Immunochromatography for the diagnosis of Mycoplasma pneumoniae infection: A systematic review and meta-analysis.
Yoon Seo Hee,Min In Kyung,Ahn Jong Gyun
The aim of this study was to evaluate the diagnostic performance of immunochromatographic tests (ICTs) for the detection of Mycoplasma pneumoniae. Medline/Pubmed, Embase, the Cochrane Library, and ISI Web of Science were searched through June 12, 2019 for relevant studies that used ICTs for the detection of M. pneumoniae infection with polymerase chain reaction (PCR) or microbial culturing as reference standards. Pooled diagnostic accuracy with 95% confidence interval (CI) was calculated using a bivariate random effects model. We also constructed summary receiver operating characteristic curves and calculated the area under the curve (AUC). Statistical heterogeneity was evaluated by χ2 test or Cochrane's Q test. Thirteen studies including 2,235 samples were included in the meta-analysis. The pooled sensitivity and specificity for diagnosing M. pneumoniae infection were 0.70 (95% CI: 0.59-0.79) and 0.92 (95% CI: 0.87-0.95), respectively. The positive likelihood ratio (LR) was 8.94 (95% CI: 4.90-14.80), negative LR 0.33 (95% CI: 0.22-0.46), diagnostic odds ratio 29.20 (95% CI: 10.70-64.20), and AUC 0.904. In subgroup analysis, ICTs demonstrated similar pooled sensitivities and specificities in populations of children only and mixed populations (children + adults). Specimens obtained from oropharyngeal swabs exhibited a higher sensitivity and specificity than those of nasopharyngeal swab. Moreover, pooled estimates of sensitivity and accuracy for studies using PCR as a reference standard were higher than those using culture. The pooled sensitivity and specificity of Ribotest Mycoplasma®, the commercial kit most commonly used in the included studies, were 0.66 and 0.89, respectively. Overall, ICT is a rapid user-friendly method for diagnosing M. pneumoniae infection with moderate sensitivity, high specificity, and high accuracy. This suggests that ICT may be useful in the diagnostic workup of M. pneumoniae infection; however, additional studies are needed for evaluating the potential impact of ICT in clinical practice.
Increased Serum Interleukin-10 but not Interleukin-4 Level in Children with Mycoplasma pneumoniae Pneumonia.
Medjo Biljana,Atanaskovic-Markovic Marina,Nikolic Dimitrije,Radic Snezana,Lazarevic Ivana,Cirkovic Ivana,Djukic Slobodanka
Journal of tropical pediatrics
Background:Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia in children, and it has been associated with wheezing. The aim of this study was to examine the serum level of interleukin (IL)-4 and IL-10 in children with Mycoplasma pneumoniae pneumonia (MPP) and to analyse them in relation to the presence of wheezing. Methods:The study included 166 children with radiologically confirmed pneumonia. MP infection was confirmed by enzyme-linked immunosorbent assay (ELISA) serum MP-IgM and MP-IgG test and throat swab MP DNA with real-time polymerase chain reaction. Serum levels of IL-4 and IL-10 were measured using ELISA. Results:There was no significant difference in serum level of IL-4 between children with MPP and those with non-MPP. Among children with MPP, we found similar level of IL-4 regardless of the personal and family history of allergy and asthma or the presence of wheezing. A significantly higher level of IL-10 was found in children with MPP than in children with non-MPP (32.92±18.582 vs. 27.01±14.100 pg/ml, p =0.022). Furthermore, wheezing children with MPP had a significantly higher level of IL-10 than children with MPP without wheezing (43.75±26.644 vs. 27.50±10.211 pg/ml, p=0.027). Conclusion:Our results show significantly increased serum level of IL-10 in children with MPP, which was significantly higher in children with wheezing. These findings may suggest a role of IL-10 in the pathogenesis of MPP and in the occurrence of wheezing during acute MP infection.
Severe Mycoplasma pneumoniae pneumonia requiring intensive care in children, 2010-2019.
Lee Kuan-Lin,Lee Chieh-Ming,Yang Te-Liang,Yen Ting-Yu,Chang Luan-Yin,Chen Jong-Min,Lee Ping-Ing,Huang Li-Min,Lu Chun-Yi
Journal of the Formosan Medical Association = Taiwan yi zhi
BACKGROUND/PURPOSE:Despite the high prevalence of Mycoplasma pneumoniae infections, reports on severe life-threatening M. pneumoniae pneumonia (MPP) in children are limited. METHODS:We retrospectively enrolled pediatric patients with PCR-positive MPP requiring ICU admission in a children's hospital in Taipei, Taiwan from Jun 2010 to October 2019. Clinical manifestations and laboratory data of severe MPP were analyzed. Macrolide susceptibility was determined by genotyping, and its relationship with clinical manifestations was also analyzed. RESULTS:Approximately 5% (34/658) children hospitalized for MPP required ICU admission. Compared with non-ICU cases (n = 291), ICU cases (n = 34) were associated with more underlying conditions, more pleural effusion, longer fever duration, longer hospital stay, the requirement of second-line antibiotic treatment, and delayed effective and second-line antibiotic treatment. Macrolide resistance was similar in ICU and non-ICU groups (53% vs 53%; p = 0.986). In severe MPP, patients requiring endotracheal intubation were associated with more septic shock, empyema, ARDS, prolonged fever after effective antibiotic treatment, delayed second-line and effective antibiotic treatment. In 18 of the 22 patients with pleural fluid analysis, the pleural effusion was alkaline (pH > 7.7) and lymphocyte-predominant. CONCLUSION:M. pneumoniae infection can cause severe life-threatening pneumonia in children. Delayed effective and second-line antibiotic treatments are associated with severe life-threatening MPP.
Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia.
Chen Yu-Chin,Hsu Wei-Yun,Chang Tu-Hsuan
Emerging infectious diseases
A high prevalence rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) has been reported in Asia. We performed a systematic review and meta-analysis to investigate the effect of macrolide resistance on the manifestations and clinical judgment during M. pneumoniae infections. We found no difference in clinical severity between MRMP and macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections. However, in the pooled data, patients infected with MRMP had a longer febrile period (1.71 days), length of hospital stay (1.61 day), antibiotic drug courses (2.93 days), and defervescence time after macrolide treatment (2.04 days) compared with patients infected with MSMP. The risk of fever lasting for >48 hours after macrolide treatment was also significantly increased (OR 21.24), and an increased proportion of patients was changed to second-line treatment (OR 4.42). Our findings indicate diagnostic and therapeutic challenges after the emergence of MRMP. More precise diagnostic tools and clearly defined treatment should be appraised in the future.
Comparison of high-dose and low-dose corticosteroid therapy for refractory Mycoplasma pneumoniae pneumonia in children.
Okumura Toshihiko,Kawada Jun-Ichi,Tanaka Masaharu,Narita Kotaro,Ishiguro Tomonori,Hirayama Yuji,Narahara Sho,Tsuji Genki,Sugiyama Yuichiro,Suzuki Michio,Tsuji Takeshi,Hoshino Shin,Nakatochi Masahiro,Muramatsu Hideki,Kidokoro Hiroyuki,Takahashi Yoshiyuki,Sato Yoshiaki,
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
BACKGROUND:Mycoplasma pneumoniae pneumonia (MPP) is generally a self-limiting disease, but it may become refractory. It is thought that refractory MPP is linked to the excessive immunologic responses of the host. Consequently, the use of adjunctive systemic corticosteroids may have beneficial effects. In this study, we compared the effects of high- and low-dose corticosteroid therapy in a pediatric population with refractory MPP. METHODS:We retrospectively collected data from 91 pediatric MPP patients treated with adjunctive systemic corticosteroids between April 2014 and October 2016. The patients were divided into the following two groups: high-dose corticosteroid group (2 mg/kg/day or more of prednisolone equivalents; n = 38) and low-dose corticosteroid group (<2 mg/kg/day; n = 53). Additionally, we compared the number of febrile days post-corticosteroid administration. We used 25 paired patients in a propensity score matching analysis to correct for confounding factors both by age and by days (from onset till corticosteroid therapy initiation). RESULTS:We observed that in the high-dose corticosteroid group defervescence following corticosteroid therapy initiation was achieved significantly earlier and length of hospitalization was significantly shorter (0.8 ± 1.0 vs. 1.5 ± 1.4 days and 8.2 ± 2.4 vs. 10.7 ± 2.7 days, respectively). In the propensity score matching, we observed that significant differences in the length of fever following corticosteroid therapy initiation and hospitalization were still present. Further, neither of the groups developed corticosteroid-related adverse events. CONCLUSION:Our results suggest that patients with refractory MPP treated with high-dose corticosteroid could achieve defervescence earlier and have a shorter hospitalization.
An adult case of severe life-threatening Mycoplasma pneumoniae pneumonia due to a macrolide-resistant strain, Japan: a case report.
Matsumoto Munehiro,Nagaoka Kentaro,Suzuki Masaru,Konno Satoshi,Takahashi Kei,Takashina Taichi,Ishiguro Nobuhisa,Nishimura Masaharu
BMC infectious diseases
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.
Diversity in Genotype Distribution of Mycoplasma pneumoniae Obtained from Children and Adults.
Yan Chao,Yang Huijuan,Sun Hongmei,Zhao Hanqing,Feng Yanling,Xue Guanhua,Li Shaoli,Cui Jinghua,Ni Shanshan
Japanese journal of infectious diseases
The aim of this study was to explore whether there was any specific genotype responsible for the high prevalence of Mycoplasma pneumoniae infection in children. A total of 247 M. pneumoniae-DNA positive clinical specimens including 200 from children and 47 from adults, collected in Beijing, China, during the same period, were analyzed. We performed P1-restriction fragment length polymorphism analysis (RFLP), multi-locus variable number tandem repeat analysis (MLVA) and detected the macrolide resistance-associated mutations in 23S rRNA of the clinical specimens. In the present study, we observed P1 genotype 1 and MLVA type M4-5-7-2 accounted for the majority of the cases across all ages in Beijing. Macrolide resistance-associated mutants of M. pneumoniae were also at a high level with 90.5% (181/200) in children and 76.6% (36/47) in adults. However, more diverse genotypes and a higher prevalence of macrolide resistance-associated mutations were found in the pediatric specimens. Further investigations are warranted to help to explain the difference of morbidity and molecular characteristics across the demographic spectrum.
