam, and azithromycin were initiated under a clinical diagnosis of community-acquired pneumonia. After treatment initiation, her fever had not subsided, and the pulmonary lesion had extended to the entire lower lobe. Thus, treatment with prednisolone as steroid pulse therapy was initiated from clinical day 7. However, neither her symptoms nor her pulmonary lesion improved; therefore, she was transferred to our hospital for further examination and treatment. On admission (clinical day 14), her indirect hemagglutination titer for MP was elevated at 1:2560, and bronchoalveolar fluid examination yielded positive results for the mycoplasma antigen. Based on these clinical findings, we confirmed a case of severe life-threatening MP pneumonia. Since her respiratory condition was extremely severe, we initiated levofloxacin and tetracycline. Two days later (clinical day 16), her fever, malaise, and hypoxia resolved, and her pulmonary lesions had significantly improved. Further molecular identification yielded the DNA of MP from her bronchoalveolar fluid, and mutation of A2063G in the 23S rRNA gene was revealed. Based on these results and the clinical course, we confirmed our case as severe MP pneumonia due to a macrolide-resistant strain. Conclusion More awareness is needed on the emergence of macrolide-resistant MP infection in adults, because severe infection could develop despite initial treatment with macrolide and steroid therapy, which are generally considered as standard therapy for MP.
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Affiliation(s)
- Munehiro Matsumoto
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Nagaoka
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kei Takahashi
- Division of Respiratory Medicine, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Taichi Takashina
- Division of Respiratory Medicine, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Nobuhisa Ishiguro
- Department of Infection Control, Hokkaido University Hospital, Sapporo, Japan
| | - Masaharu Nishimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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21
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Rosas L, Rao K, McGough C, Becker A. A Rare Case of Bartonella Encephalitis With Hemiplegia. Child Neurol Open 2019; 6:2329048X19826480. [PMID: 30746387 PMCID: PMC6360466 DOI: 10.1177/2329048x19826480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/11/2018] [Accepted: 01/03/2019] [Indexed: 12/23/2022] Open
Abstract
The authors describe a 12-year-old girl with an atypical presentation of Bartonella encephalitis. She presented with fever and altered mental status and developed flaccid paralysis of her left upper extremity a day later. An electroencephalogram showed slowing over her right hemisphere. She had mild leukocytosis and bandemia, but her imaging and cerebrospinal studies were unrevealing. After five days, her symptoms resolved and she was discharged home on doxycycline due to suspicion for Bartonella encephalitis. The patient admitted to playing with a kitten two months prior, but she lacked the classic regional lymphadenopathy. Bartonella titers were sent during her hospitalization and returned positive after her discharge. Cat scratch disease neurologic manifestations are uncommon, with hemiplegia being exceedingly rare. This case illustrates that focal neurologic signs may develop during cat scratch disease infection and suggests that cat scratch disease encephalitis should be considered during evaluation of a pediatric patient with acute flaccid paralysis.
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Affiliation(s)
- Laura Rosas
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
- Laura Rosas, BBA, Graduate Medical Education, 6431 Fannin Street, Suite, JJL 310, Houston, TX 77030, USA.
| | - Kavya Rao
- Division of Child Neurology, Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
| | - Christine McGough
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Ashley Becker
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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22
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Al Yazidi LS, Hameed H, Kesson A, Herath A, Pandit C, Britton P. A 6-year-old girl with severe, focal Mycoplasma pneumoniae pneumonia. J Paediatr Child Health 2019; 55:107-109. [PMID: 30066973 DOI: 10.1111/jpc.14141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/17/2018] [Accepted: 06/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Laila S Al Yazidi
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,College of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hina Hameed
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Alison Kesson
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Aruna Herath
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Philip Britton
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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23
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Gramegna A, Sotgiu G, Di Pasquale M, Radovanovic D, Terraneo S, Reyes LF, Vendrell E, Neves J, Menzella F, Blasi F, Aliberti S, Restrepo MI. Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective. BMC Infect Dis 2018; 18:677. [PMID: 30563504 PMCID: PMC6299604 DOI: 10.1186/s12879-018-3565-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity. METHODS A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis. RESULTS Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP. CONCLUSIONS Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation.
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Affiliation(s)
- Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Marta Di Pasquale
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Dejan Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Section of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Silvia Terraneo
- Respiratory Unit, San Paolo Hospital, Department of Medical Sciences, University of Milan, Milan, Italy
| | - Luis F. Reyes
- Division of Pulmonary Diseases and Critical Care Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Ester Vendrell
- Intensive Care Unit, Hospital de Matarò, Consorci Sanitari del Maresme, Carretera de Cirera s/n, 08304 Matarò, Barcelona, Spain
| | - Joao Neves
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda USL Reggio Emilia, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases and Critical Care Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - on behalf of the GLIMP Study Group
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
- Clinical Epidemiology and Medical Statistics Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Section of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
- Respiratory Unit, San Paolo Hospital, Department of Medical Sciences, University of Milan, Milan, Italy
- Division of Pulmonary Diseases and Critical Care Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX USA
- Intensive Care Unit, Hospital de Matarò, Consorci Sanitari del Maresme, Carretera de Cirera s/n, 08304 Matarò, Barcelona, Spain
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
- Department of Medical Specialties, Pneumology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda USL Reggio Emilia, Italy
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Review on the laboratory diagnosis of Mycoplasma pneumoniae infection. INFECTION INTERNATIONAL 2018. [DOI: 10.2478/ii-2018-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractMycoplasma pneumoniae(MP) is an important pathogen of community-acquired pneumonia in children. As a type of self-limited disease, most MP infections cause mild clinical symptoms, but they can also lead to severe pneumonia or extrapulmonary complications. The resistance rate of MP has increased in recent years. Early and rapid diagnosis of MP infection is important for the treatment and prognosis of the disease. Current methods for diagnosing MP infection include isolation culture, serological diagnosis, and molecular biological diagnosis. This review summarizes the recent research progress in the internal and external laboratory diagnoses of MP infection both at home and abroad and the advantages and disadvantages of various diagnostic methods.
