Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications

Abstract

Mycoplasma pneumoniae (Mp) is a leading cause of community acquired pneumonia. Knowledge regarding Mp pneumonia obtained from animal models or human subjects has been discussed in many different reports. Accumulated expertise concerning this critical issue has been hard to apply clinically, and potential problems may remain undiscovered. Therefore, our multidisciplinary team extensively reviewed the literature regarding Mp pneumonia, and compared findings from animal models with those from human subjects. In human beings, the characteristic pathological features of Mp pneumonia have been reported as alveolar infiltration with neutrophils and lymphocytes and lymphocyte/plasma cell infiltrates in the peri-bronchovascular area. Herein, we demonstrated the novel aspects of Mp pneumonia that the severity of the Mp pneumonia seemed to depend on the host innate immunity to the Mp, which might be accelerated by antecedent Mp exposure (re-exposure or latent respiratory infection) through up-regulation of Toll-like receptor 2 expression on bronchial epithelial cells and alveolar macrophages. The macrolides therapy might be beneficial for the patients with macrolide-resistant Mp pneumonia via not bacteriological but immunomodulative effects. This exhaustive review focuses on pathogenesis and extends to some therapeutic implications such as clarithromycin, and discusses the various diverse aspects of Mp pneumonia. It is our hope that this might lead to new insights into this common respiratory disease.

In Vitro Activities and Spectrum of the Novel Fluoroquinolone Lascufloxacin (KRP-AM1977)

“…The MIC 50 and MIC 90 values of lascufloxacin against M. pneumoniae were 0.12 and 0.25 g/ml, respectively, which were similar to or slightly superior to those of levofloxacin. The emergence of macrolide resistance in M. pneumoniae has been reported (9), and macrolide-resistant isolates were detected in the present study. The MIC 90 s of clarithromycin and azithromycin were Ͼ16 and 16 g/ml, respectively; on the other hand, lascufloxacin showed potent activity against macrolide-resistant M. pneumoniae clinical isolates.…”

Mycoplasma pneumoniae infection: Basics

“…Importantly, macrolide‐resistant Mp was first isolated from Japanese children in 2000 and in adults in 2007, all of whom possessed a 23S‐rRNA mutation. In the 2000s, the prevalence of macrolide‐resistant Mp having either an A2063G or an A2064G mutation rapidly increased in Japan as well as in East Asia, with a notably high isolation rate (92%) in China (Figure ) …”

Macrolide resistance mechanisms inEnterobacteriaceae: Focus on azithromycin

“…These agents have classically been used in the treatment of infections related to Gram-positive microorganisms, such as respiratory tract infections associated with Streptococcus pneumoniae, Mycoplasma pneumoniae or Legionella pneumophila among other microorganisms, soft tissue infections by Staphylococcus aureus or Streptococcus pyogenes or other infections such as those by Helicobacter pylori (Saraya et al, 2014;U gurlu et al, 2014;Zuckerman, 2004). Furthermore, macrolides rank among the treatments considered for different infections due to Gram-negative microorganisms, such as Bordetella pertussis, Bartonella spp., Chlamydia spp., Neisseria gonorrhoeae, Treponema spp.…”