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Difference of clinical features in childhood Mycoplasma pneumoniae pneumonia
You-Sook Youn, Kyung-Yil Lee, Ja-Young Hwang, Jung-Woo Rhim, Jin-Han Kang, Joon-Sung Lee, Ji-Chang Kim
BMC Pediatrics , 2010, DOI: 10.1186/1471-2431-10-48
Abstract: The diagnosis of MP was made by examinations at both admission and discharge and by two serologic tests: the indirect microparticle agglutinin assay (≥1:40) and the cold agglutinins titer (≥1:32). A total of 191 children with MP were grouped by age: ≤2 years of age (29 patients), 3-5 years of age (81 patients), and ≥6 years of age (81 patients). They were also grouped by pneumonia pattern: bronchopneumonia group (96 patients) and segmental/lobar pneumonia group (95 patients).Eighty-six patients (45%) were seroconverters, and the others showed increased antibody titers during hospitalization. Among the three age groups, the oldest children showed the longest duration of fever, highest C-reactive protein (CRP) values, and the most severe pneumonia pattern. The patients with segmental/lobar pneumonia were older and had longer fever duration and lower white blood cell (WBC) and lymphocyte counts, compared with those with bronchopneumonia. The patient group with the most severe pulmonary lesions had the most prolonged fever, highest CRP, highest rate of seroconverters, and lowest lymphocyte counts. Thrombocytosis was observed in 8% of patients at admission, but in 33% of patients at discharge.In MP, older children had more prolonged fever and more severe pulmonary lesions. The severity of pulmonary lesions was associated with the absence of diagnostic IgM antibodies at presentation and lymphocyte count. Short-term paired IgM serologic test may be mandatory for early and definitive diagnosis of MP.Mycoplasma pneumoniae (M. pneumoniae) is an important causative organism of respiratory infections in children and young adults. M. pneumoniae pneumonia (MP) has been reported in 10-40% of community-acquired pneumonia cases, and recent studies have indicated that younger children (<5 years of age), as well as school-aged children, are prone to M. pneumoniae infection [1-6]. In Korea, M. pneumoniae epidemics have occurred every 3-4 years since the 1980s; in the most recent epidem
Hemophagocytic Syndrome Associated with Mycoplasma pneumoniae Pneumonia  [PDF]
Yuji Koike,Nao Aoki
Case Reports in Pediatrics , 2013, DOI: 10.1155/2013/586705
Abstract: Mycoplasma pneumoniae (Mp) sometimes causes immunological complications in children. We present a rare case of hemophagocytic syndrome (HPS) caused by Mp in a previously healthy 7-year-old Japanese girl. A chest radiograph obtained to evaluate the source of her fever showed infiltration in the lower right lung with mild splenomegaly. We could diagnose the patient with HPS on the basis of the hemophagocytic-lymphohistiocytosis- (HLH) 2004 criteria. She met the criteria for fever, splenomegaly, neutrophil count (<1,000/μL), platelet count (<10.0?×?104/μL), fasting triglyceride level (>265?mg/dL), and ferritin level (>500?ng/mL). Furthermore, a peripheral blood smear showed an increased number of monocytes/macrophages with erythrophagocytosis. Treatment with clarithromycin and prednisolone, which was initiated soon after the diagnosis, was successful. Mp infection might partly progress to HPS in certain conditions. Clinicians should be aware of HPS caused by Mp and start appropriate treatment as soon as possible if the disease is suspected. 1. Introduction Mycoplasma pneumoniae (Mp) is well known to cause upper and lower respiratory tracts infections, including pharyngitis, bronchitis, and pneumonia. Mp also causes immunological complications in children, such as Stevens-Johnson syndrome, Guillain-Barré syndrome, Kawasaki disease [1], aseptic meningitis, and hemophagocytic syndrome (HPS). HPS is characterized by abnormal activation of monocytes/macrophages and consequently overproduction of proinflammatory cytokines [2, 3]. Among various types of HPS, secondary HPS is often associated with infections such as virus, bacteria, fungi, and parasites [4]. However, Mp rarely causes secondary HPS, and there have so far been few reports concerning HPS due to Mp [5, 6]. We herein report a 7-year-old girl who was diagnosed as having HPS associated with Mp pneumonia, and we successfully treated her with an appropriate antibiotic along with corticosteroid soon after the diagnosis. 