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25
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Yang L, Yang Z, Cheng L, Cheng J, Cheng L, Sun Y, Li W, Song K, Huang W, Yin Y, Tao S, Zhang Q. Lectin Microarray Combined with Mass Spectrometry Identifies Haptoglobin-Related Protein (HPR) as a Potential Serologic Biomarker for Separating Nonbacterial Pneumonia from Bacterial Pneumonia in Childhood. Proteomics Clin Appl 2018; 12:e1800030. [PMID: 29785832 DOI: 10.1002/prca.201800030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/29/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Etiological diagnosis of pediatric patients with community-acquired pneumonia is difficult. For therapy, one of the major problems is the difficulty in separating bacterial pneumonia which would benefit from antibiotics from nonbacterial pneumonia. Therefore, to identify potential biomarkers for distinguishing nonbacterial pneumonia from bacterial pneumonia are sought . EXPERIMENTAL DESIGN Lectin microarray containing 91 lectins is used to screen serums from pediatric patients with pneumonia. Lectin-based pull-down assay combined with LC-MS/MS is used to identify the potential biomarkers. RESULTS SNA-I, a lectin binding preferentially to α2-6 linked sialic acid residues, shows higher binding signals (near 42 kDa) in the mycoplasma pneumonia group, when compared with the other groups. A total of 18 proteins are identified with LC-MS/MS. By western blot analysis, the authors confirm that the expression of haptoglobin-related protein (HPR) is elevated in pediatric patients with pneumonia compared with normal children (p < 0.001). Furthermore, HPR is higher in the mycoplasma pneumonia group (p < 0.01) and the viral pneumonia group (p < 0.05), when compared with the bacterial pneumonia group. CONCLUSIONS AND CLINICAL RELEVANCE These results indicate that HPR is a potential serologic biomarker which can differentiate between bacterial pneumonia and nonbacterial pneumonia. Detection of serum HPR might be useful for clinical diagnosis.
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Affiliation(s)
- Lin Yang
- Department of Clinic Laboratory, Shanghai Children's Medical Center, Shanghai, 200127, China
| | - Zhou Yang
- Wayen Biotechnologies (Shanghai), Inc., Shanghai, 201203, China
| | - Lei Cheng
- Wayen Biotechnologies (Shanghai), Inc., Shanghai, 201203, China
| | - Juan Cheng
- Department of Clinic Laboratory, Shanghai Children's Medical Center, Shanghai, 200127, China
| | - Li Cheng
- Shanghai Center for Systems Biomedicine, Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yangyang Sun
- Shanghai Center for Systems Biomedicine, Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Wenting Li
- Wayen Biotechnologies (Shanghai), Inc., Shanghai, 201203, China
| | - Kai Song
- Wayen Biotechnologies (Shanghai), Inc., Shanghai, 201203, China
| | - Weichun Huang
- Department of Clinic Laboratory, Shanghai Children's Medical Center, Shanghai, 200127, China
| | - Yong Yin
- Department of Pulmonary Disease, Shanghai Children's Medical Center, Shanghai, 200127, China
| | - Shengce Tao
- Shanghai Center for Systems Biomedicine, Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Qinghua Zhang
- Wayen Biotechnologies (Shanghai), Inc., Shanghai, 201203, China.,Shanghai-MOST Key Laboratory of Health and Disease Genomics, Shanghai, 201203, China
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26
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Ortiz de la Tabla V, Berruezo M, García Payá E, Fernández M, García JA, Masiá M, Gutiérrez F. Evaluation of the Virclia ® automated chemiluminescent immunoassay system for diagnosing pneumonia caused by Mycoplasma pneumoniae. J Clin Lab Anal 2018; 32:e22431. [PMID: 29508444 DOI: 10.1002/jcla.22431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/15/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Mycoplasma pneumoniae is considered an important etiologic agent of community-acquired pneumonia (CAP) in outpatients. We aimed to evaluate the diagnostic accuracy of a quick automated chemiluminescent immunoassay (CLIA) for M. pneumoniae in a population-based prospective study of CAP. METHODS A total of 137 outpatients diagnosed with CAP were included in the study. Acute- and convalescent phase sera were analyzed for IgG and IgM to M. pneumoniae with both CLIA (VirClia® ) and ELISA immunoassays. Conventional serological criteria by quantitative ELISA were considered as reference standard. Sensitivity and specificity of the assay were assessed with the construction of receiver operating characteristic (ROC) curves, and the kappa index was used to evaluate the accuracy of the IgG and IgM determinations in the acute phase. RESULTS Thirty-eight patients were diagnosed with pneumonia by M. pneumoniae. ROC curves for IgG and IgM of convalescent and acute phase (C/A) quotients by the CLIA and ELISA assays were comparable. Specifically, for the CLIA, the best C/A quotient for IgG was 2.617 (sensitivity, 94.9%; specificity, 99.9%), and for IgM 1.400 (sensitivity, 65.8%; specificity, 100%). Regarding the acute phase, the best diagnostic accuracy for the CLIA was obtained with an IgG index of 1.120 (sensitivity, 89.5%; specificity, 73.7%). The CLIA was very simple to execute and required a minimum sample handling. CONCLUSION The accuracy of the Virclia® assay for the diagnosis of M. pneumoniae infection in outpatients with CAP was equivalent to the quantitative ELISA. The CLIA was quicker to perform and displayed better analytic workability than conventional ELISA.
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Affiliation(s)
| | - Marta Berruezo
- Microbiology Service, Hospital Universitario de San Juan, Alicante, Spain
| | - Elena García Payá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Fernández
- Infectious Diseases Unit, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain
| | - José Alberto García
- Infectious Diseases Unit, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain
| | - Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain
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Namkoong H, Yamazaki M, Ishizaki M, Endo I, Harada N, Aramaki M, Tanaka Y, Kaburagi S, Ichikawa M, Ohata T, Sakaguchi S, Saito F, Nakao A, Yuki H, Mitamura K. Clinical Evaluation of the Immunochromatographic System Using Silver Amplification for the Rapid Detection of Mycoplasma pneumoniae. Sci Rep 2018; 8:1430. [PMID: 29362380 PMCID: PMC5780467 DOI: 10.1038/s41598-018-19734-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
Mycoplasma pneumoniae infection is conventionally diagnosed using serum antibody testing, microbial culture, and genetic testing. Recently, immunochromatography-based rapid mycoplasma antigen test kits have been developed and commercialised for rapid diagnosis of M. pneumoniae infection. However, as these kits do not provide sufficient sensitivity and specificity, a rapid test kit with improved accuracy is desired. The present prospective study evaluated a rapid M. pneumoniae diagnostic system utilizing a newly developed silver amplification immunochromatography (SAI) system. We performed dilution sensitivity test and the prospective clinical study evaluating the SAI system. The subjects of the clinical study included both children and adults. All patients suspected to have mycoplasma pneumonia (169 patients) were sequentially enrolled. Twelve patients did not agree to participate and 157 patients were enrolled in the study. The results demonstrate excellent performance of this system with 90.4% sensitivity and 100.0% specificity compared with real-time polymerase chain reaction. When compared with loop-mediated isothermal amplification (LAMP) methods, the results also demonstrate a high performance of this system with 93.0% sensitivity and 100.0% specificity. The SAI system uses a dedicated device for automatic analysis and reading, making it highly objective, and requires less human power, supporting its usefulness in clinical settings.
