Detection and Characterization of Mycoplasma pneumoniae during an Outbreak of Respiratory Illness at a University

Waller, Jessica L.; Diaz, Maureen H.; Petrone, Brianna L.; Benitez, Alvaro J.; Wolff, Bernard J.; Edison, Laura; Tobin-D’Angelo, Melissa; Moore, Ashley; Martyn, Audrey; Dishman, Hope; Drenzek, Cherie; Turner, Kim; Hicks, Lauri A.; Winchell, Jonas M.

doi:10.1128/jcm.02810-13

Cited by 47 publications

(49 citation statements)

References 24 publications

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“…MLVA types 4572 and 3562 each were the predominant MLVA pattern identified in five outbreaks. The pattern of MLVA type distribution over the study period approximately mirrored the P1 typing distribution, consistent with a previously observed correlation between P1 and MLVA types (22).…”

Section: Resultssupporting

confidence: 72%

“…The greatest diversity in MLVA types in a single outbreak setting was observed in the investigation having the highest number of specimens. The appearance of clonality in the remaining two outbreaks was likely due to testing of too few specimens to obtain an accurate representation of the diversity of circulating strains, as has been suggested previously (20,22). Cocirculation of P1 types in both endemic and epidemic settings has been documented (22,31).…”

Section: Discussionmentioning

confidence: 87%

“…MLVA types were reported using four loci (Mpn13, Mpn14, Mpn15, and Mpn16) as previously suggested (20)(21)(22). High-resolution melt (HRM) analysis for identification of the macrolide susceptibility genetic profile was performed with a slight modification of the original procedure (9); the modification consisted of using a nested PCR approach to allow standardization of input material into the HRM reactions.…”

Section: Methodsmentioning

confidence: 99%

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Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

2015

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Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently, pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve with empirical antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae M ycoplasma pneumoniae is a common respiratory pathogen in adults and children worldwide and is a leading cause of community-acquired pneumonia (CAP). The majority of infections are self-limiting, and empirical treatment without pathogen-specific diagnostic testing is common in the primary care setting. In fact, the current treatment guidelines do not recommend diagnostic testing for suspected CAP of atypical bacterial etiology in adults in the outpatient setting unless a change in the patient treatment regimen is anticipated (1). The recommendation to perform diagnostic testing for M. pneumoniae infection in children is classified as a weak recommendation and likely not routinely performed, in part due to a lack of available diagnostic tests in the primary care setting and at state and local public health laboratories (2). The estimates of the actual number of cases occurring annually are inexact due to the lack of systematic surveillance and reporting. Although historically noted to occur in 3-to 7-year cycles, outbreaks of M. pneumoniae are common and may last for several months as a result of the long incubation period and prolonged carriage after resolution of symptoms (3-5).Excessive or inappropriate antibiotic use provides selective pressure for the development of antimicrobial resistance. In M. pneumoniae infections, macrolide resistance is an emerging threat worldwide, and in some parts of the world, Ͼ90% of M. pneumoniae infections are caused by resistant strains (6, 7). In the United States, the incidence of infection with macrolide-resistant M. pneumoniae strains is not well defined, although the trait has been consistently reported over the past decade (8-10). Macrolide-resistant M. pneumoniae infection has been associated with increased febrile period, increased duration of persistent cough, and extended antibiotic therapy compared to macrolide-sensitive strains (11-16).Methods for molecular typing of M. pneumoniae strains have been developed, including discrimination of two major types and variants based on the sequence of the P1 adhesion molecule gene and identification of multiple types using multilocus variablenumber tandem-repeat analysis (MLVA) to examine four or five polymorphic loci. Despite development of these sophisticated typing methods, character...

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Section: Resultssupporting

confidence: 72%

Section: Discussionmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

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Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

2015

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“…34 MLVA typing may also not be a reliable measure of clonality because multiple MLVA types may circulate in a single outbreak setting. 35 A second, more likely hypothesis is that there was a large outbreak of Mp in the community, which resulted in an increased rate of SJS due to an overall increased rate of exposure to Mp. This is supported by a community-wide investigation, which found a significant increase in atypical pneumonia diagnoses, macrolide prescriptions, and positive Mp testing.…”