2. Case Presentation A previously healthy 7-year-old Japanese girl presented to her physician with three-day history of fever, cough, and malaise and was referred to our outpatient clinic by the physician for evaluation of fever and leukocytopenia. Physical examinations revealed mild hepatosplenomegaly, however, no lymphadenopathy nor skin rash. Chest auscultation revealed also normal breath sounds. A chest radiograph obtained to evaluate the source of her fever showed infiltration in the lower right lung with mild splenomegaly (Figure 1). Laboratory findings were as follows: white blood
Climate Variability and Nonstationary Dynamics of Mycoplasma pneumoniae Pneumonia in Japan  [PDF]
Daisuke Onozuka, Luis Fernando Chaves
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095447
Abstract: Background A stationary association between climate factors and epidemics of Mycoplasma pneumoniae (M. pneumoniae) pneumonia has been widely assumed. However, it is unclear whether elements of the local climate that are relevant to M. pneumoniae pneumonia transmission have stationary signatures of climate factors on their dynamics over different time scales. Methods We performed a cross-wavelet coherency analysis to assess the patterns of association between monthly M. pneumoniae cases in Fukuoka, Japan, from 2000 to 2012 and indices for the Indian Ocean Dipole (IOD) and El Ni?o Southern Oscillation (ENSO). Results Monthly M. pneumoniae cases were strongly associated with the dynamics of both the IOD and ENSO for the 1–2-year periodic mode in 2005–2007 and 2010–2011. This association was non-stationary and appeared to have a major influence on the synchrony of M. pneumoniae epidemics. Conclusions Our results call for the consideration of non-stationary, possibly non-linear, patterns of association between M. pneumoniae cases and climatic factors in early warning systems.
Características clínico-radiológicas e hematológicas das pneumonias causadas pelo Mycoplasma pneumoniae
Vervloet, Letícia Alves;Camargos, Paulo Augusto Moreira;Soares, Dami?o Ranulfo Fernandes;Oliveira, Gabriel Ant?nio de;Oliveira, Janúncio Nunes de;
Jornal de Pediatria , 2010, DOI: 10.1590/S0021-75572010000600006
Abstract: objective: to describe the clinical, hematological and radiographic characteristics of children hospitalized for mycoplasma pneumoniae pneumonia. method: the study population consisted of 190 children between 3 months and 16 years old, hospitalized for radiographically confirmed pneumonia. patients were divided into two groups, to wit: 95 children with mycoplasma pneumoniae pneumonia, as diagnosed using the enzyme-linked immunosorbent assay (elisa) method; and 95 children with pneumonia caused by other etiologic agents. using a validated scoring system, the clinical, hematological and radiographic findings of both groups were compared to differentiate mycoplasma pneumoniae pneumonia (group 1) from pneumonia caused by other etiologic agents (group 2), itself divided into two groups, bacterial (n = 75) and viral (n = 20). results: mycoplasma pneumoniae pneumonia was found most often in girls (p < 0.01), older children (p < 0.01), and patients with dry cough (p < 0.01) and extrapulmonary manifestations (p < 0.01). the clinical, hematological and radiographic variables of mycoplasma pneumoniae pneumonia (mean score = 6.95) scored between those found in bacterial (mean score = 8.27) and viral pneumonia (mean score = 0.90). conclusion: results suggest that the scoring system can contribute to the presumptive diagnosis of mycoplasma pneumoniae pneumonia and help differentiate pneumonic status caused by other etiologic agents.
Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ)
Heike von Baum, Tobias Welte, Reinhard Marre, Norbert Suttorp, Christian Lück, Santiago Ewig
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-62
Abstract: Based on prospective data from 4532 patients with CAP included in the German CAP-Competence Network (CAPNETZ), we studied the incidence, clinical characteristics, and outcome of patients with Mycoplasma pneumoniae pneumonia (MPP). The diagnosis of MPP was based on a positive PCR from respiratory samples and/or a positive IgM-titer from an acute phase serum sample.307 patients (6.8%) had definite MPP (148 with positive PCR, 204 with positive IgM, 46 with positive PCR and IgM). Compared to patients with other definite and unknown etiologies, patients with MPP were significantly younger (41 ± 16 versus 62 ± 17 and 61 ± 18 years), had fewer co-morbidities, presented with a less severe disease, showed a lower inflammatory response in terms of leukocyte counts (median 8850 versus 13200 and 11000 μL) and CRP values (60 versus 173 and 73 mg/L), and had better outcomes, including a shorter length of hospitalization (9 ± 5 versus 14 ± 11 and 12 ± 9 days), fewer patients requiring mechanical ventilation (0.3 versus 4.5 and 2.1%), and a minimal mortality (0.7 versus 8.7 and 6.5%).In this large series of patients with definite MPP according to very strict criteria, MPP appears as a condition with a high incidence, quite specific clinical presentation, and a largely benign course. In view of a widely favorable clinical outcome, recent recommendations including regular coverage of atypical pathogens in patients with mild to moderate CAP might be reconsidered for patients in Germany as well as in other countries with comparable epidemiological settings.Mycoplasma pneumoniae as an important pathogen of community-acquired pneumonia (CAP) is only rarely diagnosed in routine practice. This is explained by the many limitations of paired serology which still is the applied diagnostic tool in most cases. In several epidemiologic studies of CAP, largely relying on paired serology, Mycoplasma pneumoniae was identified in 5–15% of cases, resulting in a second or third rank pathogen causing C
Retrospective survey for sialidase activity in Mycoplasma pneumoniae isolates from cases of community-acquired pneumonia
Meghan May, Daniel R Brown
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-195
Abstract: No sialidase activity was detected by spectrofluorometric assay of 15 laboratory strains and 91 clinical isolates of M. pneumoniae banked over many years from patients having radiologically-confirmed, uncomplicated community-acquired pneumonia.The annotated genome of strain M129 (GenBank NC_000912, ATCC 29342), also isolated from a patient with pneumonia, accurately represents the absence of sialidase genes from strains of M. pneumoniae typically associated with uncomplicated community-acquired pneumonia. A possible involvement of sialidase in neurologic or other extra-respiratory manifestations of M. pneumoniae mycoplasmosis remains to be investigated.Mycoplasma pneumoniae is primarily associated with interstitial pneumonitis, tracheobronchitis, desquamative bronchitis and pharyngitis, collectively referred to as primary atypical pneumonia (PAP) [1,2]. Mycoplasmosis accounts for 20 - 30% of community-acquired pneumonia (CAP) cases, constituting significant disease and economic burdens in North America and Western Europe. Following its initial association with PAP, other diseases involving M. pneumoniae invasion of non-respiratory tissues were reported [Table 1]. Neurologic, dermal, hemotropic, cardiac, arthritic, hepatic, pancreatic, nephritic, and musculoskeletal pathologies have been described[2-12]; many of those diseases occurred secondarily to PAP, either through dissemination of M. pneumoniae from the respiratory tract, or following associated autoimmune disorders [3]. Primary extra-respiratory M. pneumoniae infections in the absence of PAP, including meningoencephalitis, hepatitis, and pancreatitis, have also been described [13,14], and M. pneumoniae has been isolated from the urogenital tract in the absence of clinical signs.The majority of studies on clinical aspects of M. pneumoniae mycoplasmosis address the diagnosis, treatment and prevention of CAP, while factors predisposing to extra-respiratory diseases remain virtually unexplored. Extracellular "spre
Macrolide-resistant Mycoplasma pneumoniae in adolescents with community-acquired pneumonia
Naoyuki Miyashita, Yasuhiro Kawai, Hiroto Akaike, Kazunobu Ouchi, Toshikiyo Hayashi, Takeyuki Kurihara, Niro Okimoto
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-126
Abstract: A total of 99 cases with M. pneumoniae pneumonia confirmed by polymerase chain reaction (PCR) and culture were analyzed. Forty-five cases were pediatric patients less than 16 years old, 26 cases were 16 to 19-year-old adolescent patients and 28 cases were adult patients. Primers for domain V of 23S rRNA were used and DNA sequences of the PCR products were compared with the sequence of an M. pneumoniae reference strain.Thirty of 45 pediatric patients (66%), 12 of 26 adolescent patients (46%) and seven of 28 adult patients (25%) with M. pneumoniae pneumonia were found to be infected with macrolide-resistant M. pneumoniae (MR patients). Although the prevalence of resistant strains was similar in pediatric patients between 2008 and 2011, an increase in the prevalence of resistant strains was observed in adolescent patients. Among 30 pediatric MR patients, 26 had an A-to-G transition at position 2063 (A2063G) and four had an A-to-G transition at position 2064 (A2064G). In 12 adolescent MR patients, 10 showed an A2063G transition and two showed an A2064G transition, and in seven adult MR patients, six showed an A2063G transition and one showed an A2064G transition.The prevalence of macrolide-resistant M. pneumoniae is high among adolescent patients as well as pediatric patients less than 16-years old. To prevent outbreaks of M. pneumoniae infection, especially macrolide-resistant M. pneumoniae, in closed populations including among families, in schools and in university students, physicians should pay close attention to macrolide-resistant M. pneumoniae.