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Affiliation(s)
- Ho Namkoong
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan. .,Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | | | | | - Ikumi Endo
- Clinical Laboratory, Eiju General Hospital, Tokyo, Japan
| | - Noriaki Harada
- Clinical Laboratory, Eiju General Hospital, Tokyo, Japan
| | - Megumi Aramaki
- Department of Pediatrics, Eiju General Hospital, Tokyo, Japan
| | - Yuko Tanaka
- Department of Pediatrics, Eiju General Hospital, Tokyo, Japan
| | | | | | - Takanori Ohata
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Shinji Sakaguchi
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Ayumi Nakao
- Department of Pediatrics, Eiju General Hospital, Tokyo, Japan
| | - Hideki Yuki
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Keiko Mitamura
- Department of Pediatrics, Eiju General Hospital, Tokyo, Japan
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Detection of Mycoplasma pneumoniae Among Children with Pneumonia Using Bacterial Culture, Polymerase Chain Reaction, and the Enzyme-linked Immunosorbent Assay Techniques in Ahvaz, Iran. Jundishapur J Microbiol 2018. [DOI: 10.5812/jjm.55554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lee HJ, Lee YT, Kim KH, Yang EA, Kim HS, Chun YH, Yoon JS, Kim HH, Kim JT. Diagnostic value of serum IgM enzyme-linked immunosorbent assays in polymerase chain reaction-positive Mycoplasma pneumonia in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.5.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Tae Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Hoon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwan Soo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Hong Chun
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Dorzin SE, Halaby C, Quintos ML, Noor A, El-Chaar G. Antimicrobial Stewardship Program Using Plan-Do-Study-Act Cycles to Reduce Unjustified Antibiotic Prescribing in Children Admitted With an Asthma Exacerbation. J Pediatr Pharmacol Ther 2017; 22:436-443. [PMID: 29290744 DOI: 10.5863/1551-6776-22.6.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Antimicrobial stewardship programs (ASPs) ensure appropriate antibiotic use, reduce health care costs, and minimize antibiotic resistance. National asthma guidelines do not recommend antibiotics during an exacerbation unless the child has an infection or comorbidities. The American Academy of Pediatrics (AAP) established a benchmark for unjustified antibiotic use at 6.6%.9 A retrospective study at our institution showed that 7.8% of antibiotics were prescribed without justification in children admitted for asthma. The purpose of this study was to reduce unjustified antibiotic use at our institution by 25% in children through an ASP directed toward asthma. METHODS The study period lasted from November 2015 to March 2016. Children 6 months to 17 years of age, admitted for an asthma exacerbation, were included while those with comorbidities were excluded. A multidisciplinary team from pediatric pharmacotherapy, pulmonology, emergency department (ED), infectious diseases, and quality improvement was formed to focus on process improvement. Interventions were executed in a series of Plan-Do-Study-Act cycles. In cycle 1, our asthma guidelines on appropriate antibiotic use were disseminated to pediatric house staff and posted in pediatric units. Cycle 2 encompassed presenting the ASP and guidelines to the pediatric ED staff. Cycle 3 consisted of a journal club with the pulmonary division to discuss the role of azithromycin in an asthma exacerbation. RESULTS In cycle 1, twenty-four patients were reviewed in November 2015. Antibiotics were prescribed in 8/24 (33%) children, with an unjustified rate of 2/24 (8.3%). In cycle 2, twenty-three patients were reviewed in December and January with 8/23 (35%) prescribed antibiotics and an unjustified rate of 2/23 (8.7%). For cycle 3, in February and March 2016, twenty-one children were reviewed. Antibiotics were prescribed in 6/21 (27%) children and all were justified. In total, 68 patients were included in our study and had an unjustified antibiotic prescribing rate of 4/68 (5.9%), a reduction of 25%. CONCLUSION Our ASP surpassed the benchmark set by AAP guidelines, by reducing the percentage of unjustified antibiotics in children with asthma to 5.9%.
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Affiliation(s)
- Sasha E Dorzin
- Department of Pharmacy (SED, GE), NYU Winthrop Hospital, Mineola, New York, Pediatric Pulmonary Medicine (CH), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Quality and Patient Safety (MLQ), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Pediatric Infectious Diseases (AN), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Pharmacy (GE), NYU Winthrop Hospital, Mineola, New York, and Department of Clinical Health Professions, St John's University College of Pharmacy and Health Sciences, Jamaica, New York
| | - Claudia Halaby
- Department of Pharmacy (SED, GE), NYU Winthrop Hospital, Mineola, New York, Pediatric Pulmonary Medicine (CH), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Quality and Patient Safety (MLQ), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Pediatric Infectious Diseases (AN), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Pharmacy (GE), NYU Winthrop Hospital, Mineola, New York, and Department of Clinical Health Professions, St John's University College of Pharmacy and Health Sciences, Jamaica, New York
| | - Maria Lyn Quintos
- Department of Pharmacy (SED, GE), NYU Winthrop Hospital, Mineola, New York, Pediatric Pulmonary Medicine (CH), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Quality and Patient Safety (MLQ), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Pediatric Infectious Diseases (AN), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Pharmacy (GE), NYU Winthrop Hospital, Mineola, New York, and Department of Clinical Health Professions, St John's University College of Pharmacy and Health Sciences, Jamaica, New York
| | - Asif Noor
- Department of Pharmacy (SED, GE), NYU Winthrop Hospital, Mineola, New York, Pediatric Pulmonary Medicine (CH), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Quality and Patient Safety (MLQ), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Pediatric Infectious Diseases (AN), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Pharmacy (GE), NYU Winthrop Hospital, Mineola, New York, and Department of Clinical Health Professions, St John's University College of Pharmacy and Health Sciences, Jamaica, New York
| | - Gladys El-Chaar
- Department of Pharmacy (SED, GE), NYU Winthrop Hospital, Mineola, New York, Pediatric Pulmonary Medicine (CH), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Quality and Patient Safety (MLQ), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Pediatric Infectious Diseases (AN), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Pharmacy (GE), NYU Winthrop Hospital, Mineola, New York, and Department of Clinical Health Professions, St John's University College of Pharmacy and Health Sciences, Jamaica, New York
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A sensitive and rapid immunoassay for Mycoplasma pneumoniae in children with pneumonia based on single-walled carbon nanotubes. Sci Rep 2017; 7:16442. [PMID: 29180641 PMCID: PMC5703884 DOI: 10.1038/s41598-017-16652-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/15/2017] [Indexed: 02/04/2023] Open
Abstract
Mycoplasma pneumoniae(MP) is a leading pathogen of respiratory infection, especially community-acquired pneumonia (CAP), in children worldwide. However, its diagnosis is frequently ineffective because bacterial culture and serology test are usually positive 1–2 weeks or more after the disease onset. To achieve a better detection efficiency, the single-walled carbon nanotubes(SWCNT) were coupled with the colloidal gold-monoclonal antibody immunochromatographic strips(CGIC). Interestingly, the SWCNT/CGIC assay allowed MP identification, with a detection limit of 1 × 102 copies/ml. Using referenced throat swabs of 97 MP and 40 non-MP cases, the assay yielded 72.2% sensitivity, 100.0% specificity, 100.0% positive predictive value (PPV), 59.7% negative predictive value (NPV). In summary, our assay was far more effective than any conventional methods for the diagnosis of acute MP. The ease of use, rapid and stability further enhance its feasibility for clinical use on-site.