The correlation between vitamin a status and refractory Mycoplasma Pneumoniae pneumonia (RMPP) incidence in children.
Li Yuanyuan,Guo Ziyao,Zhang Guangli,Tian Xiaoyin,Li Qinyuan,Chen Dapeng,Luo Zhengxiu
BACKGROUND:Vitamin A plays a pivotal role in respiratory infection, accurate estimation of vitamin A status was recommended in planning and implementing interventions. As infections affect serum vitamin A productions, the real status need to be adjusted by acute phase protein (APP). Mycoplasma pneumoniae is an important cause of respiratory infection in children, the association between vitamin A concentrations and refractory Mycoplasma pneumoniae pneumonia (RMPP) remains unclear. METHODS:181 MPP patients were enrolled in this retrospective study, adjusted vitamin A concentrations and other parameters were compared between RMPP and general-MPP (GMPP) patients. Multivariate logistic regression test was performed to evaluate the association between vitamin A levels and RMPP incidence, linear correlation tests were applied to evaluate correlation between vitamin A concentrations and fever duration, length of stay (LOS). RESULTS:Vitamin A concentrations in RMPP group were significantly lower than those in GMPP patients (P < 0.05), vitamin A (OR = 0.795, 95% C. I 0.669-0.946) and CRP (OR = 1.050, 95% C. I 1.014-1.087) were independently associated with RMPP incidence. Linear correlation tests found vitamin A concentrations were negatively correlated with fever duration and LOS (P < 0.001). CONCLUSIONS:Serum vitamin A concentrations were independently associated with RMPP incidence, which may correlate with reduced incidence of RMPP.
Pathogenic Analysis of the Bronchoalveolar Lavage Fluid Samples With Pediatric Refractory Pneumonia.
Zhao Fei,Liu Jinrong,Xiao Di,Liu Liyong,Gong Jie,Xu Juan,Li Huimin,Zhao Shunying,Zhang Jianzhong
Frontiers in cellular and infection microbiology
We conducted a pathogenic analysis in the bronchoalveolar lavage fluid (BALF) samples from refractory pneumonia (RMPP) children. A total of 150 BALF samples from 60 RMPP patients were analyzed to investigate pathogenic changes. The characteristics of were analyzed through culture, real-time PCR, genotyping, antimicrobial susceptibility testing and proteomics. The other pathogens were determined using culture, sequencing and nucleic acid detection. In 60 RMPP cases, the bacterial co-infection rate was 5%, while that of virus was 33.3%. The poor prognosis rate was 61.7%. The DNA positive rate among the 150 samples was 98.7%, while the culture positive rate was 56.7% for . Significant differences were noticed in the positivity of culture obtained from samples with a disease course of at least 3 weeks compared with those within 3 weeks. The genotype 1 strains showed a macrolide resistant (MLr) rate of 100%, and that for genotype 2 was 90.1%. Proteomics showed that there were 57 proteins up-regulated in the MLs , half of which were membrane-associated protein with adhesion or toxicity. Pediatric RMPP usually presented with viral co-infection, but it caused limited effects on the progression and prognosis of RMPP. Persistent presence of viable is not necessary in the later stage of RMPP. The expression of virulence factor in the MLr was higher than that of the MLs , which was more common in the RMPP children.
[Clinical features and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children].
Chen Yu,Tian Wei-Min,Chen Qi,Zhao Hong-Ying,Huang Ping,Lin Zhi-Qing,Chen Ling
Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics
OBJECTIVE:To study the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia and its treatment regimens in children. METHODS:The samples of throat swab or bronchoalveolar lavage fluid were collected from 136 children with Mycoplasma pneumoniae pneumonia. Quantitative real-time PCR was used to detect 2063/2064 A:G mutation in 23S rRNA, and according to such results, the children were divided into drug-resistance group with 81 children and sensitive group with 55 children. The two groups were compared in terms of age composition, respiratory symptoms, extrapulmonary complications, laboratory markers, imaging changes, treatment regimens, and length of hospital stay. RESULTS:Compared with the sensitive group, the drug-resistance group had significantly longer duration of pyrexia and severe fever, a significantly higher percentage of children with reduced blood oxygen saturation, and significantly higher levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) (P<0.05). The conventional azithromycin treatment had a good clinical effect in the sensitive group, while corticosteroid therapy was usually needed in the drug-resistance group. CONCLUSIONS:Macrolide-resistant Mycoplasma pneumoniae infection cannot be identified based on a single clinical feature, but prolonged duration of pyrexia and severe fever, reduced blood oxygen saturation, and increased ALT and LDH can suggest the presence of this disease. Azithromycin combined with glucocorticoids may be a good treatment regimen for children with macrolide-resistant Mycoplasma pneumoniae pneumonia.
Clinical Evaluation of a Novel Point-of-Care Assay To Detect Mycoplasma pneumoniae and Associated Macrolide-Resistant Mutations.
Kakiuchi Toshihiko,Miyata Ippei,Kimura Reiji,Shimomura Goh,Shimomura Kunihisa,Yamaguchi Satoru,Yokoyama Takato,Ouchi Kazunobu,Matsuo Muneaki
Journal of clinical microbiology
The recent increase in macrolide-resistant Mycoplasma pneumoniae in Asia has become a continuing problem. A point-of-care testing method that can quickly detect M. pneumoniae and macrolide-resistant mutations (MR mutations) is critical for proper antimicrobial use. Smart Gene (Mizuho Medy Co., Ltd., Tosu City, Saga, Japan) is a compact and inexpensive fully automatic gene analyzer that combines amplification with PCR and the quenching probe method to specify the gene and MR mutations simultaneously. We performed a clinical evaluation of this device and its reagents on pediatric patients with suspected M. pneumoniae respiratory infections and evaluated the impact of the assay on antimicrobial selection. Using real-time PCR as a comparison control, the sensitivity of Smart Gene was 97.8% (44/45), its specificity was 93.3% (98/105), and its overall concordance rate was 94.7% (142/150). The overall concordance rate of Smart Gene diagnosis of MR mutations in comparison with sequence analysis was 100% (48/48). The ratio of MR mutations was significantly higher at high-level medical institutions than at a primary medical clinic ( = 0.023), and changes in antibiotic therapy to drugs other than macrolides were significantly more common in patients with MR mutations ( = 0.00024). Smart Gene demonstrated excellent utility in the diagnosis of M. pneumoniae and the selection of appropriate antimicrobials for MR mutations at primary medical institutions, which play a central role in community-acquired pneumonia care. The use of this device may reduce referrals to high-level medical institutions for respiratory infections, thereby reducing the medical and economic burdens on patients.
Clinical characteristics of infections caused by Mycoplasma pneumoniae P1 genotypes in children.
Rodman Berlot Jasna,Krivec Uroš,Praprotnik Marina,Mrvič Tatjana,Kogoj Rok,Keše Darja
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Mycoplasma pneumoniae (M. pneumoniae) isolates can be classified into two major genetic groups, P1 type 1 (MP1) and P1 type 2 (MP2), based on the DNA sequence of the P1 adhesion protein gene. The aim of our study was to determine if M. pneumoniae P1 genotype is associated with disease manifestation and severity of acute M. pneumoniae infection. We compared epidemiological and clinical data of children infected with either MP1 or MP2. In addition, we separately analysed data of patients presenting with individual manifestations of M. pneumoniae infection. Data of 356 patients infected with MP1 were compared with those of 126 patients infected with MP2. MP2-infected children presented with higher median baseline C-reactive protein levels and were admitted to the hospital more often. The distribution of P1 genotype varied among groups of patients with different manifestations of M. pneumoniae infection. MP2 was more common than MP1 among patients with neurological and cardiovascular manifestations, whereas MP1 was more prevalent in other manifestations. The results from our large cohort indicate that the two P1 subtypes may have different pathogenic potential and that infections with MP2 strains could be more virulent than those with MP1 strains.
Real-Time PCR and Quantitative Culture for Load in Pharyngeal Swabs from Children at Preliminary Diagnosis and Discharge.
Zhao Fei,Guan Xuemei,Li Jing,Liu Liyong,Gong Jie,He Lihua,Meng Fanliang,Zhang Jianzhong
BioMed research international
Background:Extensive studies have focused on the diagnosis and treatment of infection; however, rare studies investigated the posttreatment conditions. We analyzed the carrying status of in the respiratory tract of children before and after treatment. Methods:Ninety-two children with pneumonia were included in this study. Clinical data were obtained from each patient, and pharyngeal swab sampling was performed at preliminary diagnosis and discharge. Real-time PCR and dilution quantitative culture were utilized to determine the DNA quantification and number of viable from samples collected upon preliminary diagnosis and discharge. Results:All the 92 cases showed DNA positivity upon preliminary diagnosis, serum IgM antibody was detected in 80 patients, and positivity of culture was observed in 82 cases. Upon discharge, the nucleotide and culture positivity were detected in 87 and 49 cases, respectively. The content of viable was 10-10 CCU/mL and 10-10 CCU/mL in the preliminary diagnosis samples and discharge samples, respectively. Conclusions:Real-time PCR was rapid and effective for the qualitative diagnosis of at the early stage, but it cannot be used to evaluate the prognosis of patients with infection. Quantitative analysis for DNA could not directly reflex the viable strain content.
Serological diagnosis of Mycoplasma pneumoniae infection by using the mimic epitopes.
