Emerging Role of Mycoplasma pneumoniae in Children with Acute Pharyngitis

Esposito, Susanna; Cavagna, Roberta; Bosis, Samantha; Droghetti, Roberta; Faelli, Nadia; Principi, Nicola

doi:10.1007/s10096-002-0780-7

Cited by 31 publications

(27 citation statements)

References 14 publications

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“…Inflammation of the throat may be present, especially in children, with or without cervical adenopathy, and conjunctivitis and myringitis sometimes occur (7,125,152). Children under 5 years of age are most likely to manifest coryza and wheezing, and progression to pneumonia is relatively uncommon, whereas older children aged 5 to 15 years are more likely to develop bronchopneumonia, involving one or more lobes, sometimes requiring hospitalization (137,273,392).…”

Section: Vol 17 2004 M Pneumoniae As a Human Pathogen 707mentioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur

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Section: Vol 17 2004 M Pneumoniae As a Human Pathogen 707mentioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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“…It has recently been demonstrated that a significant part of non-streptococcal acute pharyngitis may be associated with Mycoplasma pneumoniae and/or Chlamydia pneumoniae infection, but it has not been established whether these atypical bacteria act simply as co-pathogens or as primary aetiological agents, nor is it known what the outcome of such infections is when they are not treated with antibiotics Esposito et al, 2002b). Definition of the real role of M. pneumoniae and C. pneumoniae in causing acute pharyngitis would be useful for deciding the best diagnostic and therapeutic approach.…”

Section: Introductionmentioning

confidence: 99%

“…11 years) without any history of respiratory tract infection or antibiotic treatment in the 3 months before enrolment, who were seen for minor surgical problems, were enrolled as a control group. The study protocol was approved by the institutional review board of the University of Milan and written informed consent was obtained from the parents or legal guardians of all participants.Upon enrolment, systematic recordings were made of the children's demographic characteristics and medical history by using standardized written questionnaires Esposito et al, 2002b). Questions included duration of breast-feeding, living conditions, childcare attendance, number and age of family members, birth rank, smoking habits of family members living together, number and type of respiratory infections in the previous 6 months, presence of a history of recurrent pharyngitis (defined as at least three acute episodes in the 6 months preceding enrolment) (Korppi, 1997;Esposito et al, 2002b) and number and type of antimicrobials administered during the previous 6 months.…”

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Aetiology of acute pharyngitis: the role of atypical bacteria

Esposito

Blasi

Bosis

et al. 2004

Journal of Medical Microbiology

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In order to establish the role of atypical bacteria and compare characteristics of different infectious agents in acute pharyngitis, 127 patients with acute pharyngitis (66 males; median age, 5 . 33 years; range, 6 months to 14 years) and 130 healthy subjects of similar sex and age were studied. Serology with paired samples and PCR on nasopharyngeal aspirates and throat cultures were used to identify bacteria and viruses. Viruses were identified in 43 patients (33 . 8 %) and five controls (3 . 8 %; P , 0 . 0001), potential bacterial pathogens in 34 patients (26 . 8 %) and 26 controls (20 %; P ¼ 0 . 256) and mixed viral/bacterial pathogens in 26 patients (20 . 5 %) and none of the controls (P , 0 . 0001). The main aetiological agents were adenovirus, respiratory syncytial virus (RSV), Mycoplasma pneumoniae, Streptococcus pyogenes and Chlamydia pneumoniae. M. pneumoniae was the agent found most frequently as a single pathogen. A history of recurrent pharyngitis, having older siblings and a negative outcome were significantly more common among patients with acute M. pneumoniae infection than among those with infections due to other pathogens or healthy controls. This study demonstrates that: (i) adenovirus and RSV have a prominent role in acute pharyngitis; (ii) S. pyogenes is found frequently, but it is not possible to distinguish simple carriers from patients with a true infection; (iii) M. pneumoniae appears to be able to cause acute pharyngitis per se; and (iv) C. pneumoniae seems to be mainly a co-pathogen. To avoid the risk of an incorrect therapeutic approach, simple laboratory investigations that allow rapid identification of M. pneumoniae infections are urgently needed. INTRODUCTIONAcute pharyngitis is one of the most common childhood illnesses to be diagnosed in an outpatient setting (Bisno et al., 1997(Bisno et al., , 2002Bisno, 2001). Viruses and Streptococcus pyogenes are considered to be the most frequent causes of this disease, but particular attention is usually given only to streptococcal cases, as they may be followed by severe early and late complications and are the only ones for which antibiotic treatment is definitely indicated (Bisno et al., 1997(Bisno et al., , 2002Bisno, 2001).It has recently been demonstrated that a significant part of non-streptococcal acute pharyngitis may be associated with Mycoplasma pneumoniae and/or Chlamydia pneumoniae infection, but it has not been established whether these atypical bacteria act simply as co-pathogens or as primary aetiological agents, nor is it known what the outcome of such infections is when they are not treated with antibiotics Esposito et al., 2002b). Definition of the real role of M. pneumoniae and C. pneumoniae in causing acute pharyngitis would be useful for deciding the best diagnostic and therapeutic approach. If these bacteria are primary causes of pharyngitis, and if the disease is likely to have a more complicated course unless treated with adequate antimicrobial agents, some cases that are not usually treated (as they are considered t...