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Copete AR, Aguilar YA, Rueda ZV, Vélez LA. Genotyping and macrolide resistance of Mycoplasma pneumoniae identified in children with community-acquired pneumonia in Medellín, Colombia. Int J Infect Dis 2017; 66:113-120. [PMID: 29155089 PMCID: PMC7129344 DOI: 10.1016/j.ijid.2017.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 01/19/2023] Open
Abstract
The majority of the Mycoplasma pneumoniae isolates obtained from the children with community-acquired pneumonia in this study were a variant of type 2. There was an absence of the mutations in the 23S rRNA gene related to macrolide resistance. Induced sputum sample has higher percentage of positive PCR to diagnose Mycoplasma pneumoniae compared to nasopharyngeal swab.
Objectives The aim of this study was to describe the genotypes and the main characteristics of community-acquired pneumonia (CAP) caused by Mycoplasma pneumoniae in hospitalized children in Medellín and neighboring municipalities during the period 2011–2012. Methods The M. pneumoniae genotype was determined by PCR and sequencing of the p1 and 23S rRNA genes from induced sputum samples and nasopharyngeal swabs (NPS). Samples were obtained from children with CAP who were hospitalized in 13 healthcare centers. In addition, a spatio-temporal analysis was performed to identify the potential risk areas and clustering of the cases over time. Results A variant of type 2 was the dominant genotype in the induced sputum (96.1%) and NPS (89.3%) samples; the type 1 variant was identified in 3.9% and 10.7% of these samples, respectively. No strains with mutations in the 23S rRNA gene associated with macrolide resistance were found. The cases in Medellín were mainly concentrated in the northeastern areas and western districts. However, no temporal relationship was found among these cases. Conclusions A variant of type 2 of M. pneumoniae prevailed among children with CAP during the study period. No strains with mutations associated with macrolide resistance were found.
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Affiliation(s)
- Angela Rocio Copete
- Research Group of Problems in Infectious Diseases (GRIPE), School of Medicine, Universidad de Antioquia UdeA, Medellín, Colombia.
| | - Yudy Alexandra Aguilar
- Research Group of Problems in Infectious Diseases (GRIPE), School of Medicine, Universidad de Antioquia UdeA, Medellín, Colombia.
| | | | - Lázaro Agustín Vélez
- Research Group of Problems in Infectious Diseases (GRIPE), School of Medicine, Universidad de Antioquia UdeA, Medellín, Colombia; Unit of Infectious Diseases, Hospital Universitario San Vicente Fundación, Medellín, Colombia.
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Bhoopalan SV, Chawla V, Hogan MB, Wilson NW, Das SU. Bullous Skin Manifestations of Mycoplasma pneumoniae Infection: A Case Series. J Investig Med High Impact Case Rep 2017; 5:2324709617727759. [PMID: 28959692 PMCID: PMC5593211 DOI: 10.1177/2324709617727759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/26/2017] [Accepted: 07/16/2017] [Indexed: 12/02/2022] Open
Abstract
Bullous skin lesions are uncommon in children. While it is well known that Mycoplasma infections are associated with papular skin manifestations, bullous skin lesions are not commonly reported. Mycoplasma pneumoniae is a very common bacterial pathogen causing respiratory tract infection in children and adults. We report 2 children with serology-confirmed Mycoplasma infection who were hospitalized for blistering skin lesions. Both of our patients responded well to corticosteroids and one of them required intravenous immunoglobulin. The aim of this case report is to raise awareness that Mycoplasma pneumoniae infection can present with bullous skin lesions, and to briefly review the pathophysiology, diagnosis, and management of the skin manifestation of Mycoplasma infection.
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Affiliation(s)
| | - Vonita Chawla
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
| | | | - Nevin W Wilson
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
| | - Samrat U Das
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
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Cooperstock MS, Swedo SE, Pasternack MS, Murphy TK. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III-Treatment and Prevention of Infections. J Child Adolesc Psychopharmacol 2017; 27:594-606. [PMID: 36358106 PMCID: PMC9836684 DOI: 10.1089/cap.2016.0151] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) and its subset, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS), are emerging autoimmune encephalopathies of childhood. Management guidelines are needed. This article, from the PANS/PANDAS Consortium, presents a consensus management guideline for the infection components. Accompanying papers from the Consortium discuss psychiatric and immunomodulatory management. Methods: Literature was reviewed and integrated with the clinical experience of the authors to provide a set of practical guidelines. This article was submitted to all members of the PANS/PANDAS Consortium, and their additional comments were added. Results: The relationships between PANS and infections are reviewed. An approach to the retrospective diagnosis of group A streptococcal infection for an operational definition of PANDAS is proposed. An initial course of anti-streptococcal treatment is proposed for all newly diagnosed PANS cases. Chronic secondary antimicrobial prophylaxis is suggested for children with PANDAS who have severe neuropsychiatric symptoms or recurrent group A Streptococcus-associated exacerbations. Guidelines for children with non-streptococcal PANS include vigilance for streptococcal pharyngitis or dermatitis in the patient and close contacts. All patients with PANS or PANDAS should also be closely monitored for other intercurrent infections, including sinusitis and influenza. Intercurrent infections should be diagnosed and treated promptly according to current standard guidelines. A guideline for the assessment of infection at initial onset or during neuropsychiatric exacerbations is also presented. Standard immunizations and attention to vitamin D are encouraged. Data indicating limited utility of adenotonsillectomy and probiotics are presented. Conclusion: A working guideline for the management of infection issues in PANS and PANDAS, based on literature and expert opinion, is provided.