Shi Wenyuan,Zhao Lanhua,Li Shengtao,Xu Guizhen,Zeng Yanhua
World journal of microbiology & biotechnology
Nowadays, there is lack of effective serological detection method for Mycoplasma pneumoniae (M. pneumoniae) infection in clinic. In this study, the mimic epitopes of M. pneumoniae were screened to evaluate the role in the serodiagnosis of M. pneumoniae infection. The M. pneumoniae-positive serum was used as the target for biopanning to phage display random 7-peptide library. The positive phage clones were selected and the DNA were sequenced and analyzed by BLAST. The representative phages were identified using dot immunoblotting and ELISA. The exogenous heptapeptides were synthesized and their reactions with M. pneumonia-positive serum were tested by indirect ELISA. Two heptapeptides, namely heptapeptide 1: TVNFKLY and heptapeptide 2: LPQRLRT, were screened out from the randomly selected 40 phages after the four bio-panning rounds. They had high homologies to some M. pneumoniae antigens. Besides, the representative bacteriophage containing heptapeptide 1 or 2 could react with the M. pneumonia- positive serum. The sensitivities of heptapeptide 1 and heptapeptide 2 for the diagnosis of M. pneumoniae infection were 90.1 and 80.0%, respectively, and the specificities were 94.3 and 97.1%, respectively. Therefore the two heptapeptides were the mimic epitopes of M. pneumoniae and might have potential serological diagnosis value for M. pneumoniae infection.
Immunodominant proteins P1 and P40/P90 from human pathogen Mycoplasma pneumoniae.
Vizarraga David,Kawamoto Akihiro,Matsumoto U,Illanes Ramiro,Pérez-Luque Rosa,Martín Jesús,Mazzolini Rocco,Bierge Paula,Pich Oscar Q,Espasa Mateu,Sanfeliu Isabel,Esperalba Juliana,Fernández-Huerta Miguel,Scheffer Margot P,Pinyol Jaume,Frangakis Achilleas S,Lluch-Senar Maria,Mori Shigetarou,Shibayama Keigo,Kenri Tsuyoshi,Kato Takayuki,Namba Keiichi,Fita Ignacio,Miyata Makoto,Aparicio David
Mycoplasma pneumoniae is a bacterial human pathogen that causes primary atypical pneumonia. M. pneumoniae motility and infectivity are mediated by the immunodominant proteins P1 and P40/P90, which form a transmembrane adhesion complex. Here we report the structure of P1, determined by X-ray crystallography and cryo-electron microscopy, and the X-ray structure of P40/P90. Contrary to what had been suggested, the binding site for sialic acid was found in P40/P90 and not in P1. Genetic and clinical variability concentrates on the N-terminal domain surfaces of P1 and P40/P90. Polyclonal antibodies generated against the mostly conserved C-terminal domain of P1 inhibited adhesion of M. pneumoniae, and serology assays with sera from infected patients were positive when tested against this C-terminal domain. P40/P90 also showed strong reactivity against human infected sera. The architectural elements determined for P1 and P40/P90 open new possibilities in vaccine development against M. pneumoniae infections.
Mycoplasma pneumoniae Genotypes and Clinical Outcome in Children.
Meyer Sauteur Patrick M,Pánisová Elena,Seiler Michelle,Theiler Martin,Berger Christoph,Dumke Roger
Journal of clinical microbiology
Factors leading to the wide range of manifestations associated with Mycoplasma pneumoniae infection are unclear. We investigated whether M. pneumoniae genotypes are associated with specific clinical outcomes. We compared M. pneumoniae loads and genotypes of children with mucocutaneous disease to those of children with pneumonia, family members with upper respiratory tract infection (URTI), and carriers from a prospective cohort study (= 47; 2016 to 2017) and to those of other children with mucocutaneous disease from a case series (= 7; 2017 to 2020). Genotyping was performed using macrolide resistance determination, P1 subtyping, multilocus variable-number tandem-repeat analysis (MLVA), and multilocus sequence typing (MLST). Comparisons were performed with a pairwise Wilcoxon rank sum test and a Fisher exact test with corrections for multiple testing, as appropriate. M. pneumoniae loads did not statistically differ between patients with mucocutaneous disease and those with pneumonia or carriers. Macrolide resistance was detected in 1 (1.9%) patient with mucocutaneous disease. MLVA types from 2016 to 2017 included 3-5-6-2 (= 21 [46.7%]), 3-6-6-2 (= 2 [4.4%]), 4-5-7-2 (= 14 [31.1%]), and 4-5-7-3 (= 8 [17.8%]), and they correlated with P1 subtypes and MLST types. MLVA types were not associated with specific outcomes such as mucocutaneous disease, pneumonia, URTI, or carriage. They were almost identical within families but varied over geographic location. MLVA types in patients with mucocutaneous disease differed between 2016 to 2017 (3-5-6-2, = 5 [62.5%]) and 2017 to 2020 (4-5-7-2, = 5 [71.4%]) ( = 0.02). Our results suggest that M. pneumoniae genotypes may not determine specific clinical outcomes.
Early diagnosis and appropriate respiratory support for Mycoplasma pneumoniae pneumonia associated acute respiratory distress syndrome in young and adult patients: a case series from two centers.
Ding Lin,Zhao Yu,Li Xuyan,Wang Rui,Li Ying,Tang Xiao,Sun Bing,He Hangyong
BMC infectious diseases
BACKGROUND:Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community acquired pneumonia (CAP). Establishing an early diagnosis of M. pneumoniae pneumonia in patients with acute respiratory distress syndrome (ARDS) may have important therapeutic implications. METHODS:We describe diagnosis and management of M. pneumoniae pneumonia induced ARDS in a case series of adults and youth hospitalized with radiographically confirmed CAP prospectively enrolled in an observational cohort study in two university teaching hospitals, from November 2017 to October 2019. RESULTS:In all 10 patients, early and rapid diagnosis for severe M. pneumoniae pneumonia with ARDS was achieved with polymerase chain reaction (PCR) or metagenomic next-generation sequencing (mNGS) testing of samples from the lower respiratory tract or pleural effusion. The average PaO/FiO of all patients was 180 mmHg. Of the 10 cases, 4 cases had moderate ARDS (100 mmHg ≤ PaO/FiO < 200 mmHg) and 3 cases had severe ARDS (PaO/FiO < 100 mmHg). High flow nasal cannula (HFNC) was applied in all patients, though only two patients were sufficiently supported with HFNC. Invasive mechanical ventilation (IMV) was required in 5 patients. High resistance (median 15 L/cmHO/s) and low compliance (median 38 ml/cmHO) was observed in 4 cases. In these 4 cases, recruitment maneuvers (RM) were applied, with 1 patient demonstrating no response to RM. Prone positioning were applied in 4 cases. Two cases needed ECMO support with median support duration of 5.5 days. No patient in our case series received corticosteroid therapy. All patients were survived and were discharged from hospital. CONCLUSIONS:Early and rapid diagnosis of severe M. pneumoniae pneumonia with ARDS can be achieved with PCR/mNGS tests in samples from the lower respiratory tract or pleural effusion. In our case series, half of M. pneumoniae pneumonia induced ARDS cases were adequately supported with HFNC or NIV, while half of cases required intubation. RM and prone position were effective in 30% of intubated cases, and 20% needed ECMO support. When early anti-mycoplasmal antibiotics were given together with sufficient respiratory support, the survival rate was high with no need for corticosteroid use.
Human adenovirus Coinfection aggravates the severity of Mycoplasma pneumoniae pneumonia in children.
Gao Jiaojiao,Xu Lili,Xu Baoping,Xie Zhengde,Shen Kunling
BMC infectious diseases
BACKGROUND:Mycoplasma pneumoniae (M. pneumoniae) is an important pathogen of community-acquired pneumonia (CAP) in children. The coinfection rate of M. pneumoniae pneumonia (MPP) can reach 52% in some areas, but the effects of coinfection with different pathogens have not been clearly recognized. METHODS:The cases of MPP hospitalized in Beijing Children's Hospital from 1/1/2014 to 12/31/2016 were screened. MPP patients coinfected with Human adenovirus (HAdV) were categorized into the research group. Patients with single M. pneumoniae infection were categorized into the control group, matching the research group by age and admission time with a ratio of 1:3. Clinical manifestations, laboratory examinations, and disease severity were compared between these two groups. RESULTS:A total of 2540 hospitalized MPP cases were screened in Beijing Children's Hospital, among which thirty cases were enrolled in the research group and ninety cases were enrolled in the control group. The results indicated that patients in the research group had longer hospital stays, longer fever durations and a higher rate of dyspnea, as well as a larger proportion applications of oxygen therapy and noninvasive continuous positive airway pressure (NCPAP). No obvious differences were found in lab examinations within the two groups. Regarding disease severity, the proportions of extremely severe pneumonia and severe disease defined by the clinical score system were higher in the research group than in the control group. CONCLUSION:Compared with single M. pneumoniae infection, MPP coinfected with HAdV in children was relatively more serious.
Evaluation of Lightmix Mycoplasma macrolide assay for detection of macrolide-resistant Mycoplasma pneumoniae in pneumonia patients.
Wagner K,Imkamp F,Pires V P,Keller P M
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
OBJECTIVES:Rapid detection of macrolide resistance-associated mutations in Mycoplasma pneumoniae is crucial for effective antimicrobial treatment. We evaluated the Lightmix Mycoplasma macrolide assay for the detection of point mutations at nucleotide positions 2063 and 2064 in the 23S ribosomal RNA (rRNA) gene of M. pneumoniae that confer macrolide resistance. METHODS:Samples from 3438 patients with a respiratory tract infection were analysed by M. pneumoniae real-time PCR, and 208 (6%) of them were tested positive. In this retrospective study, 163 M. pneumoniae real-time PCR-positive samples were analysed by the Lightmix assay, and results were compared to targeted 23S rRNA sequencing. RESULTS:Macrolide-resistant M. pneumoniae were found in 15 (9%) of 163 retrospectively analysed samples. The Lightmix assay showed a sensitivity of 100% (95% confidence interval, 78.2-100) and a specificity of 100% (95% confidence interval, 97.5-100) as the detected M. pneumoniae genotype (148 wild type and 15 non-wild type) was confirmed by 23S rRNA sequencing in all samples. CONCLUSIONS:The Lightmix assay is an easy-to-use and accurate molecular test that allows rapid determination of macrolide resistance in M. pneumoniae.
Serological and molecular detection of Mycoplasma pneumoniae in children with community-acquired lower respiratory tract infections.