Section: Case-control Analysismentioning

confidence: 99%

Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

et al. 2015

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BACKGROUND: Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado.METHODS: Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection.RESULTS: During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 10.0, confidence interval [CI] 1.3-5.1), preceding respiratory symptoms (OR 30.0, CI 1.6-72.6), an erythrocyte sedimentation rate $35 mg/dL (OR 22.8, CI 2.1-244.9), and #3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23). CONCLUSIONS:We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.WHAT'S KNOWN ON THIS SUBJECT: StevensJohnson syndrome (SJS) is a rare and severe immunologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such as Mycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare. WHAT THIS STUDY ADDS:We describe the largest SJS outbreak reported in children, which was also Mp-associated. In the first case-control study of this disease, we identify predictors of Mp-associated SJS versus non-Mp-associated SJS, including fewer skin lesions, pneumonia, and elevated erythrocyte sedimentation rate.

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“…This bacterium affects both the upper and lower respiratory tracts of individuals of all age groups, and infections occur endemically and epidemically worldwide (1,2). Many outbreaks of M. pneumoniae respiratory infections have been reported in the community and in closed or semiclosed settings, such as military bases, hospitals, religious communities, schools, and institutions for the mentally disabled and may be associated with considerable morbidity (1,(3)(4)(5)(6). Since 2010, a substantial increased incidence of M. pneumoniae infections has been reported in several countries (7)(8)(9).…”

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confidence: 99%

Molecular Epidemiology of Mycoplasma pneumoniae: Genotyping Using Single Nucleotide Polymorphisms and SNaPshot Technology

et al. 2015

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i Molecular typing of Mycoplasma pneumoniae is an important tool for identifying grouped cases and investigating outbreaks. In the present study, we developed a new genotyping method based on single nucleotide polymorphisms (SNPs) selected from the whole-genome sequencing of eight M. pneumoniae strains, using the SNaPshot minisequencing assay. Eight SNPs, localized in housekeeping genes, predicted lipoproteins, and adhesin P1 genes were selected for genotyping. These SNPs were evaluated on 140 M. pneumoniae clinical isolates previously genotyped by multilocus variable-number tandem-repeat analysis (MLVA-5) and adhesin P1 typing. This method was also adapted for direct use with clinical samples and evaluated on 51 clinical specimens. The analysis of the clinical isolates using the SNP typing method showed nine distinct SNP types with a Hunter and Gaston diversity index (HGDI) of 0.836, which is higher than the HGDI of 0.583 retrieved for the MLVA-4 typing method, where the nonstable Mpn1 marker was removed. A strong correlation with the P1 adhesin gene typing results was observed. The congruence was poor between MLVA-5 and SNP typing, indicating distinct genotyping schemes. Combining the results increased the discriminatory power. This new typing method based on SNPs and the SNaPshot technology is a method for rapid M. pneumoniae typing directly from clinical specimens, which does not require any sequencing step. This method is based on stable markers and provides information distinct from but complementary to MLVA typing. The combined use of SNPs and MLVA typing provides powerful discrimination of strains. Mycoplasma pneumoniae is the second leading cause of community-acquired pneumonia behind Streptococcus pneumoniae. This bacterium affects both the upper and lower respiratory tracts of individuals of all age groups, and infections occur endemically and epidemically worldwide (1, 2). Many outbreaks of M. pneumoniae respiratory infections have been reported in the community and in closed or semiclosed settings, such as military bases, hospitals, religious communities, schools, and institutions for the mentally disabled and may be associated with considerable morbidity (1, 3-6). Since 2010, a substantial increased incidence of M. pneumoniae infections has been reported in several countries (7-9). Molecular typing methods for M. pneumoniae have been developed for the identification of grouped cases and investigation of outbreaks (10). Until recently, the most common typing methods for M. pneumoniae were based on the analysis of single nucleotide polymorphisms (SNPs) within the gene encoding the major immunogenic protein P1, which is involved in adhesion to host cells. Several methodologies were used, including PCR-restriction fragment length polymorphism (11), amplification and gene sequencing (12), real-time PCR with high-resolution melt analysis (13), and pyrosequencing (14). However, due to the homogeneity of the M. pneumoniae species, few polymorphisms have been identified, and P1-based typing methods allow th...

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Detection and Characterization of Mycoplasma pneumoniae during an Outbreak of Respiratory Illness at a University

Cited by 47 publications

References 24 publications

Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

Molecular Epidemiology of Mycoplasma pneumoniae: Genotyping Using Single Nucleotide Polymorphisms and SNaPshot Technology

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