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Affiliation(s)
- Michael S Cooperstock
- Division of Infectious Diseases, University of Missouri School of Medicine, Columbia, Missouri
| | - Susan E Swedo
- Department of Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health (NIMH), Rockville, Maryland
| | - Mark S Pasternack
- Department of Pediatric Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
| | - Tanya K Murphy
- Director and Professor of Pediatric Neuropsychiatry, Pediatrics and Psychiatry, University of South Florida, St. Petersburg, Florida
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Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev 2017; 30:747-809. [PMID: 28539503 PMCID: PMC5475226 DOI: 10.1128/cmr.00114-16] [Citation(s) in RCA: 339] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mycoplasma pneumoniae is an important cause of respiratory tract infections in children as well as adults that can range in severity from mild to life-threatening. Over the past several years there has been much new information published concerning infections caused by this organism. New molecular-based tests for M. pneumoniae detection are now commercially available in the United States, and advances in molecular typing systems have enhanced understanding of the epidemiology of infections. More strains have had their entire genome sequences published, providing additional insights into pathogenic mechanisms. Clinically significant acquired macrolide resistance has emerged worldwide and is now complicating treatment. In vitro susceptibility testing methods have been standardized, and several new drugs that may be effective against this organism are undergoing development. This review focuses on the many new developments that have occurred over the past several years that enhance our understanding of this microbe, which is among the smallest bacterial pathogens but one of great clinical importance.
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Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China, and Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | | | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Song JH, Huh K, Chung DR. Community-Acquired Pneumonia in the Asia-Pacific Region. Semin Respir Crit Care Med 2016; 37:839-854. [PMID: 27960208 PMCID: PMC7171710 DOI: 10.1055/s-0036-1592075] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. Aging population, dense urbanization, and poor access to health care make the Asia-Pacific region vulnerable to CAP. The high incidence of CAP poses a significant health and economic burden in this region. Common etiologic agents in other global regions including Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae, Staphylococcus aureus, and respiratory viruses are also the most prevalent pathogens in the Asia-Pacific region. But the higher incidence of Klebsiella pneumoniae and the presence of Burkholderia pseudomallei are unique to the region. The high prevalence of antimicrobial resistance in S. pneumoniae and M. pneumoniae has been raising the need for more prudent use of antibiotics. Emergence and spread of community-acquired methicillin-resistant S. aureus deserve attention, while the risk has not reached significant level yet in cases of CAP. Given a clinical and socioeconomic importance of CAP, further effort to better understand the epidemiology and impact of CAP is warranted in the Asia-Pacific region.
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Affiliation(s)
- Jae-Hoon Song
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Torres A, Lee N, Cilloniz C, Vila J, Van der Eerden M. Laboratory diagnosis of pneumonia in the molecular age. Eur Respir J 2016; 48:1764-1778. [PMID: 27811073 DOI: 10.1183/13993003.01144-2016] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/17/2016] [Indexed: 01/20/2023]
Abstract
Pneumonia remains a worldwide health problem with a high rate of morbidity and mortality. Identification of microbial pathogens which cause pneumonia is an important area for optimum clinical management of pneumonia patients and is a big challenge for conventional microbiological methods. The development and implementation of molecular diagnostic tests for pneumonia has been a major advance in the microbiological diagnosis of respiratory pathogens in recent years. However, with new knowledge regarding the microbiome, together with the recognition that the lungs are a dynamic microbiological ecosystem, our current concept of pneumonia is not totally realistic as this new concept of pneumonia involves a dysbiosis or alteration of the lung microbiome. A new challenge for microbiologists and clinicians has therefore arisen. There is much to learn regarding the information provided by this new diagnostic technology, which will lead to improvements in the time to antibiotic therapy, targeted antibiotic selection and more effective de-escalation and improved stewardship for pneumonia patients. This article provides an overview of current methods of laboratory diagnosis of pneumonia in the molecular age.
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Affiliation(s)
- Antoni Torres
- Dept of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Nelson Lee
- Division of Infectious Diseases, Dept of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Catia Cilloniz
- Dept of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Jordi Vila
- Servei de Microbiologia, Hospital Clinic, ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Menno Van der Eerden
- Dept of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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Chaudhry R, Ghosh A, Chandolia A. Pathogenesis of Mycoplasma pneumoniae: An update. Indian J Med Microbiol 2016; 34:7-16. [PMID: 26776112 DOI: 10.4103/0255-0857.174112] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genus Mycoplasma, belonging to the class Mollicutes, encompasses unique lifeforms comprising of a small genome of 8,00,000 base pairs and the inability to produce a cell wall under any circumstances. Mycoplasma pneumoniae is the most common pathogenic species infecting humans. It is an atypical respiratory bacteria causing community acquired pneumonia (CAP) in children and adults of all ages. Although atypical pneumonia caused by M. pneumoniae can be managed in outpatient settings, complications affecting multiple organ systems can lead to hospitalization in vulnerable population. M. pneumoniae infection has also been associated with chronic lung disease and bronchial asthma. With the advent of molecular methods of diagnosis and genetic, immunological and ultrastructural assays that study infectious disease pathogenesis at subcellular level, newer virulence factors of M. pneumoniae have been recognized by researchers. Structure of the attachment organelle of the organism, that mediates the crucial initial step of cytadherence to respiratory tract epithelium through complex interaction between different adhesins and accessory adhesion proteins, has been decoded. Several subsequent virulence mechanisms like intracellular localization, direct cytotoxicity and activation of the inflammatory cascade through toll-like receptors (TLRs) leading to inflammatory cytokine mediated tissue injury, have also been demonstrated to play an essential role in pathogenesis. The most significant update in the knowledge of pathogenesis has been the discovery of Community-Acquired Respiratory Distress Syndrome toxin (CARDS toxin) of M. pneumoniae and its ability of adenosine diphosphate (ADP) ribosylation and inflammosome activation, thus initiating airway inflammation. Advances have also been made in terms of the different pathways behind the genesis of extrapulmonary complications. This article aims to comprehensively review the recent advances in the knowledge of pathogenesis of this organism, that had remained elusive during the era of serological diagnosis. Elucidation of virulence mechanisms of M. pneumoniae will help researchers to design effective vaccine candidates and newer therapeutic targets against this agent.