Kumar Surinder,Garg Indu Bala,Sethi G R
Diagnostic microbiology and infectious disease
This study was designed to evaluate the incidence of Mycoplasma pneumoniae infection in children with community-acquired lower respiratory tract infections (LRTIs). A total of 245 patients 6 months to 12 years of age were investigated for M. pneumoniae employing serological tests, polymerase chain reaction (PCR), nested PCR, and reverse transcription PCR (RT-PCR) on throat swab samples. Forty five (59.2%) children <5 years and 31 (40.7%) children ≥5 years age group were positive for M. pneumoniae infection, and this difference was statistically significant (P ≤ 0.01).Clinical and radiological findings across M.pneumoniae-positive and -negative cases were comparable. Serology, PCR, nested PCR, and RT-PCR together detected M. pneumoniae infection in 76 (31%) patients. Sensitivity, specificity, and positive and negative predictive values of PCR were 16.18%, 95.48%, 57.89%, and 74.78%, respectively, and those of serology were 57.89%, 74.78%, 16.18%, and 95.48%, respectively. Serological and molecular detection in combination is useful for rapid and reliable diagnosis of M. pneumoniae infections in children with LRTIs.
Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia.
Tang Mingyu,Wang Dong,Tong Xing,Wu Yufen,Zhang Jing,Zhang Lei,Yin Yong,Cao Qing
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.
Time to Mycoplasma Pneumoniae RNA Clearance for Wheezy vs. Non-Wheezy Young Children with Community-Acquired Pneumonia.
Chen Jiande,Ji Fengjuan,Yin Yong,Yuan Shuhua
Journal of tropical pediatrics
OBJECTIVES:We sought to investigate the dynamics of Mycoplasma pneumoniae (Mp) RNA in hospitalized young children with community-acquired pneumonia (CAP) and to explore whether Mp RNA clearance differed for wheezy and non-wheezy group after the onset of azithromycin treatment. METHODS:We included hospitalized young children (1-72 months of age) with CAP caused by Mp infection. Mp RNA was detected as soon as the patient was admitted and the dynamics of Mp-RNA were monitored after the beginning of azithromycin treatment on Days 4, 7, 14 and 28. RESULTS:Among 40 hospitalized young children with Mycoplasma pneumoniae pneumonia (Mpp), 16 had wheezing. Time to first positive Mp-RNA confirmation after symptom onset of Mpp was similar for the wheezy group (median 7 days, interquartile range 7-10.5) and the non-wheezy group (median 7 days, interquartile range 5.8-8.3). The duration of positive Mp-RNA detection after the onset of azithromycin treatment was shorter among the wheezy group than in the non-wheezy group (median 4 vs. 7 days; hazard ratio 2.083; 95% confidence interval: 1.023-4.244). CONCLUSIONS:Mp-RNA clearance was significantly faster among Mpp young children with wheezing than in those without wheezing after the onset of azithromycin treatment.Lay summaryWe sought to investigate the dynamics of Mycoplasma pneumoniae (Mp) RNA in hospitalized young children with community-acquired pneumonia and to explore whether Mp RNA clearance differed for wheezy and non-wheezy group after the onset of azithromycin treatment. Our study suggested that Mp-RNA clearance was significantly faster among Mycoplasma pneumoniae pneumonia young children with wheezing than in those without wheezing after the onset of azithromycin treatment.
Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia.
Zhou Yajuan,Wang Jing,Chen Wenjuan,Shen Nan,Tao Yue,Zhao Ruike,Luo Lijuan,Li Biru,Cao Qing
BMC infectious diseases
BACKGROUND:Cases of refractory Mycoplasma pneumoniae pneumonia have been increasing recently; however, whether viral coinfection or macrolide-resistant M. infection contribute to the development of refractory M. pneumoniae pneumonia remains unclear. This study aimed to investigate the impacts of viral coinfection and macrolide-resistant M. pneumoniae infection on M. pneumoniae pneumonia in hospitalized children and build a model to predict a severe disease course. METHODS:Nasopharyngeal swabs or sputum specimens were collected from patients with community-acquired pneumonia meeting our protocol who were admitted to Shanghai Children's Medical Center from December 1, 2016, to May 31, 2019. The specimens were tested with the FilmArray Respiratory Panel, a multiplex polymerase chain reaction assay that detects 16 viruses, Bordetella pertussis, M. pneumoniae, and Chlamydophila pneumoniae. Univariate and multivariate logistic regression models were used to identify the risk factors for adenovirus coinfection and macrolide-resistant mycoplasma infection. RESULTS:Among the 107 M. pneumoniae pneumonia patients, the coinfection rate was 56.07%, and 60 (60/107, 56.07%) patients were infected by drug-resistant M. pneumoniae. Adenovirus was the most prevalent coinfecting organism, accounting for 22.43% (24/107). The classification tree confirmed that viral coinfection was more common in patients younger than 3 years old. Adenovirus coinfection and drug-resistant M. pneumoniae infection occurred more commonly in patients with refractory M. pneumoniae pneumonia (P = 0.019; P = 0.001). A prediction model including wheezing, lung consolidation and extrapulmonary complications was used to predict adenovirus coinfection. The area under the receiver operating characteristic curve of the prediction model was 0.795 (95% CI 0.679-0.893, P < 0.001). A prolonged fever duration after the application of macrolides for 48 h was found more commonly in patients infected by drug-resistant M. pneumoniae (P = 0.002). A fever duration longer than 7 days was an independent risk factor for drug-resistant Mycoplasma infection (OR = 3.500, 95% CI = 1.310-9.353, P = 0.012). CONCLUSIONS:The occurrence of refractory M. pneumoniae pneumonia is associated with adenovirus coinfection and infection by drug-resistant M. pneumoniae. A prediction model combining wheezing, extrapulmonary complications and lung consolidation can be used to predict adenovirus coinfection in children with M. pneumoniae pneumonia. A prolonged fever duration indicates drug-resistant M. pneumoniae infection, and a reasonable change in antibiotics is necessary.
miR‑146a‑5p suppresses ATP‑binding cassette subfamily G member 1 dysregulation in patients with refractory Mycoplasma pneumoniae via interleukin 1 receptor‑associated kinase 1 downregulation.
Li Hu-Nian,Zhao Xu,Zha Yong-Jiu,Du Fang,Liu Jie,Sun Liang
International journal of molecular medicine
In the present study, we examined the function of microRNA (miR)‑146a‑5p in patients with refractory Mycoplasma pneumoniae pneumonia. In brief, the expression of miR‑146a‑5p was reduced in patients with refractory Mycoplasma pneumoniae pneumonia. Downregulation of miR‑146a‑5p reduced inflammation in an in vitro model of refractory Mycoplasma pneumoniae pneumonia, whilst overexpression of miR‑146a‑5p promoted inflammation. Downregulation of miR‑146a‑5p induced the protein expression of ATP‑binding cassette subfamily G member 1 (ABCG1) and interleukin 1 receptor‑associated kinase 1 (IRAK‑1), while suppressed expression was observed of the aforementioned proteins following overexpression of miR‑146a‑5p in an in vitro model of refractory Mycoplasma pneumoniae pneumonia. The administration of small interfering RNA against RXR or IRAK‑1 attenuated the effects of miR‑146a‑5p on inflammation in an in vitro model of refractory Mycoplasma pneumoniae pneumonia. Collectively, these results suggested that miR‑146a‑5p reduced ABCG1 expression in refractory Mycoplasma pneumoniae pneumonia via downregulation of IRAK‑1.
Identify clinical factors related to Mycoplasma pneumoniae pneumonia with hypoxia in children.
Ling Yaoyao,Zhang Tongqiang,Guo Wei,Zhu Zhenli,Tian Jiao,Cai Chunquan,Xu Yongsheng
BMC infectious diseases
BACKGROUND:To analyze the clinical characteristics of Mycoplasma pneumoniae pneumonia with hypoxia in children, and identify the associated risk factors of hypoxia in MPP. METHODS:A retrospective case-control study was performed on 345 children with Mycoplasma pneumoniae pneumonia (MPP) admitted to our hospital wards from January 2017 to June 2019. They were divided into three groups, namely MPP with hypoxia, refractory Mycoplasma pneumoniae pneumonia (RMPP), and general Mycoplasma pneumoniae pneumonia (GMPP). The clinical features, laboratory findings, imaging, and management were collected and compared in the three groups. RESULTS:The MPP with hypoxia patients (n = 69) had longer disease duration, a higher extra-pulmonary complications rate, and more severe radiological abnormalities (P < 0.05). They also needed more complicated treatments (P < 0.05). Meanwhile, the levels of white blood cell count (WBC), C-reactive protein (CRP), lactic dehydrogenase (LDH), interleukin (IL)-6, ferritin, D-dimer, fibrinogen (FG), alanine aminotransferase (ALT) and the percentage of neutrophils in the MPP with hypoxia group were significantly higher than those in the RMPP group and the GMPP group (P < 0.05). In ROC curve analysis, the percentage of neutrophils, WBC, CRP, LDH, IL-6, ferritin, D-dimer, and ALT were contributed to identify the MPP with hypoxia patients. Multivariate logistic regression analysis revealed that ferritin> 174.15 ng/mL, IL-6 > 25.475 pg/ml, and pleural effusion were significantly associated with the incidence of hypoxia in MPP (P < 0.01). CONCLUSION:MPP with hypoxia patients presented more serious clinical manifestations. Ferritin> 174.15 ng/mL, IL-6 > 25.475 pg/ml and pleural effusion were related risk factors for hypoxia in MPP.
Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia.
Huang Xia,Li Dan,Liu Feng,Zhao Deyu,Zhu Yifan,Tang Heng
BMC infectious diseases
BACKGROUND:The levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP). METHOD:A total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group (n = 306) and a RMPP group (n = 124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP. RESULTS:(1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P < 0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P < 0. 05). D-D had the highest predictive power for RMPP (P < 0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P < 0.01). CONCLUSION:Serum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.
Multilocus Sequence Typing of Mycoplasma pneumoniae, Japan, 2002-2016.