Immune response to Mycoplasma pneumoniae P1 and P116 in patients with atypical pneumonia analyzed by ELISA
Mette Drasbek, Pernille K Nielsen, Kenneth Persson, Svend Birkelund, Gunna Christiansen
BMC Microbiology , 2004, DOI: 10.1186/1471-2180-4-7
Abstract: A recombinant protein derived from the P116 protein and one from the P1 protein were used in two ELISA tests, rP116-ELISA and rP1-ELISA. Human serum samples from patients with atypical pneumonia were tested and compared to the results of the complement fixation test. There was a good agreement between the two tests but the rP1-ELISA showed the best discrimination between positive and negative samples.Two ELISA tests based on recombinant proteins have been analysed and compared to the complement fixation test results. The two ELISA tests were found suitable for use in serodiagnostics of M. pneumoniae infections. The use of specific antigens eliminates the risk of cross reaction to an immune response against other bacteria.Mycoplasma pneumoniae is a human pathogen that colonizes the mucosal surfaces of the respiratory tract [1]. The pathogen infects the upper and the lower respiratory tract and is the leading cause of atypical pneumonia in children and young adults [2]. M. pneumoniae infections are often seen as epidemics occurring at intervals of 4–7 years. The patients show flu-like symptoms but characteristically the infection is chronic in onset and recovery [3].The lacking cell wall distinguishes Mollicutes from other eubacteria and due to the lack of cell wall M. pneumoniae is resistant to penicillin. A specific and early diagnosis is therefore important in order to select the right treatment. The standard methods for diagnosis of M. pneumoniae are culturing, serology and PCR. Since M. pneumoniae can be difficult to isolate [4] most of the laboratory diagnoses are serology tests, such as complement fixation test (CF test) and different enzyme-linked immunoabsorbent assays (ELISA) [5]. PCR has also been used for the detection of M. pneumoniae [6-8]. The CF test has a limited value producing inconclusive results, because it also measures antibodies deriving from earlier infections [9], and the glycolipid antigen which is not M. pneumoniae specific cross reacts wit
Pneumonia adquirida na comunidade e derrame pleural parapneum?nico relacionados a Mycoplasma pneumoniae em crian?as e adolescentes
Vervloet, Letícia Alves;Vervloet, Vitor Earl Cardoso;Tironi Junior, Mário;Ribeiro, José Dirceu;
Jornal Brasileiro de Pneumologia , 2012, DOI: 10.1590/S1806-37132012000200013
Abstract: objective: to determine the prevalence and the characteristics of mycoplasma pneumoniae-related community-acquired pneumonia (cap) and parapneumonic pleural effusion (ppe) in children and adolescents. methods: this was a retrospective observational study involving 121 patients with cap/ppe hospitalized in a tertiary referral hospital between 2000 and 2008, divided into six groups according to the etiologic agent (g1 to g6, respectively): m. pneumoniae with or without co-infection, in 44 patients (group 1); etiologic agents other than m. pneumoniae, in 77 (group 2); m. pneumoniae without co-infection, in 34 (group 3); streptococcus pneumoniae, in 36 (group 4); staphylococcus aureus, in 31 (group 5); and m. pneumoniae/s. pneumoniae co-infection, in 9 (group 6). results: in comparison with group 2, group 1 showed higher frequencies of females, dry cough, and previous use of beta-lactam antibiotics; longer duration of symptoms prior to admission; and lower frequencies of use of mechanical ventilation and chest tube drainage. in comparison with groups 4 and 5, group 3 showed higher