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Affiliation(s)
- R Chaudhry
- Department of Microbiology, AIIMS, New Delhi, India
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Lee SC, Youn YS, Rhim JW, Kang JH, Lee KY. Early Serologic Diagnosis of Mycoplasma pneumoniae Pneumonia: An Observational Study on Changes in Titers of Specific-IgM Antibodies and Cold Agglutinins. Medicine (Baltimore) 2016; 95:e3605. [PMID: 27175666 PMCID: PMC4902508 DOI: 10.1097/md.0000000000003605] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There have been some limitations on early diagnosis of Mycoplasma pneumoniae (MP) infection because of no immunoglobulin M (IgM) responses and variable detection rates of polymerase chain reaction in the early stage of the disease. We wanted to discuss regarding early diagnostic method using short-term paired titration of MP-specific IgM and cold agglutinins (CAs) in the early stage of MP pneumonia.The participants of this study were 418 children with MP pneumonia during 2 recent epidemics (2006-2007 and 2011), and they were diagnosed by an anti-MP IgM antibody test (Serodia Myco II) examined twice during hospitalization at presentation and around discharge (mean of 3.4 ± 1.3 days apart). CA titers were simultaneously examined twice during study period. Anti-MP IgM antibody titer ≥1:40 and CA titer ≥1:4 were considered positive, respectively. The relationships between 2 IgM antibodies in the early stage were evaluated.Regarding MP-specific antibody titers, 148 patients showed a seroconversion, 245 patients exhibited increased titers, and 25 patients had unchanged higher titers (≥1:640) during hospitalization. The median MP-specific antibody titers at each examination time were 1:80 and 1:640, respectively; those of CAs were 1:8 and 1:32, respectively. Illness duration prior to admission showed a trend of association with both titers, and patients with shorter illness duration had a higher rate of negative titers or lower titers at each examination time. CAs and MP-specific antibody titers were correlated in the total patients at presentation and at 2nd examination (P < 0.001, respectively), and the diagnostic corresponding rates of CAs to IgM antibody test were 81% to 96% in patient subgroups.Short-term paired MP specific-IgM determinations in the acute stage may be used as a definitive diagnostic method for MP pneumonia. Paired CA titers showed a correlation with MP-specific antibody titers, suggesting they can be used as an adjuvant diagnostic method.
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Affiliation(s)
- Sung-Churl Lee
- From the Department of Pediatrics, College of Medicine (S-CL, Y-SY, J-WR, J-HK, K-YL), The Catholic University of Korea, Seoul; and Department of Pediatrics (Y-SY, J-WR, K-YL), The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
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Diaz MH, Winchell JM. The Evolution of Advanced Molecular Diagnostics for the Detection and Characterization of Mycoplasma pneumoniae. Front Microbiol 2016; 7:232. [PMID: 27014191 PMCID: PMC4781879 DOI: 10.3389/fmicb.2016.00232] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/15/2016] [Indexed: 12/12/2022] Open
Abstract
Over the past decade there have been significant advancements in the methods used for detecting and characterizing Mycoplasma pneumoniae, a common cause of respiratory illness and community-acquired pneumonia worldwide. The repertoire of available molecular diagnostics has greatly expanded from nucleic acid amplification techniques (NAATs) that encompass a variety of chemistries used for detection, to more sophisticated characterizing methods such as multi-locus variable-number tandem-repeat analysis (MLVA), Multi-locus sequence typing (MLST), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), single nucleotide polymorphism typing, and numerous macrolide susceptibility profiling methods, among others. These many molecular-based approaches have been developed and employed to continually increase the level of discrimination and characterization in order to better understand the epidemiology and biology of M. pneumoniae. This review will summarize recent molecular techniques and procedures and lend perspective to how each has enhanced the current understanding of this organism and will emphasize how Next Generation Sequencing may serve as a resource for researchers to gain a more comprehensive understanding of the genomic complexities of this insidious pathogen.
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Affiliation(s)
| | - Jonas M. Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, AtlantaGA, USA
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Lluch-Senar M, Cozzuto L, Cano J, Delgado J, Llórens-Rico V, Pereyre S, Bebear C, Serrano L. Comparative "-omics" in Mycoplasma pneumoniae Clinical Isolates Reveals Key Virulence Factors. PLoS One 2015; 10:e0137354. [PMID: 26335586 PMCID: PMC4559472 DOI: 10.1371/journal.pone.0137354] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/14/2015] [Indexed: 01/21/2023] Open
Abstract
The human respiratory tract pathogen M. pneumoniae is one of the best characterized minimal bacterium. Until now, two main groups of clinical isolates of this bacterium have been described (types 1 and 2), differing in the sequence of the P1 adhesin gene. Here, we have sequenced the genomes of 23 clinical isolates of M. pneumoniae. Studying SNPs, non-synonymous mutations, indels and genome rearrangements of these 23 strains and 4 previously sequenced ones, has revealed new subclasses in the two main groups, some of them being associated with the country of isolation. Integrative analysis of in vitro gene essentiality and mutation rates enabled the identification of several putative virulence factors and antigenic proteins; revealing recombination machinery, glycerol metabolism and peroxide production as possible factors in the genetics and physiology of these pathogenic strains. Additionally, the transcriptomes and proteomes of two representative strains, one from each of the two main groups, have been characterized to evaluate the impact of mutations on RNA and proteins levels. This study has revealed that type 2 strains show higher expression levels of CARDS toxin, a protein recently shown to be one of the major factors of inflammation. Thus, we propose that type 2 strains could be more toxigenic than type 1 strains of M. pneumoniae.