Ando Mariko,Morozumi Miyuki,Adachi Yoko,Ubukata Kimiko,Iwata Satoshi
Emerging infectious diseases
In Japan, Mycoplasma pneumoniae resistance to macrolides is high. To compare sequence types (STs) of susceptible and resistant isolates, we performed multilocus sequence typing for 417 isolates obtained in Japan during 2002-2016. The most prevalent ST overall was ST3, for macrolide-resistant was ST19, and for macrolide-susceptible were ST14 and ST7.
Mycoplasma pneumoniae 23S rRNA A2063G mutation does not influence chest radiography features in children with pneumonia.
Deng Huan,Rui Jun,Zhao Deyu,Liu Feng
The Journal of international medical research
Objective To measure the rate of the A2063G mutation in the Mycoplasma pneumoniae ( M. pneumoniae) 23S rRNA domain V in children with pneumonia and to determine the correlation between radiographic findings and the presence of the A2063G mutation. Methods Patients who were hospitalized with a confirmed diagnosis of M. pneumoniae pneumonia were enrolled in this study. M. pneumoniae strains were collected for genotype analysis. Chest radiography was performed on all children prior to and following macrolide treatment. Clinical and imaging data were obtained. Results Of 211 patients, 195 (92.42%) harboured M. pneumoniae with the A2063G mutation. No significant differences were identified in inflammation score, chest radiography inflammation absorption grade before and after macrolide treatment, or pulmonary complications (atelectasis, hydrothorax, or pleuritis) prior to macrolide treatment when children were stratified based on the presence or absence of the A2063G mutation. Conclusions A high proportion of children with pneumonia harboured strains of M. pneumoniae with the A2063G mutation in the 23S rRNA domain V. However, no obvious chest radiographic features of M. pneumoniae pneumonia were associated with the A2063G variant.
Relationships between the varied ciliated respiratory epithelium abnormalities and severity of Mycoplasma pneumoniae pneumonia.
Jiang Wujun,Qian Lulu,Liang Hui,Tian Man,Liu Feng,Zhao Deyu
Scandinavian journal of infectious diseases
BACKGROUND:The pathogenesis of Mycoplasma pneumoniae infection involves cytoadherence of M. pneumoniae to the ciliated respiratory epithelium (CRE), followed by CRE injury caused by the M. pneumoniae. However, whether CRE abnormalities are related to the severity of M. pneumoniae pneumonia (MP) remains to be determined. METHODS:Thirty-eight patients with MP and 8 controls who underwent fiber-optic bronchoscopy with bronchial biopsy were included in this study. Patients with MP were divided into 2 groups: a mild disease group (12 patients) and a severe disease group (26 patients). The clinical features, laboratory findings, chest radiographic findings, and CRE abnormalities were characterized. RESULTS:Patients with severe pneumonia had a higher epithelial integrity score than those with mild pneumonia (5.1 ± 0.76 vs 3.8 ± 0.75; p < 0.01). Patients with severe CRE abnormalities had a longer duration of fever (p < 0.01), higher C-reactive protein (p < 0.01), and lower proportion of blood lymphocytes (p < 0.05) compared to those with mild abnormalities. Patients with a positive bacteria culture had a higher epithelial integrity score compared to those with a negative culture (6.0 ± 0.44 vs 4.8 ± 0.71; p < 0.01). CONCLUSIONS:CRE abnormalities are closely related to the severity of MP. These findings extend our current knowledge of MP.
[Value of simultaneous amplification and testing in early diagnosis of Mycoplasma pneumoniae pneumonia and related influencing factors].
Chen Dan,Sun Xiao-Min,Guo Ming-Fa,Guo Qing,Zhang Guang-Chao,Ren Yan-Hong
Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics
OBJECTIVE:To investigate the value of simultaneous amplification and testing (SAT) in the early diagnosis of Mycoplasma pneumoniae pneumonia (MPP) in children and related influencing factors. METHODS:A total of 526 children with community-acquired pneumonia who were hospitalized between December 2016 and December 2017 were enrolled. Particle agglutination was used to measure serum Mycoplasma pneumoniae (MP) antibody (MP-Ab). The value of SAT in the diagnosis of MPP was evaluated based on these results. RESULTS:Based on the results of serum MP-Ab measurement, 165 children were diagnosed with MPP. MP-SAT had a sensitivity of 90.9% (150/165), a specificity of 97.9% (368/376), and high accuracy (Youden index=0.89) in the diagnosis of MPP, suggesting that there was good consistency between these two methods (Kappa=0.90). The diagnostic sensitivity of MP-SAT in children with a short course of disease was significantly higher than that in children with a long course of disease (P=0.031). The diagnostic sensitivity of MP-SAT was significantly higher than that of single serum MP-Ab measurement (P=0.018), with poor consistency between these two methods (Kappa=0.039). MP-SAT had good consistency with double serum MP-Ab measurement (Kappa=0.91). The multivariate logistic regression analysis showed that course of disease (≥7 days) and out-of-hospital macrolide treatment were the main factors influencing the results of MP-SAT (P<0.05). CONCLUSIONS:MP-SAT has high value in the early diagnosis of MPP and can effectively cover the shortage of single serum MP-Ab test in the acute stage and thus provide help for early clinical diagnosis. MP-SAT test should be performed in the early stage of the disease (<7 days) and before the application of macrolide treatment.
Circulating Antibody-Secreting Cell Response During Mycoplasma pneumoniae Childhood Pneumonia.
Meyer Sauteur Patrick M,Trück Johannes,van Rossum Annemarie M C,Berger Christoph
The Journal of infectious diseases
BACKGROUND:We recently demonstrated that the measurement of Mycoplasma pneumoniae (Mp)-specific immunoglobulin (Ig)M antibody-secreting cells (ASCs) improved diagnosis of Mp infection. Here, we aimed to describe Mp ASC kinetics and duration in comparison to conventional measures such as pharyngeal Mp deoxyribonucleic acid (DNA) and serum antibodies. METHODS:This is a prospective longitudinal study of 63 community-acquired pneumonia (CAP) patients and 21 healthy controls (HCs), 3-18 years of age, from 2016 to 2017. Mycoplasma pneumoniae ASCs measured by enzyme-linked immunospot assay were assessed alongside Mp DNA and antibodies during 6-month follow-up. RESULTS:Mycoplasma pneumoniae ASCs of the isotype IgM were found in 29 (46%), IgG were found in 27 (43%), and IgA were found in 27 (43%) CAP patients. Mycoplasma pneumoniae ASCs were detected from 2 days to a maximum of 6 weeks after symptom onset, whereas Mp DNA and antibodies persisted until 4 months (P = .03) and 6 months (P < .01). Mycoplasma pneumoniae ASCs were undetectable in HCs, in contrast to detection of Mp DNA in 10 (48%) or antibodies in 6 (29%) controls for a prolonged time. The Mp ASC response correlated with clinical disease, but it did not differ between patients treated with or without antibiotics against Mp. CONCLUSIONS:Mycoplasma pneumoniae-specific ASCs are short-lived and associated with clinical disease, making it an optimal resource for determining Mp pneumonia etiology.
Increased Frequency of Th17 Cells in Children With Mycoplasma pneumoniae Pneumonia.
Wang Xiaowei,Chen Xiaojun,Tang Heng,Zhu Jifeng,Zhou Sha,Xu Zhipeng,Liu Feng,Su Chuan
Journal of clinical laboratory analysis
BACKGROUND:Mycoplasma pneumoniae (M. pneumoniae, MP) is recognized globally as a significant cause of primary atypical pneumonia in humans, particularly in children. Overzealous host immune responses are viewed as key mediators of the pathogenesis of M. pneumoniae infection. Although Th17 cells have been identified as key modulators in the clearance of pathogens and induction of autoimmunity caused by excessive immune responses, little is known about the role of Th17 cells in patients with M. pneumoniae infection. METHODS:The percentages of T cells, CD4 T cells and Th17 cells in children with M. pneumoniae infection were measured by flow cytometry. RESULTS:We documented an increased frequency of Th17 cells in children with M. pneumoniae infection. Furthermore, we found a significantly higher percentage of Th17 cells in M. pneumoniae-infected children with extrapulmonary manifestations, compared with children without extrapulmonary manifestations. In addition, patients who experienced a short course of Mycoplasma pneumoniae pneumonia (MPP) showed an increase in the percentage of Th17 cells. CONCLUSION:Our findings suggest that Th17 cells may be involved in the clearance of M. pneumoniae during an acute infection. Excessive Th17 cell responses may also contribute to the immuno-pathological damage observed during persistent infection.
Utility of a rapid diagnosis kit for Mycoplasma pneumoniae pneumonia in children, and the antimicrobial susceptibility of the isolates.
Ozaki Takao,Nishimura Naoko,Ahn Jaekun,Watanabe Naoko,Muto Taichiro,Saito Akiko,Koyama Norio,Nakane Kazumasa,Funahashi Keiji
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
We evaluated a kit for the rapid diagnosis of Mycoplasma pneumoniae infection and investigated the antimicrobial susceptibility of the isolates. A total of 194 otherwise healthy children, aged 0.3-14.9 years, were diagnosed as having pneumonia by chest X-ray findings between December 2003 and November 2004, and were admitted to Showa Hospital. Isolation of M. pneumoniae was attempted from a throat swab obtained on admission, and the complement fixation titer was measured in paired serum samples obtained at admission and at the convalescent stage. We also used a rapid diagnosis kit (ImmunoCard Mycoplasma) for the detection of specific immunoglobulin M antibody in paired sera. Pneumonia due to M. pneumoniae was defined by isolation of this microorganism, or by seroconversion, or a >or=4-fold increase in the antibody titer. Using each isolate, we determined the minimum inhibitory concentrations for five antimicrobial agents by the broth dilution method. M. pneumoniae pneumonia was diagnosed in 45 children (23.2%). The ImmunoCard had a sensitivity of 31.8% using admission serum and 88.6% using paired sera, while the specificity was 78.1% and 70.5%, respectively. M. pneumoniae was isolated from 14 of the 45 patients (31.1%). The 50%/90% minimum inhibitory concentration (microg/ml) of erythromycin, clarithromycin, azithromycin, minocycline, and levofloxacin was 0.006/0.012, <or=0.003/<or=0.003, <or=0.003/<or=0.003, 0.78/1.56, and 0.39/0.78, respectively. For a rapid diagnosis of M. pneumoniae pneumonia, the ImmunoCard was not effective. Macrolides showed superior in vitro antimicrobial activity against M. pneumoniae isolates causing pediatric pneumonia.