frequencies of previous use of beta-lactam antibiotics and dry cough; longer duration of symptoms prior to admission; a lower frequency of use of chest tube drainage; a higher mean age and a lower frequency of nausea/vomiting (versus group 4 only); and a lower frequency of use of mechanical ventilation (versus group 5 only). m. pneumoniae/s. pneumoniae co-infection increased the duration of symptoms prior to admission. conclusions: in this sample, the prevalence of m. pneumoniae-related cap/ppe was 12.75%. although the disease was milder than that caused by other microorganisms, its course was longer. our data suggest that m. pneumoniae-related cap and ppe in children and adolescents should be more thoroughly investigated in brazil.
Utilidad de la reacción de polimerasa en cadena para la detección de Mycoplasma pneumoniae en adultos mayores con neumonía adquirida en la comunidad Diagnostic utility of the polymerase chain reaction for the diagnosis of Mycoplasma pneumoniae in elderly patients with community-acquired pneumonia
Revista chilena de infectología , 2005,
Abstract: Mycoplasma pneumoniae es una causa frecuente de neumonía adquirida en la comunidad (NAC) en ni os y adultos jóvenes, existiendo escasa información de su frecuencia en el adulto mayor. Se analizó la reacción de polimerasa en cadena (RPC) con dos pares de partidores, gen de la adhesina P1 y gen 16S rRNA, para la detección de M. pneumoniae en lavado faríngeo de 84 pacientes de 60-96 a os con diagnóstico clínico de NAC, desde septiembre de 2002 hasta agosto de 2004. Los resultados de la RPC fueron comparados con los de la serología mediante inmunofluorescencia indirecta (IFI). Se detectó infección por M. pneumoniae mediante serología o RPC en 11 de 84 pacientes (13,1%). La serología fue positiva en 8 (72,7%) y la RPC en 7 (63,6%) muestras. La serología en la muestra de suero en fase aguda fue positiva en 5 de 11 pacientes (45,4%), en 4 de ellos por la presencia de IgM. En 4 pacientes con serología positiva la RPC fue negativa. En 3 pacientes con serología negativa la RPC fue positiva. Las dos RPC mostraron 100% de correlación y la sensibilidad fue la misma; no se detectaron muestras con efecto inhibitorio de la reacción. En conclusión, M. pneumoniae debería ser considerado en la etiología de la NAC en adultos mayores. La detección de este microorganismo debe basarse en el uso combinado de serología y RPC Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in children and young adults, but limited information about its prevalence in the elderly is available. The polymerase chain reaction (PCR) with primers targeting the cytadhesine P1 gene and the 16S rRNA gene was analyzed for detecting M. pneumoniae in throat washings of 84 patients, aged 60-96 years, with clinical diagnosis of CAP, from September 2002 through August 2004, in Santiago, Chile. PCR results were compared with serology performed by indirect immunofluorescence (IFI). Specimens from 11 of 84 patients (13.1%) were positive for M. pneumoniae by any test. The IFI test was positive in 8 (72.7%) patients and PCR in 7 (63.6%) cases. The acute phase sera allowed diagnosis of M. pneumoniae in 5 of 11 patients (45.4%), 4 of them showing an IgM response. PCR was negative in 4 patients with positive serology and 3 patients were positive only by PCR. The two PCR primers showed 100% correlation, and a similar sensitivity; no inhibitory specimens for PCR were detected. In conclusion, M. pneumoniae should be considered as a potential etiologic agent of CAP in the elderly. Its detection must be performed by a combination of PCR and serology
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