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Affiliation(s)
- Maria Lluch-Senar
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
- * E-mail: (MLS); (LS)
| | - Luca Cozzuto
- Bioinformatics Unit, Centre for Genomic Regulation (CRG) and UPF, Dr. Aiguader 88, Barcelona, Spain
| | - Jaime Cano
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
| | - Javier Delgado
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
| | - Verónica Llórens-Rico
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
| | - Sabine Pereyre
- Univ. Bordeaux, INRA, USC-EA3671 Mycoplasmal and Chlamydial Infections in Humans, Bordeaux, France
- Bacteriology department, Bordeaux University Hospital, Bordeaux, France
| | - Cécile Bebear
- Univ. Bordeaux, INRA, USC-EA3671 Mycoplasmal and Chlamydial Infections in Humans, Bordeaux, France
- Bacteriology department, Bordeaux University Hospital, Bordeaux, France
| | - Luis Serrano
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
- * E-mail: (MLS); (LS)
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Henderson KC, Sheppard ES, Rivera-Betancourt OE, Choi JY, Dluhy RA, Thurman KA, Winchell JM, Krause DC. The multivariate detection limit for Mycoplasma pneumoniae as determined by nanorod array-surface enhanced Raman spectroscopy and comparison with limit of detection by qPCR. Analyst 2015; 139:6426-34. [PMID: 25335653 DOI: 10.1039/c4an01141d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Mycoplasma pneumoniae is a cell wall-less bacterial pathogen of the human respiratory tract that accounts for up to 20% of community-acquired pneumonia. At present, the standard for detection and genotyping is quantitative polymerase chain reaction (qPCR), which can exhibit excellent sensitivity but lacks standardization and has limited practicality for widespread, point-of-care use. We previously described a Ag nanorod array-surface enhanced Raman spectroscopy (NA-SERS) biosensing platform capable of detecting M. pneumoniae in simulated and true clinical throat swab samples with statistically significant specificity and sensitivity. We report here that differences in sample preparation influence the integrity of mycoplasma cells for NA-SERS analysis, which in turn impacts the resulting spectra. We have established a multivariate detection limit (MDL) using NA-SERS for M. pneumoniae intact-cell sample preparations. Using an adaptation of International Union of Pure and Applied Chemistry (IUPAC)-recommended methods for analyzing multivariate data sets, we found that qPCR had roughly 10× better detection limits than NA-SERS when expressed in CFU ml(-1) and DNA concentration (fg). However, the NA-SERS MDL for intact M. pneumoniae was 5.3 ± 1.0 genome equivalents (cells per μl). By comparison, qPCR of a parallel set of samples yielded a limit of detection of 2.5 ± 0.25 cells per μl. Therefore, for certain standard metrics NA-SERS provides a multivariate detection limit for M. pneumoniae that is essentially identical to that determined via qPCR.
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Olson D, Watkins LKF, Demirjian A, Lin X, Robinson CC, Pretty K, Benitez AJ, Winchell JM, Diaz MH, Miller LA, Foo TA, Mason MD, Lauper UL, Kupfer O, Kennedy J, Glodé MP, Kutty PK, Dominguez SR. Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome. Pediatrics 2015; 136. [PMID: 26216320 PMCID: PMC4516944 DOI: 10.1542/peds.2015-0278] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado. METHODS Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection. RESULTS During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 7.5, confidence interval [CI] 1.6–35.1), preceding respiratory symptoms (OR 30.0, CI 3.3–269.4) [corrected] an erythrocyte sedimentation rate ≥35 mg/dL (OR 22.8, CI 2.1-244.9), and ≤3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23). CONCLUSIONS We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.
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Affiliation(s)
| | - Louise K. Francois Watkins
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia Demirjian
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xia Lin
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine C. Robinson
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Kristin Pretty
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado
| | | | | | - Maureen H. Diaz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa A. Miller
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Teresa A. Foo
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | | | | | - Preeta K. Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Specificity and Strain-Typing Capabilities of Nanorod Array-Surface Enhanced Raman Spectroscopy for Mycoplasma pneumoniae Detection. PLoS One 2015; 10:e0131831. [PMID: 26121242 PMCID: PMC4487258 DOI: 10.1371/journal.pone.0131831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 06/07/2015] [Indexed: 01/29/2023] Open
Abstract
Mycoplasma pneumoniae is a cell wall-less bacterial pathogen of the human respiratory tract that accounts for > 20% of all community-acquired pneumonia (CAP). At present the most effective means for detection and strain-typing is quantitative polymerase chain reaction (qPCR), which can exhibit excellent sensitivity and specificity but requires separate tests for detection and genotyping, lacks standardization between available tests and between labs, and has limited practicality for widespread, point-of-care use. We have developed and previously described a silver nanorod array-surface enhanced Raman Spectroscopy (NA-SERS) biosensing platform capable of detecting M. pneumoniae with statistically significant specificity and sensitivity in simulated and true clinical throat swab samples, and the ability to distinguish between reference strains of the two main genotypes of M. pneumoniae. Furthermore, we have established a qualitative lower endpoint of detection for NA-SERS of < 1 genome equivalent (cell/μl) and a quantitative multivariate detection limit of 5.3 ± 1 cells/μl. Here we demonstrate using partial least squares- discriminatory analysis (PLS-DA) of sample spectra that NA-SERS correctly identified M. pneumoniae clinical isolates from globally diverse origins and distinguished these from a panel of 12 other human commensal and pathogenic mycoplasma species with 100% cross-validated statistical accuracy. Furthermore, PLS-DA correctly classified by strain type all 30 clinical isolates with 96% cross-validated accuracy for type 1 strains, 98% cross-validated accuracy for type 2 strains, and 90% cross-validated accuracy for type 2V strains.
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Al-Zaidy SA, MacGregor D, Mahant S, Richardson SE, Bitnun A. Neurological Complications of PCR-ProvenM. pneumoniaeInfections in Children: Prodromal Illness Duration May Reflect Pathogenetic Mechanism. Clin Infect Dis 2015; 61:1092-8. [DOI: 10.1093/cid/civ473] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/09/2015] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE OF REVIEW We present the key advances in the infections that clinicians conventionally associate with atypical pneumonia: legionellosis, Mycoplasma pneumonia, Chlamydophila species pneumonia and Q fever. RECENT FINDINGS There have been significant developments in molecular diagnosis to include Mycoplasma pneumoniae and Chlamydophila pneumoniae in multiplex PCR of respiratory specimens. There are diagnostic challenges in distinguishing carriage from infection, which is recognized in C. pneumoniae and now also evident in M. pneumoniae. Macrolide-resistant M. pneumoniae has emerged in Asia. There are new antimicrobials on the horizon in the ketolide class with activity against typical and atypical pathogens and useful empirical agents. SUMMARY There are few advances in our knowledge of the epidemiology of atypical pathogens or the effectiveness of antimicrobial therapy--empirical or pathogen specific. However, if molecular testing becomes widely implemented, there will be an increased understanding of the epidemiology and presentation of atypical pneumonia and a shift to more targeted antimicrobial therapy.