[Evaluation of ELISA kits for detection of Mycoplasma pneumoniae--specific IgG, IgA, IgM antibodies on the diagnosis of Mycoplasma pneumoniae infection in children].
Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases
A retrospective study was conducted to evaluate the utility of Mycoplasma pneumoniae IgG (quantitative), IgA (quantitative), IgM (qualitative) ELISA kits (Medac Diagnostika, Germany) for the diagnosis of M. pneumoniae pneumonia in children under 16 years of age. This study included a total of 159 serum samples from 113 patients with acute respiratory diseases such as bronchitis, pneumonia, which were classified into three groups according to the results of a particle agglutination (PA) test as a reference method, that is, Group I (Mycoplasma-definite cases): Group I-a (paired 52 samples from 26 cases); a four-fold or greater rise of antibody from an acute phase PA titer of < or = 1:80, Group I-b (paired 12 samples from 6 cases); a four-fold or greater rise of antibody from an acute phase PA titer of > or = 1:160, Group I-c (48 samples from 38 cases); a single high PA titer of > or = 1:640 either or both in acute or convalescent serum, Group II (Mycoplasma-probable cases, 18 samples from 17 cases): a PA titer of 1:160 or 320 was observed either or both in acute or convalescent serum, but the above serological criteria for Group I were not fulfilled, Group III (non-cases, 29 samples from 26 cases): a PA titer of any sample was < or = 1:80. The ELISA tests were performed according to the supplier's recommendations, and the results were classified according to the interpretation provided by the supplier: Early stage of infection (category 1,2), Acute- (3,4,5), Current- (6), Past- (7), and No-infection (8). The day of onset of fever (defined as a body temperature of > or = 37.5 degrees Celsius) was denoted as day 0. As a result from Group I, the category initially observed following the onset of fever was category 8 (triple negative), and the predominance of category 8 was replaced by category 1 (IgM solely positive) after day 4, followed by a shift of predominance to category 4 (IgM and IgG double positive) or 5 (triple positive) after day 10 or later. Specifically, category 1 was rather exclusively observed before day 21 following the onset of fever. These results suggest that category 1, when observed, is a useful marker of acute infection by Mycoplasma pneumoniae in children because it appears early in the acute phase and no longer observed beyond the convalescent phase. On the other hand, significance of detecting IgA antibody, which must be important for adults, was not remarkable in our study. Five samples in group II and 3 samples in group III fell into category 1. Whether or not such cases, in the absence of significant PA titers, can be taken actually as mycoplasmal infection remains to be clear. This study validated the utility of this ELISA methodology in terms of the acute phase diagnosis using a single point serum sample for Mycoplasma pneumoniae infection specifically in children.
Clinical Role of Serum Interleukin-17A in the Prediction of Refractory Pneumonia in Children.
Zhao Jiuling,Ji Xin,Wang Yushui,Wang Xin
Infection and drug resistance
Background: pneumonia (MPP) is a common community-acquired pneumonia (CAP) in children, which may become refractory MPP (RMPP) to treatment. Objective:The purpose of this study was to evaluate the clinical utility of measuring serum interleukin (IL)-17A to predict RMPP. Patients and Methods:A retrospective clinical study at a single pediatric center included a review of the medical records of all children hospitalized for CAP between November 2015 and October 2019. The diagnosis of MPP was based on clinical presentation, chest radiography, and measurement of serum anti- immunoglobulin IgM antibody titer using the microparticle agglutination method or sputum samples for by PCR. Serum levels of IL-18 and IL-17A were determined by ELISA. Results:Of the 625 children diagnosed with CAP, there were 154 children with MPP and without underlying diseases who were divided into a non-refractory MPP (NRMPP) group (n = 109) and a RMPP group (n = 45). The RMPP group had a higher incidence of tachypnea, cyanosis, hypoxia, segmental or lobar pneumonia, pleural effusion, and a longer period of hospitalization compared with NRMPP group (all values < 0.05). A serum IL-17A level above 10.8 pg/mL was a predictor for RMPP: area under the curve (AUC) 0.822; standard error (SE) 0.039; 95% confidence interval (CI) 0.746-0.897; diagnostic sensitivity and specificity of 77.8% and 77.1%, respectively. An LDH level above 436.5 IU/L and an IL-18 level above 464.5 pg/mL were the second most useful markers for RMPP: AUC 0.775, 0.775; SE 0.038, 0.039; 95% CI 0.700-0.850, 0.698-0.852; sensitivity 77.8%, 82.2%; specificity 62.4%, 59.6%; respectively. Conclusion:This preliminary study of MPP in a pediatric population has shown that measurement of serum IL-17A may be a useful marker for the predictor of RMPP.
Chlamydophila pneumoniae serology: cross-reaction with Mycoplasma pneumoniae infection.
Miyashita Naoyuki,Akaike Hiroto,Teranishi Hideto,Kawai Yasuhiro,Ouchi Kazunobu,Kato Tadashi,Hayashi Toshikiyo,Okimoto Niro,
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
Atypical pathogens Mycoplasma pneumoniae and Chlamydophila pneumoniae play an important role in community-acquired pneumonia. However, it has been pointed out that positive enzyme-linked immunosorbent assay (ELISA, Hitazyme C. pneumoniae) IgM reactivity is frequent among M. pneumoniae pneumonia patients. To clarify the reactivity of ELISA IgM in M. pneumoniae pneumonia, findings were compared with immunoblotting, ELNAS Plate C. pneumoniae (ELNAS) and the micro-immunofluorescence (MIF) test. Ninety-eight serologically confirmed cases with M. pneumoniae pneumonia and 10 cases with C. pneumoniae pneumonia were enrolled in this study. C. pneumoniae IgM-positive cases measured by the ELISA were observed in 30 (30 %) patients with M. pneumoniae pneumonia. However, there were no positive cases by immunoblotting, ELNAS, or MIF test. These cases determined to be IgM positive only in the ELISA were all negative by another serological test, recombinant enzyme immunoassay (rEIA), and these positive results in the ELISA were considered to be false-positive reactions. In contrast, IgM-positive findings in patients with C. pneumoniae pneumonia did not show any positive reaction in M. pneumoniae antibody titer. ELISA showed a high frequency of false-positive findings in patients with M. pneumoniae pneumonia, which included false-positive cases with a high titer for IgM. To accurately diagnose C. pneumoniae infection in various studies, including respiratory infections, researchers should consider the IgM false-positive reaction with ELISA in patients with suspected atypical pneumonia.
[Application of Mycoplasma pneumoniae antibody and load index in the diagnosis of Mycoplasma pneumoniae pneumonia in children].
Xie Hui,Li Ji-Ming,Zhang Hui-Fen,Wang Ye,Zhong Li-Lin,Lian Qing-Rong,Dong Hong-Ba
Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics
OBJECTIVE:To study the role of Mycoplasma pneumoniae (MP) load and antibody measurements in the diagnosis of MP pneumonia. METHODS:A total of 115 children with MP pneumonia and 400 healthy children were enrolled. The MP load and total antibody level were measured at different stages, and the MP load index (MPLI) was calculated. RESULTS:The cut-off value of MPLI for MP infection was 6.12. MPLI and total antibody titer increased during the course of the disease, while MP-DNA decreased rapidly. Within the same time of blood collection, the group with a higher MP load had a significantly higher total antibody titer than the group with a lower MP load (P<0.05). Within 2 weeks of the course of the disease, the negative antibody group had a significantly higher MPLI than the positive antibody group (P<0.05). CONCLUSIONS:MPLI provides a standardized quantitative value of MP-DNA and plays an important role in the early diagnosis of MP infection.
Arthritis associated with Mycoplasma pneumoniae in a pediatric patient: A case report.
Mărginean Cristina Oana,Georgescu Anca Meda,Meliţ Lorena Elena
INTRODUCTION:Mycoplasma pneumoniae (MP) infection in infants is usually overlooked and it might result in important complications if left untreated. MP-induced arthritis is probably the least common extrapulmonary manifestation and frequently leads to delays in the diagnosis. PATIENT CONCERNS:We report the case of a 2-year-old female child admitted in our clinic for prolonged fever (onset 2 weeks before the admission), for which the general practitioner established the diagnosis of acute pharyngitis and recommended antibiotics. But the fever persisted and the patient was referred to a pediatrician. DIAGNOSIS:The laboratory tests revealed leukocytosis with neutrophilia, elevated C-reactive protein and liver cytolysis. The blood and urine cultures, as well as the serological hepatitis B and C, toxoplasmosis, Epstein Barr virus, Rubella, Herpes virus, and cytomegalovirus were negative. The chest X-ray established the diagnosis of pneumonia. The fever persisted for approximately 2 weeks after admission. On the 2nd week of admission, the patient began to experience gait difficulties complaining of pain in the right hip and ankle. The cardiology and pneumology consults revealed no pathological findings. The evolution was favorable after the initiation of Levofloxacin and MP infection was detected as we suspected. Moreover, the ultrasound of the hip revealed a mild joint effusion, while the ankle joint appeared to be normal at ultrasound. Thus, we established the diagnosis of hip and ankle arthritis based on the clinical and ultrasound findings. INTERVENTIONS:Levofloxacin by vein was continued for 5 days, replaced afterwards with clarithromycin orally for 2 weeks. OUTCOMES:The gait difficulties persisted for approximately 5 months from the initial diagnosis, and improved once the titer of immunoglobulin M anti-MP antibodies lowered considerably. After more than 8 months, the patient was completely asymptomatic and the immunoglobulin M anti-MP was close to the normal range. CONCLUSION:The awareness of MP-induced arthritis in children represents the cornerstone in preventing diagnostic delays and initiating the proper treatment.