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“…Mycoplasma pneumoniae is a common respiratory bacterial pathogen that affects both the upper and lower respiratory tracts of children and adults (1)(2)(3)(4)(5)(6)(7)(8)(9). More recent data demonstrate an association between M. pneumoniae respiratory infection and reactive airway disease and asthma (10)(11)(12)(13)(14)(15).…”

mentioning

confidence: 99%

Variation in Colonization, ADP-Ribosylating and Vacuolating Cytotoxin, and Pulmonary Disease Severity among Mycoplasma pneumoniae Strains

Techasaensiri¹,

Tagliabue²,

Cagle³

et al. 2010

Am J Respir Crit Care Med

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Rationale: Mycoplasma pneumoniae was recently discovered to produce an ADP-ribosylating and vacuolating cytotoxin, designated CARDS toxin, which is hypothesized to be a primary pathogenic mechanism responsible for M. pneumoniae-induced pulmonary inflammation. It is unknown if cytotoxin production varies with M. pneumoniae strain or if variation in cytotoxin production affects pulmonary disease severity. Objectives: To examine the production of CARDS toxin by various strains of M. pneumoniae and compare the disease manifestations elicited by these strains in an experimental model of M. pneumoniae respiratory infection. Methods: BALB/c mice were inoculated once intranasally with SP4 broth (negative control) or three different M. pneumoniae strains: M129-B7, M129-B9, or S1. Mice were assessed at 1, 2, 4, 7, 10, and 14 days after inoculation. Outcome variables included comparisons among M. pneumoniae strains relative to bronchoalveolar lavage (BAL) M. pneumoniae quantitative culture, CARDS toxin-based PCR, and CARDS toxin protein determinations, as well as cytokine and chemokine concentrations. Graded lung histopathologic score (HPS) was also assessed. Measurements and Main Results: CARDS toxin concentrations were significantly increased in mice inoculated with strain S1 compared with mice inoculated with M129-B7 or M129-B9 strains. Quantitative M. pneumoniae culture and polymerase chain reaction were also significantly greater in mice infected with S1 strain compared with the other two strains, as were lung HPS and concentrations of IFN-g, IL-12, IL-1a, macrophage inflammatory protein-1a, and keratinocytederived chemokine. In addition, a significant positive correlation was found between CARDS toxin concentration and lung HPS. Conclusions: CARDS toxin concentrations in BAL are directly linked to the ability of specific M. pneumoniae strains to colonize, replicate, and persist, and elicit lung histopathology. This variation among strains may predict the range in severity of pulmonary disease observed among patients.Keywords: Mycoplasma pneumoniae; toxin; pneumonia; asthma; ADPribosylating Mycoplasma pneumoniae is a common respiratory bacterial pathogen that affects both the upper and lower respiratory tracts of children and adults (1-9). More recent data demonstrate an association between M. pneumoniae respiratory infection and reactive airway disease and asthma (10-15). Although M. pneumoniae has been recognized as a significant clinical pathogen for decades, its virulence determinants have only been partially deciphered. M. pneumoniae is believed to primarily act as an extracellular parasite, with its pathogenicity dependent on its attachment to respiratory epithelium and subsequent initiation of injury to the host. Much investigation has been directed at understanding the mechanisms responsible for the essential process of extracellular attachment (16)(17)(18)(19). In addition, M. pneumoniae has been reported to possess invasive and intracellular survival capabilities. However, the microbial factors responsible f...

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Emerging Role of Mycoplasma pneumoniae in Children with Acute Pharyngitis

Cited by 31 publications

References 14 publications

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

Aetiology of acute pharyngitis: the role of atypical bacteria

Variation in Colonization, ADP-Ribosylating and Vacuolating Cytotoxin, and Pulmonary Disease Severity among Mycoplasma pneumoniae Strains

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