Diagnosis of <i>Mycoplasma pneumoniae</i> Pneumonia with Measurement of Specific Antibody-Secreting Cells

Sauteur, Patrick M. Meyer; Trück, Johannes; Unger, Wendy W.J.; Paioni, Paolo; Relly, Christa; Staubli, Georg; Haas, Thorsten; Gysin, Claudine; Bachmann, Lucas M.; Rossum, Annemarie M. C. van; Berger, Christoph

doi:10.1164/rccm.201904-0860le

Cited by 34 publications

(60 citation statements)

References 12 publications

(26 reference statements)

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“…Of these, 29 (46%) were Mp-positive, determined by detection of Mp IgM ASCs. As detailed elsewhere [9], all 29 Mp IgM ASC-positive patients were also Mp PCR positive and IgM positive. However, Mp PCR was also positive in 3 (5%) patients who were Mp IgM ASC and IgM negative, and Mp IgM was found in another 3 (5%) patients who were Mp IgM ASC and PCR negative.…”

Section: Study Populationmentioning

confidence: 64%

“…Patients were enrolled between 1 May 2016 and 30 April 2017, at University Children's Hospital Zurich [9]. CAP was clinically defined as the presence of fever >38.5°C and tachypnea according to the British Thoracic Society (BTS) guidelines [2].…”

Section: Patientsmentioning

confidence: 99%

“…All enrolled patients were investigated for Mp in pharyngeal swab samples by specific real-time PCR [9,14]. If additional consent was given, blood samples were collected for separation of peripheral blood mononuclear cells (PBMCs) and serum [9]. Serum was stored at −80°C.…”

Section: Specimen Collection and Diagnostic Testingmentioning

confidence: 99%

“…Serum was stored at −80°C. As detailed elsewhere [9], only CAP patients were included in this study if fresh (isolated ≤4 hours) PBMCs were available to avoid poor ELISpot assay performance, and tested for the presence of Mp IgM ASCs. A CAP patient with a positive Mp IgM ASC ELISpot assay result was considered to have CAP caused by Mp (Mp positive).…”

Section: Specimen Collection and Diagnostic Testingmentioning

confidence: 99%

“…blood immunoglobulin M (IgM) antibody-secreting cells (ASCs) by enzyme-linked immunospot (ELISpot) assay improves diagnosis of Mp infection in CAP [9]. This test differentiated between Mp infection and carriage.…”

mentioning

confidence: 99%

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Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Sauteur

Krautter

Ambroggio

et al. 2019

Clinical Infectious Diseases

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Background. There are no reliable signs or symptoms that differentiate Mycoplasma pneumoniae (Mp) infection in communityacquired pneumonia (CAP) from other etiologies. Additionally, current diagnostic tests do not reliably distinguish between Mp infection and carriage. We previously determined that the measurement of Mp-specific immunoglobulin M antibody-secreting cells (ASCs) by enzyme-linked immunospot assay allowed for differentiation between infection and carriage. Using this new diagnostic test, we aimed to identify clinical and laboratory features associated with Mp infection.Methods. This is a prospective cohort study of children, 3-18 years of age, with CAP from 2016 to 2017. Clinical features and biomarkers were compared between Mp-positive and -negative groups by Mann-Whitney U test or Fisher exact test, as appropriate. Area under the receiver operating characteristic curve (AUC) differences and optimal thresholds were determined by using the DeLong test and Youden J statistic, respectively.Results. Of 63 CAP patients, 29 were Mp-positive (46%). Mp positivity was statistically associated with older age (median, 8.6 vs 4.7 years), no underlying disease, family with respiratory symptoms, prior antibiotic treatment, prolonged prodromal respiratory symptoms and fever, and extrapulmonary (skin) manifestations. Lower levels of C-reactive protein, white blood cell count, absolute neutrophil count, and procalcitonin (PCT), specifically PCT <0.25 μg/L, were statistically associated with Mp infection. A combination of age >5 years (AUC = 0.77), prodromal fever and respiratory symptoms >6 days (AUC = 0.79), and PCT <0.25 μg/L (AUC = 0.81) improved diagnostic performance (AUC = 0.90) (P = .05).Conclusions. A combination of clinical features and biomarkers may aid physicians in identifying patients at high risk for Mp CAP.