Pathogenesis and association of Mycoplasma pneumoniae infection with cardiac and hepatic damage.
Fan Qing,Meng Jun,Li Peijie,Liu Zhigang,Sun Ying,Yan Ping
Microbiology and immunology
The aim of this study was to investigate the pathogenesis of Mycoplasma pneumoniae (MP) infection and its association with cardiac and hepatic damage. Between March 2013 and March 2014, 59 children with MP pneumonia (MPP) and 30 healthy children were enrolled. Serum titers of TLR4, T cell immunoglobulin and mucin-domain (TIM) 3, IL-10, TNF-α, and IFN-γ were measured both in children with MPP and healthy children. Additionally, MP-specific antibody titer and creatine kinase-MB (CK-MB), and alanine transaminase (ALT) titers were measured in patients with MPP. There were significant differences between the MPP patients and healthy controls in titers of TIM1 (P < 0.01), TLR2 (P = 0.028), TLR4 (P = 0.019), IL-10 (P < 0.01), TNF-α (P < 0.01) and IFN-γ (P < 0.01); however, no significant difference was found in TIM3 titers (P = 0.8181). TIM1 was correlated with CK-MB (P = 0.025), whereas both TIM1 and TLR2 titers were correlated with MP-specific antibody titers (P < 0.001; P = 0.003, respectively). Additionally, there were correlations between ALT, TIM3, and TLR2 titers (P = 0.025; P = 0.037, respectively). The titers of TIM1 were significantly higher in patients with cardiac damage (P = 0.007) than in those without it, whereas the titers of TLR2 were significantly higher in patients with hepatic damage (P = 0.026) than in those without it. TLR2, TLR4 and TIM1 may be involved in the process of MP infection. Additionally, TLR2, TLR4, TIM1 and TIM3 may play particular roles in the pathogenesis of MPP-associated cardiac and hepatic damage.
Early Serologic Diagnosis of Mycoplasma pneumoniae Pneumonia: An Observational Study on Changes in Titers of Specific-IgM Antibodies and Cold Agglutinins.
Lee Sung-Churl,Youn You-Sook,Rhim Jung-Woo,Kang Jin-Han,Lee Kyung-Yil
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.
Common carotid arteritis and polymyalgia with Mycoplasma pneumoniae infection.
Takahashi Ippei,Ishihara Masayuki,Oishi Taku,Yamamoto Masaki,Narita Mitsuo,Fujieda Mikiya
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
A few pediatric cases with brain vasculitis most frequently affecting the middle cerebral artery have been reported in association with Mycoplasma pneumoniae infection, but involvement of the common carotid artery (CCA) before the bifurcation has not been reported to date. We report herein a case of 10-year-old boy with common carotid arteritis and polymyalgia associated with Mycoplasma pneumoniae infection. His fever and cough began 2 weeks before, and his right upper and lower extremity pains began 2 days before admission. He had initially been treated with clarithromycin followed by tosufloxacin, but his symptoms persisted. His M. pneumonia-specific antibody titer was high on admission (1:10240 by particle agglutination method) and the gene of M. pneumoniae was detected in a throat swab specimen by the loop-mediated isothermal amplification method with initial high levels of serum interleukin-8, tumor necrosis factor-α, and interleukin-18 along with elevated blood levels of complements. On the 5th day of hospitalization, vascular echograms of the extremities and neck showed increasing intima-media thickness of bilateral CCAs without stenosis and/or thrombosis and T2-weighted with lipid suppression magnetic resonance imaging of the neck showed high signal intensity of bilateral CCA walls. Coagulation studies were unremarkable and no autoantibodies were detected as far as tested. He was successfully treated by intravenous administration of prednisolone and was stable without any neurological sequelae 17 months after the onset without medication. His particle agglutination titer decreased to 1:5120, and serum interleukin-8, tumor necrosis factor-α, interleukin-18, and complement levels returned to normal.
Significance changes in the levels of myocardial enzyme in the child patients with Mycoplasma Pneumoniae Pneumonia.
Qi Xueliang,Sun Xiangguo,Li Xuemin,Kong Dejin,Zhao Luhua
Cellular and molecular biology (Noisy-le-Grand, France)
Mycoplasma is a gram-negative with thin wall bacterium that in humans, Mycoplasma pneumoniae causes pneumonia. This experiment was designed to explore the changes of myocardial enzymes in the mycoplasma pneumoniae pneumonia (MPP) child patients, and analyze the clinical value of these changes, in combination with the relevant indicators, symptoms and signs, in the evaluation of the pneumonia mycoplasma infection. For this aim, a total of 120 child patients with MPP in the acute phase,120 child patients with MPP in the recovery phase and 120 healthy children were simultaneously enrolled into this study to detect the levels of aspartate aminotransferase (AST), creatine kinase (CK), Creatine Kinase Isoenzyme (CK-MB) and lactic dehydrogenase (LDH) in blood. Results showed that MPP patients in the acute phase had higher levels of LDH, CK, CK-MB, AST, PCt, CRP, MPV, PDW, PCt, percentage of neutrophils, WBC count in the peripheral blood and ESR than those of the patients in the recovery patients and healthy children, while the level of PLT was lower (all P<0.05). In the acute phase, the level of CK-MB correlated to the fever, fever duration, extrapulmonary organ damage (except for the myocardial damage) and the antibody titer of MP (all P<0.05). It was concluded that in the acute phase of MMP, the level of CK-MB could not only reflect the myocardial damage readily but also the infection of MP as well as the resultant inflammation and disease progression, which could effectively guide the diagnosis and treatment of MPP.
Diagnostic Value of Serum ELISA of Mycoplasma Pneumoniae IgM and IgG and Passive Particle Agglutination for Mycoplasma Pneumoniae Pneumonia in Children.
Ge Menglei,Song Qinwei,Guo Qi,Zhou Lin,Li Jing,Li Zhiyan,Ma Lijuan
BACKGROUND:The study was aimed to compare ELISA results of Mycoplasma pneumoniae IgG (MP-IgG) and Mycoplasma pneumoniae IgM (MP-IgM) with the passive particle agglutination (PA) test, as well as to evaluate their application value in the diagnosis of Mycoplasma pneumoniae pneumonia (MPP) in children. METHODS:Serum MP antibodies were detected by ELISA for MP-IgM, MP-IgG, and PA for 292 patients in the MPP group and 89 patients in NMP group. The PA results were used as reference standards. These patients were treated in the respiratory department of Children's Hospital Capital Institute of Pediatrics, China, from July to December, 2019. RESULTS:In the MPP group, the positive rate for MP-IgM was 75% higher than that of the PA titer (73.97%), Pearson's coefficient was 0.711, and the Kappa coefficient was 0.662, p < 0.01, suggesting that both the correlation and the consistency of the two methods were high. In the PA-negative group (< 1:160), 22.38% of patients were MP-IgM positive, indicating that the sensitivity to MP-IgM was higher compared to PA, when the disease duration was less than 7 days. The diagnostic value for MP-IgG was lower than that for MP-IgM, and the high positive rate of MP-IgG (48.31%) in the NMP group suggested a high background value of MP-IgG in children. Testing of paired serum obtained a more accurate diagnosis. At admission, 47.57% of patients with paired serum who were negative for MP-IgM, converted to a net positive after 4 - 6 days, except for one patient. In the paired serum, 57.8% of patients had a 4-fold increase of MP-IgG. CONCLUSIONS:MP-IgM was a sensitive indicator of MP infection in children with a high consistency and correlation with the reference positive standard of PA titer ≥ 1:160. For a more accurate diagnosis, testing of paired serum is still necessary, and a 4-fold increase in MP-IgG could be the supplementary diagnosis method.
Risk of Mycoplasma pneumoniae-related hepatitis in MP pneumonia pediatric patients: a predictive model construction and assessment.
Bi Yuna,Ma Yan,Zhuo Jinhua,Zhang Lili,Yin Liyan,Sheng Hongling,Luan Jie,Li Tao
BACKGROUND:A predictive model for risk of Mycoplasma pneumoniae (MP)-related hepatitis in MP pneumonia pediatric patients can improve treatment selection and therapeutic effect. However, currently, no predictive model is available. METHODS:Three hundred seventy-four pneumonia pediatric patients with/without serologically-confirmed MP infection and ninety-three health controls were enrolled. Logistic regressions were performed to identify the determinant variables and develop predictive model. Predictive performance and optimal diagnostic threshold were evaluated using area under the receiver operating characteristic curve (AUROC). Stratification analysis by age and MP-IgM titer was used to optimize model's clinical utility. An external validation set, including 84 MP pneumonia pediatric patients, was used to verify the predictive efficiency. After univariate analysis to screen significant variables, monocyte count (MO), erythrocyte distribution width (RDW) and platelet count (PLT) were identified as independent predictors in multivariate analysis. RESULTS:We constructed MRP model: MO [^10/L] × 4 + RDW [%] - PLT [^10/L] × 0.01. MRP achieved an AUROC of 0.754 and the sensitivity and specificity at cut-off value 10.44 were 71.72 and 61.00 %, respectively in predicting MP-related hepatitis from MP pneumonia. These results were verified by the external validation set, whereas it merely achieved an AUROC of 0.540 in pneumonia without MP infection. The AUROC of MRP was 0.812 and 0.787 in infants and toddlers (0-36 months) and low MP-IgM titer subgroup (1:160-1:320), respectively. It can achieve an AUROC of 0.804 in infants and toddler with low MP-IgM titer subgroup. CONCLUSIONS:MRP is an effective predictive model for risk of MP-related hepatitis in MP pneumonia pediatric patients, especially infants and toddlers with low MP-IgM titer.
Time-series analysis: variation of anti-acetylcholine receptor antibody titer in myasthenia gravis is related to incidence of Mycoplasma pneumoniae and influenza virus infections.