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Diaz MH, Benitez AJ, Winchell JM. Investigations of Mycoplasma pneumoniae infections in the United States: trends in molecular typing and macrolide resistance from 2006 to 2013. J Clin Microbiol 2015; 53:124-30. [PMID: 25355769 PMCID: PMC4290910 DOI: 10.1128/jcm.02597-14] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently, pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve with empirical antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae infections that were supported by the Centers for Disease Control and Prevention (CDC) between 2006 and 2013. We examined 199 M. pneumoniae-positive specimens collected during this time period in order to identify trends in antimicrobial resistance and circulating types. Overall, macrolide resistance was identified in approximately 10% of M. pneumoniae infections occurring during this time period. Typing of strains revealed cocirculation of multiple multilocus variable-number tandem-repeat analysis (MLVA) and P1 types throughout this period, including diversity in types detected within individual outbreaks. Three MLVA types (4572, 3562, and 3662) accounted for 97% of the infections during the study period. A systematic surveillance program is necessary to understand the burden of M. pneumoniae disease in the United States, facilitate case and outbreak identification, and inform appropriate therapeutic and infection control strategies.
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Affiliation(s)
- Maureen H Diaz
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alvaro J Benitez
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Chou CA, Lin TI, Chen YS, Liu PY, Huang YF, Chen YY, Hsieh KS, Chen YS, Ger LP. Comparisons of etiology and diagnostic tools of lower respiratory tract infections in hospitalized young children in Southern Taiwan in two seasons. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:539-45. [PMID: 25442857 DOI: 10.1016/j.jmii.2014.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) play an important role in pediatric diseases; however, there are limited data about LRTIs in Southern Taiwan. This study aimed to investigate the clinical and epidemiological data of LRTIs in this area. METHODS Children aged under 5 years who were hospitalized at a medical center in Southern Taiwan with acute LRTIs from July 2010 to October 2010 (summer) and from March 2011 to May 2011 (spring) were prospectively enrolled. Nasopharyngeal aspirates were obtained and sent for viral cultures, multiplex polymerase chain reaction (PCR), and traditional quick tests. The clinical features, laboratory data, and imaging findings were recorded and analyzed. RESULTS A total of 90 children were enrolled, 70 of whom had detectable pathogens. The positive rate of conventional viral and bacterial cultures was 25.6%, which increased to 77.77% after combining with the two multiplex PCR methods. Adenovirus and enterovirus were the most common viral etiologies identified (26.5% of cases) and Streptococcus pneumoniae was the leading bacterial etiology (46.4%). The seasonal trend of viral infections in Southern Taiwan was different from Northern Taiwan. There were no differences in demographic data, severity of disease, or hospital stay between single and mixed infections. A similar result was found between nonpneumococcal and pneumococcal infections. CONCLUSION Viral infections were the main etiologies of LRTIs in young children. Multiplex PCR methods are rapid assays that can increase the diagnostic yield rate. Mixed infections do not seem to affect the severity of disease. Early detection may aid clinicians in appropriate decision-making and treatment.
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Affiliation(s)
- Chih-An Chou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Ting-I Lin
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Yu-Shen Chen
- Section of Infectious Diseases, Department of Internal Medicine, Pingtung Branch of Kaohsiung Veterans General Hospital, Pingtung, Taiwan
| | - Po-Yen Liu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Yung-Feng Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Ying-Yao Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Yao-Shen Chen
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Luo-Ping Ger
- Department of Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Ma YJ, Wang SM, Cho YH, Shen CF, Liu CC, Chi H, Huang YC, Huang LM, Huang YC, Lin HC, Ho YH, Mu JJ. Clinical and epidemiological characteristics in children with community-acquired mycoplasma pneumonia in Taiwan: A nationwide surveillance. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 48:632-8. [PMID: 25311405 DOI: 10.1016/j.jmii.2014.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/18/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is the leading cause of hospitalization of children. Mycoplasma pneumoniae is one of the most common pathogens. The disease severity is diverse, and the diagnosis remains a challenge to clinical pediatricians. The aims of this study are to provide a nationwide surveillance of the epidemiology and clinical manifestations of community-acquired mycoplasma pneumonia (CAMP) in children in Taiwan. METHODS The medical records of children enrolled by the Taiwan Pediatric Infectious Disease Alliance (TPIDA) project during 2010-2011 were reviewed. Hospitalized children with segmental or lobar pneumonia were included. The demographic, clinical, laboratory and radiographic data were analyzed. Nasopharyngeal swabs, pleural effusion, and serum were collected for multiplex viral and bacterial polymerase chain reaction (PCR), mycoplasma immunoglobulin M (IgM), or paired immunoglobulin G (IgG) titer. RESULTS There were overall 127 children with CAMP. Among them, 16 (12.6%) children had PCR and IgM positivity, 74 (58.3%) children had a positive serologic study, 34 (27.8%) children had positive PCR detection, and three (2.4%) children had paired IgG above a four-fold increase. Enrolled patients were divided into two groups before and after the age of 5 years. Children younger than 5 years or younger had a significantly longer hospitalization, higher intensive care unit (ICU) admission rates, and more complications. They were more frequent to receive oxygen supplementation and even surgical intervention. The white blood cell counts and C-reactive protein levels were higher in children 5 years old or younger. CONCLUSION Mycoplasma pneumoniae is an important etiology of CAP in children 5 years or younger. They had a longer length of hospitalization, higher inflammatory responses, and more complications, compared to children older than 5 years.
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Affiliation(s)
- Yun-Ju Ma
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Shih-Min Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan
| | - Yu-Hao Cho
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan.
| | - Hsin Chi
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Yi-Chuan Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Division of Infectious Diseases, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Li-Min Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, National Taiwan University and Hospital, Taipei City, Taiwan
| | - Yhu-Chering Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiao-Chuan Lin
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; School of Medicine, China Medical University, Taichung City, Taiwan; Department of Pediatrics, China Medical University Hospital, Taichung City, Taiwan
| | - Yu-Huai Ho
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Division of Infectious Disease, Department of Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jung-Jung Mu
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Centers for Disease Control, Taiwan
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