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Section: Study Populationmentioning

confidence: 64%

Section: Patientsmentioning

confidence: 99%

Section: Specimen Collection and Diagnostic Testingmentioning

confidence: 99%

Section: Specimen Collection and Diagnostic Testingmentioning

confidence: 99%

mentioning

confidence: 99%

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Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Sauteur

Krautter

Ambroggio

et al. 2019

Clinical Infectious Diseases

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Mucocutaneous Eruptions in Acutely Ill Pediatric Patients—Think of Mycoplasma pneumoniae (and Other Infections) First

Ramien

Bruckner

2020

JAMA Dermatol

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Frequency and Clinical Presentation of Mucocutaneous Disease Due to Mycoplasma pneumoniae Infection in Children With Community-Acquired Pneumonia

et al. 2020

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The diagnosis of Mycoplasma pneumoniae infection as the cause of mucocutaneous disease is challenging because current diagnostic tests are not able to differentiate M pneumoniae infection from carriage. OBJECTIVE To examine the frequency and clinical presentation of M pneumoniae-induced mucocutaneous disease in children with community-acquired pneumonia (CAP) using improved diagnostics. DESIGN, SETTING, AND PARTICIPANTS This prospective, longitudinal cohort study included 152 children aged 3 to 18 years with CAP enrolled in a CAP study from May 1, 2016, to April 30, 2017, at the University Children's Hospital Zurich. Children were inpatients or outpatients with clinically defined CAP according to the British Thoracic Society guidelines. Data analysis was performed from July 10, 2017, to June 29, 2018. MAIN OUTCOMES AND MEASURES Frequency and clinical presentation of M pneumoniaeinduced mucocutaneous disease in childhood CAP. Mycoplasma pneumoniae infection was diagnosed by polymerase chain reaction (PCR) of oropharyngeal samples and confirmed with the measurement of specific peripheral blood IgM antibody-secreting cells by enzyme-linked immunospot assay to differentiate M pneumoniae-infected patients from carriers with CAP caused by other pathogens. Mucocutaneous disease was defined as any eruptive lesion that involved skin and/or mucous membranes occurring during the CAP episode. RESULTS Among 152 enrolled children with CAP (median [interquartile range] age, 5.7 [4.3-8.9] years; 84 [55.3%] male), 44 (28.9%) tested positive for M pneumoniae by PCR; of these, 10 children (22.7%) developed mucocutaneous lesions. All 10 patients with mucocutaneous eruptions tested positive for specific IgM antibody-secreting cells. Skin manifestations were found in 3 cases (2.8%) of M pneumoniae PCR-negative CAP (P < .001). The spectrum of M pneumoniae-induced mucocutaneous disease included M pneumoniae-induced rash and mucositis (3 cases [6.8%]), urticaria (2 cases [4.5%]), and maculopapular skin eruptions (5 cases [11.4%]). Two patients had ocular involvement as the sole mucosal manifestation (bilateral anterior uveitis and nonpurulent conjunctivitis). Patients with M pneumoniae-induced mucocutaneous disease had longer duration of prodromal fever (median [interquartile range], 10.5 [8.3-11.8] vs 7.0 [5.5-9.5] days; P = .02) and higher C-reactive protein levels (median [interquartile range], 31 vs 16 [7-23] mg/L; P = .04) than patients with CAP due to M pneumoniae without mucocutaneous manifestations. They were also more likely to require oxygen (5 [50%] vs 1 [5%]; P = .007), to require hospitalization (7 [70%] vs 4 [19%]; P = .01), and to develop long-term sequelae (3 [30%] vs 0; P = .03). CONCLUSIONS AND RELEVANCEMucocutaneous disease occurred significantly more frequently in children with CAP due to M pneumoniae than in children with CAP of other origins. Mycoplasma pneumoniae-induced mucocutaneous disease was associated with increased systemic inflammation, morbidity, and a higher risk of long-term sequelae.

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Diagnosis of Mycoplasma pneumoniae Pneumonia with Measurement of Specific Antibody-Secreting Cells

Cited by 34 publications

References 12 publications

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Mucocutaneous Eruptions in Acutely Ill Pediatric Patients—Think of Mycoplasma pneumoniae (and Other Infections) First

Frequency and Clinical Presentation of Mucocutaneous Disease Due to Mycoplasma pneumoniae Infection in Children With Community-Acquired Pneumonia

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