Macrolide-resistant Mycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia

Morozumi, Miyuki; Takahashi, Takashi; Ubukata, Kimiko

doi:10.1007/s10156-009-0021-4

Cited by 187 publications

(215 citation statements)

References 87 publications

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“…A2063G was the only resistance-associated mutation we found out of 4 possible mutations the assay we used can fi nd. This is not surprising because this mutation is reportedly responsible for 90.5% of resistant M. pneumoniae (2). As recently reported from Japan, China, and Germany (2,4,7), we also found resistance in an adult patient.…”

Section: Discussionsupporting

confidence: 89%

“…This led to the suspicion of macrolide-resistant M. pneumoniae. Samples were further analyzed for possible resistance-associated mutations (A2063G/C, A2064G, and A2067G) that constitute 98% of macrolide resistance-associated mutations in M. pneumoniae (2). Real-time PCR of domain V region of the 23S rRNA gene with a high-resolution melt curve analysis utilizing the SYBR Green amplifi cation primers was used (10).…”

Section: The Studymentioning

confidence: 99%

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Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

Averbuch¹,

Hidalgo-Grass²,

Moses³

et al. 2011

Emerg. Infect. Dis.

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Macrolide resistance in Mycoplasma pneumoniae is often found in Asia but is rare elsewhere. We report the emergence of macrolide-resistant M. pneumoniae in Israel and the in vivo evolution of such resistance during the treatment of a 6-year-old boy with pneumonia.M ycoplasma pneumoniae is a leading respiratory pathogen in both pediatric (1,2) and adult (1,3) populations. Macrolides are considered the fi rst line of therapy and are almost the only treatment for children. In recent years, alarming rates of M. pneumoniae with macrolide resistance (<90%) have occurred in eastern Asia, including the People's Republic of China, Japan, and Korea (2,4-7). This was initially reported in children; however, a surge of resistance in adults was recently reported (2,4,7). Macrolide-resistant M. pneumoniae has also been suggested to be associated with a longer course of disease (2,4).In the Western Hemisphere, lower rates of macrolide resistance have been reported (<10%), however, several epidemics with notable complications have occurred (8)(9)(10)(11). We report the detection of macrolide resistance in M. pneumoniae in Israel. The StudyA previously healthy 6-year-old boy was hospitalized after 2 weeks with fever up to 40°C. At onset of illness, a diagnosis of pharyngitis was made. Streptococcus pyogenes was isolated from his throat, and amoxicillin was prescribed without any clinical response. Later, a clinical diagnosis of sinusitis was made, and amoxicillin-clavulanate was prescribed. A chest radiograph done at that time reportedly showed no abnormalities. Laboratory investigation before admission showed leukocytosis of 19,600 cells/mm 3 with 2,200 monocytes/mm 3 and 7,600 neutrophils/mm 3 ; L-lactate dehydrogenase (LDH) was 1,854 U/L (reference value up to 600 U/L).Ten days after the beginning of his illness, his fever decreased for 2 days and then reappeared, together with cough, resulting in hospitalization. At admission, pneumonia of the right middle and lower lobe was confi rmed by chest radiograph. Laboratory tests showed leukocytes within normal ranges, erythrocyte sedimentation rate (ESR) 80/h, and C-reactive protein (CRP) 15 mg/L (reference range up to 0.5 mg/L). Treatment with penicillin was started without clinical improvement. Azithromycin (10 mg/kg/d) was added on the third day. After receiving this treatment, his leukocytes increased to 20,000 cells/mm 3 with ESR 97/h and CRP 22.5 mg/L. The β-lactam coverage was switched to cefuroxime and later to ceftriaxone because no response was observed. Chest ultrasound showed a small pleural effusion. Bronchoscopy showed thick mucus secretions; respiratory specimens tested were negative for respiratory syncytial virus, infl uenza viruses A and B, parainfl uenza virus, human metapneumovirus, and adenovirus, as were results of urine tests for Legionella spp. and blood tests for pneumococcal antigen and cryptococcal antigen.Throat swab specimens were collected and DNA extracted by boiling. Samples were positive for M. pneumoniae by real-time PCR based on the detection of ...

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Section: Discussionsupporting

confidence: 89%

Section: The Studymentioning

confidence: 99%

Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

Averbuch¹,

Hidalgo-Grass²,

Moses³

et al. 2011

Emerg. Infect. Dis.