Iwasa Kazuo,Yoshikawa Hiroaki,Hamaguchi Tsuyoshi,Sakai Kenji,Shinohara-Noguchi Moeko,Samuraki Miharu,Takahashi Kazuya,Yanase Daisuke,Ono Kenjiro,Ishida Chiho,Yoshita Mitsuhiro,Nakamura Hiroyuki,Yamada Masahito
Objectives The exacerbating factors of myasthenia gravis (MG) are unknown. However, it has been speculated that infections may play a role in disease progression. Methods We calculated the adjusted anti-acetylcholine receptor antibody (Adj-AChR-Ab) titers (range, 0-1) in 58 MG patients between 2006 and 2012. We determined the relationship between Adj-AChR-Ab titer and infection incidence. Results A cross-correlation function (CCF) analysis of Adj-AChR-Ab titer and incidence of Mycoplasma pneumoniae (M. pneumoniae) (r = 0.449, P < 0.0001) and influenza virus (r = 0.411, P < 0.001) infections indicated significant correlations. MG with thymoma was highly correlated with M. pneumoniae infection (r = 0.798, P < 0.0001). The relative risk for Adj-AChR-Ab titer was 1.407 for M. pneumoniae (95% CI, 1.193-1.661 for an increase in one infected patient per monitoring point) and 1.158 for influenza (95% CI, 1.071-1.253 for 100 infected patients). Conclusion Variation of Adj-AChR-Ab titer is significantly influenced by the presence of M. pneumoniae and influenza virus infections.
High Mycoplasma pneumoniae loads and persistent long-term Mycoplasma pneumoniae DNA in lower airway associated with severity of pediatric Mycoplasma pneumoniae pneumonia.
Liu Jinrong,Zhao Fei,Lu Jie,Xu Hui,Liu Hui,Tang Xiaolei,Yang Haiming,Zhang Jianzhong,Zhao Shunying
BMC infectious diseases
BACKGROUND:An increased number of refractory mycoplasma pneumoniae (MP) pneumonia (MPP) cases have been reported. However the duration of MP infection in lower airway and the course of anti-MP treatment remains unclear. METHODS:We retrospectively reviewed the medical records of 94 MPP children. Patients were classified into two groups. The long-term group (Group LT) was defined as bronchoalveolar lavage fluid (BALF) remained MP-positive by PCR after 30 days of the disease course. The non-long-term group (Group NLT) was defined as BALF became MP-negative by PCR within 30 days of disease and patients who only needed one bronchoscopy lavage therapy. MP loads, clinical outcomes were analyzed along with other clinical measurements. RESULTS:The average levels of inflammatory markers such as C reactive protein and lactate dehydrogenase in Group LT were significantly higher than those in Group NLT. Airway and lung damage in Group LT were more severe than Group NLT. 28 patients developed necrotizing pneumonia and 8 patients developed pulmonary embolism in Group LT. Mean maximum MP loads in BALF were 10 and 10 in Groups LT and NLT, respectively. There was persistent MP DNA in Group LT, even lasted for 120 days. One severe MPP patient in Group LT had MP-associated bloodstream infection. After 3 months of follow-up, chest imaging revealed incomplete absorption of pulmonary consolidation in 33 patients of Group LT [including 13 airway obliterans (AO) patients] and in 7 patients of Group NLT (including 2 AO patients). CONCLUSION:MP loads of BALF were associated with the subsequent duration of MP DNA in lower airway. High MP loads and persistent long-term MP DNA in lower airway were associated with severity of pediatric MPP.
Role of E-selectin for diagnosing myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia.
Deng Ming-Hong,Lin Chun-Wang,Sun Yan-Na,Zeng Xiang-Lin,Wen Fang
Annals of clinical biochemistry
Backgrounds Effects of myocardial injury on E-selectin remain unclear. Thus, we investigated the diagnostic value of E-selectin for myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia. Methods In this prospective and blinded clinical study, plasma E-selectin, cardiac troponin I, creatine kinase isoenzyme MB, interleukin-6 and tumor necrosis factor alpha concentrations were measured in paediatric patients with mycoplasma pneumoniae pneumonia (MPP group, n = 138). The control group comprised 120 healthy children. The definition of cardiac injury was based on cardiac troponin I or CK-MB (with or possibly without abnormal electrocardiogram evidence). Diagnostic value of E-selectin for myocardial injury was determined by analysing receiver operating characteristic curves. Results Among the 138 mycoplasma pneumoniae pneumonia patients, 40 patients were identified with myocardial injury, while 98 patients were identified without myocardial injury. Plasma E-selectin concentrations were: 40.22 ± 4.80 ng/mL, in patients with myocardial injury; 18.55 ± 2.16 ng/mL, in patients without myocardial injury and 12.39 ± 3.27 ng/mL, in healthy children. For the 40 patients identified with myocardial injury, area under the receiver operating characteristic curve value for plasma E-selectin concentrations was 0.945 (95% CI: 0.899-0.991), and optimal diagnostic cut-off value was 29.93 ng/mL (positive likelihood ratio = 72.5). Conclusion E-selectin was shown to be an effective index for myocardial injury in paediatric patients with mycoplasma pneumoniae pneumonia, and its role in other causes of myocardial injury warrants further investigation.
Increased Total Serum Immunoglobulin E in Children Developing Mycoplasma pneumoniae-related Extra-pulmonary Diseases.
Poddighe Dimitri,Comi Elena Virginia,Brambilla Ilaria,Licari Amelia,Bruni Paola,Marseglia Gian Luigi
Iranian journal of allergy, asthma, and immunology
Mycoplasma pneumoniae has been recognized to be involved in several extra-pulmonary diseases, but the underlying immunologic mechanisms are still largely unknown. Recently, we observed a significant elevation of serum Immunoglobulin E (IgE) in a small group of these children. Here, we assessed total serum IgE levels in children affected with Mycoplasma pneumoniae-related extra-pulmonary diseases. We prospectively collected the data of 162 children admitted to the hospital (because of respiratory infections or extra-pulmonary diseases) who were evaluated for Mycoplasma pneumoniae serology and total serum IgE levels, concomitantly. Based upon clinical and serology aspects, 3 groups of children were identified: I) with non-mycoplasma respiratory disease; II) with mycoplasma-related respiratory diseases; III) with extra-pulmonary diseases related to concomitant/recent Mycoplasma pneumoniae infection. Interestingly, children with Mycoplasma pneumoniae-related extra-pulmonary diseases showed a significant elevation of total serum IgE. In particular, patients developing Mycoplasma pneumoniae-related extra-pulmonary diseases (group III) showed significantly higher level of IgE than both previous groups (p<0.001 vs. group I; p<0.01 vs. group II). In conclusion, hospitalized children diagnosed with Mycoplasma pneumoniae-related extra-pulmonary diseases resulted to have significantly increased serum IgE compared to children developing respiratory illnesses only.
Prevalence of Mycoplasma pneumoniae infection in pediatric patients with acute asthma exacerbation.
Kassisse Elías,García Hecmary,Prada Linair,Salazar Ixora,Kassisse Jorge
Archivos argentinos de pediatria
INTRODUCTION:Mycoplasma pneumoniae may be involved in refractory asthma exacerbation. OBJECTIVE:To determine the prevalence of Mycoplasma pneumoniae infection in patients with acute asthma exacerbation. Material and method. A prospective, crosssectional, observational, case-control study was carried out in patients older than 2 years old and younger than 12. Immunoglobulin M (IgM) antibodies were serologically determined for M. pneumoniae, using the NovaLisa® NovaTec kit for enzyme-linked immunosorbent assay (ELISA). Test results ≥ 11 NTU (NovaTec units) were regarded as positive. The statistical analysis was performed by means of the analysis of variance (ANOVA) and the χ² test, with a significance level of p < 0.05. RESULTS:One hundred and eighty children were studied, of which 130 had asthma and 50 comprised the control group. Specific IgM was positive for 60 patients, that is 46.15% of the asthmatic children (p < 0.001). The severity of the exacerbation was directly related to IgM levels (p < 0.001). Hospitalization rate was 75%, and it was significantly associated to specific IgM levels (p < 0.001). CONCLUSION:Our data suggest that children with acute asthma show a high prevalence (46%) of Mycoplasma pneumoniae infection and that there is a close relation between severe acute asthma exacerbation and the presence of Mycoplasma pneumoniae infection. These findings might result in therapeutic implications centered in the use of specific antibiotics to fight this atypical organism. Key words: acute asthma, exacerbation, Mycoplasma pneumoniae.
The diagnostic value of serological studies in pediatric patients with acute Mycoplasma pneumoniae infection.
Lin Lih-Ju,Chang Fu-Chieh,Chi Hsin,Jim Wai-Tim,Tsung-Ning Huang Daniel,Kung Yen-Hsin,Huang Ching-Ying,Chiu Nan-Chang,Chang Lung
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi
BACKGROUND:Mycoplasma pneumoniae is a common pathogen of respiratory tract infections in pediatric patients. Serological studies are traditional methods for the diagnosis. However, early diagnosis of M. pneumoniae infections remains problematic. We investigate the value of early serum immunoglobulin A (IgA), in addition to immunoglobulin G (IgG), and immunoglobulin M (IgM) levels, in children infected with M. pneumoniae. METHODS:From August 2016 to February 2017, we enrolled pediatric patients based on both clinical symptoms and chest x-ray, and confirmed by positive throat culture for M. pneumoniae. Serum titers of M. pneumoniae IgM, IgG, and IgA during the acute phase were checked. All respiratory samples were further analyzed by polymerase chain reaction (PCR). Diagnostic values of different tests were evaluated. RESULTS:Fifty-six patients fulfilled the diagnostic criteria, with a median age of 4.84 years. Most of them (89.3%) were enrolled within 7 days of disease onset. PCR was positive in 71.4% of the study population. Early IgG samples were of limited value in diagnosing M. pneumoniae infection, of which 89.3% showed a negative result. Positive rates of early serum IgA and IgM were 48.2% and 46.4%, respectively. In combination with IgA and/or IgM, the sensitivity increased to 71.4% during their early clinical course. CONCLUSIONS:In the pediatric population, combined serological tests of M. pneumoniae IgA and IgM, offer an accurate method of early diagnosis comparable to that of PCR, and can be an alternative choice for prompt detection of mycoplasma infections when PCR and culture are not available.