View full text Add to dashboard Cite

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“…Although the 14-and 15-membered macrolides are generally considered as the first-choice agents against M. pneumoniae infections in children, it has been reported that more than 40z of M. pneumoniae isolates are resistant to macrolides in Japan (1,2). Macrolide-resistant M. pneumoniae is also emerging in several other countries, primarily in children (3)(4)(5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

“…The mutations that induce a high level of macrolide resistance are an A to G transition at position 2063 and an A to C transition at position 2064; whereas, low-level resistance is induced by a C to A or G transition at position 2617 and an A to T transition at position 2063 (1,9). All of the macrolide-resistant M.…”

mentioning

confidence: 99%

In Vitro Activities of 11 Antimicrobial Agents against Macrolide-Resistant Mycoplasma pneumoniae Isolates from Pediatric Patients: Results from a Multicenter Surveillance Study

et al. 2012

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SUMMARY: Macrolide-resistant Mycoplasma pneumoniae is emerging in several countries, and it is mainly observed in children. To our knowledge, we conducted the first multicenter prospective epidemiological study of macrolide-resistant M. pneumoniae in order to investigate regional differences in the susceptibility of macrolide-resistant M. pneumoniae to antibacterial agents. The in vitro activities of 11 antimicrobial agents against macrolide-resistant M. pneumoniae isolates from 5 different areas of Japan were investigated. Among 190 M. pneumoniae isolates from pediatric patients, 124 (65.2z) isolates showed macrolide resistance and possessed an A2063G transition in domain V of the 23S rRNA. These isolates showed high resistance to erythromycin, clarithromycin, and azithromycin with minimum inhibitory concentrations (MICs) AE16 mg/ml. Conversely, quinolones such as garenoxacin, moxifloxacin, tosufloxacin, and levofloxacin exhibited potent antimycoplasmal activity. No regional differences were observed with respect to the MICs among the 5 areas in Japan.

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“…Furthermore, M. pneumoniae infections may also lead to several extra-pulmonary conditions, such as myocarditis, pericarditis, meningitis, neuritis, and hemolytic anemia, sometimes with fatal outcomes [5][6][7]. Because treatment of M. pneumoniae infections with β-lactam antibiotics is ineffective and the clinical manifestations of M. pneumoniae infections are complicated and nonspecific, a rapid, sensitive, and specific laboratory test is vital for early diagnosis of M. pneumoniae infections [8,9].…”

Section: Introductionmentioning

confidence: 99%

Comparison of P1 and 16S rRNA genes for detection of Mycoplasma pneumoniae by nested PCR in adults in Zhejiang, China

Zhou

Chen

et al. 2015

J Infect Dev Ctries

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Introduction: Mycoplasma pneumoniae (M. pneumoniae) is the most common atypical pathogen that causes respiratory infections in humans. Laboratory tests are important in the diagnosis of M. pneumoniae because of the atypical features in clinical signs and symptoms. Nowadays, both the P1 adhesin gene and 16S ribosomal (r) RNA (rRNA) gene of M. pneumoniae have been widely detected by polymerase chain reaction (PCR). The purpose of the present study was to evaluate the most suitable target in the detection of M. pneumonia via nested PCR. Methodology: Both the P1 adhesin gene and 16S rRNA gene for nested PCR reaction conditions were optimized through an orthogonal test and single-factor experiment. Then, the sensitivity of the two sets of targets was evaluated. Finally, based on the optimal conditions, 55 clinical samples of throat swabs collected from adult patients in 2013 were examined by established nested PCR. Result: The results revealed that PCR detection of the 16S rRNA gene was more sensitive than the P1 adhesin gene because the detection limits for both the P1 gene and 16S rRNA gene were at least 100 fg and 10 fg of M. pneumoniae DNA, respectively. Furthermore, the positive rate for detection of the 16S rRNA gene (30/55; 54.5%) was higher than that of the P1 adhesin gene (25/55; 45.5%). Conclusion: Our results indicate that the 16S rRNA gene is more suitable for diagnosis of M. pneumoniae infection than the P1 adhesin gene due to its higher sensitivity and positive rate in clinical samples.

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Macrolide-resistant Mycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia

Cited by 187 publications

References 87 publications

Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

Macrolide Resistance inMycoplasma pneumoniae, Israel, 2010

In Vitro Activities of 11 Antimicrobial Agents against Macrolide-Resistant Mycoplasma pneumoniae Isolates from Pediatric Patients: Results from a Multicenter Surveillance Study

Comparison of P1 and 16S rRNA genes for detection of Mycoplasma pneumoniae by nested PCR in adults in Zhejiang, China

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