Study of Two Separate Types of Macrolide-Resistant Mycoplasma pneumoniae Outbreaks

Abstract

bTo study the complete natural process of a Mycoplasma pneumoniae outbreak in a semiclosed room such as a primary school room, we investigated two separate M. pneumoniae outbreaks involving 81 students in total in two primary schools in Hangzhou, China. M. pneumoniae isolates from pharyngeal swabs were detected by fluorescence quantitative real-time PCR (RT-PCR) and culture. The class in school M had 39 students, with 12 (30.8%) with positive M. pneumoniae detection results. The class from school J had 42 students, with 13 (31.0%) positive. The strains from two classes were confirmed to represent two clones (3/4/5/7/2 and 5/4/5/7/2) and to be macrolide resistant (A2063G) according to P1 and multilocus variable-number tandem-repeat analysis (MLVA) genotyping, determination of MIC of antibiotics, and sequencing. Students with M. pneumoniae isolates detected were divided into three groups: those carrying the isolates, those with upper respiratory tract infection (URI), and those with pneumonia. Longitudinal sampling performed using pharyngeal swabs showed that the persistence of M. pneumoniae was longest in the group of students with pneumonia. M. pneumoniae causes pneumonia outbreaks in schools, and the incidence of pneumonia has a higher rate than that of URI. The persistence of M. pneumoniae, with a median duration of 79.50 days in the group of students with pneumonia, differs from that of the infection state. Mycoplasma pneumoniae is one of the most common pathogens causing respiratory infection in both children and adults. It is an important pathogen that causes community-acquired pneumonia (CAP). About 4% to 20.8% of CAP cases in adults and 23% to 30% of cases in children are due to M. pneumoniae, especially in children older than 5 years of age, for whom the proportion is nearly 50% (1-5). It may cause various respiratory tract infections such as pharyngitis, croup, tracheobronchitis, and bronchiolitis besides pneumonia. Some data showed that the presence of M. pneumoniae in the upper respiratory tract was common in asymptomatic children, while others indicated that there was no evidence of asymptomatic carriage (6-8).M. pneumoniae causes numerous outbreaks in closed or semiclosed settings such as kindergartens, primary schools, middle schools, and universities (9-13). In China, M. pneumoniae infection is not a notifiable disease, so the prevalence of M. pneumoniae infection in schools is unclear. However, outbreaks of M. pneumoniae infections in semiclosed settings have been reported in recent years, and a resistant strain has emerged (12). In this study, we collaborated with the Center for Disease Control and Prevention (CDC) of Hangzhou, China, and investigated the prevalence of M. pneumoniae infection in two classes in two primary schools in Hangzhou, China. Therefore, this study helped us to get a better understanding of the complete natural process of M. pneumoniae outbreak and its results will contribute to prevention of M. pneumoniae infection in schools in the future. MATERIALS AND METHODSEthics sta...

Outbreak of macrolide-resistant mycoplasma pneumoniae in a primary school in Beijing, China in 2018

“…Subsequently, cases began to appear in the neighboring class. This result was different from previous research result of outbreaks in two primary schools [19]. This result indicates that good environmental and hygienic conditions are important for the prevention and control of respiratory infections disease outbreaks.…”

“…Zheng et al reported that the MRMP rates increased from 17% in 2005 to 76% in 2006 and 100% in 2007 and 2008 in Shanghai, China [11]. Wang et al reported that the MRMP was at a high rate of more than 90% from 2008 to 2012 in Beijing [19]. The above research results showed that MRMP spread rapidly in parts of Asia.…”

“…In China, M. pneumoniae infection is not a notifiable disease, so the prevalence of M. pneumoniae infection in schools is unclear and the severity of M. pneumoniae outbreaks was still under discussion. However, several outbreaks of M. pneumoniae have been reported at schools in China, and macrolide-resistant strains have emerged [18, 19]. This is the largest outbreak of a macrolide-resistant strain of M. pneumoniae at a primary school in China in recent years and this outbreak attracted widespread concerns from local governments, health administrative departments and public health departments.…”

“…In China, M. pneumoniae infection is not a notifiable disease, most patients infected with MP are seldom symptomatic, patients rarely seek medical attention, and the clinical syndrome overlaps with other pneumonia etiologies, so the M. pneumoniae infection prevalence in the community was widely underestimated. However, several recent outbreaks of M. pneumoniae infections among children and adults have been reported, and macrolide-resistant strains have emerged [18, 19].…”

Characteristics and Outcome of Severe Mycoplasma pneumoniae Pneumonia Admitted to PICU in Shanghai: A Retrospective Cohort Study

“…In South Africa, Carrim et al ( 10 ) found age under 6 years to be an independent risk factor for severe disease (odds ratio, 7.1; 95% CI, 1.7–28.7). High levels of macrolide resistance have been noted in Japan (50–90%) ( 11 ) and China (90–100%) ( 12 , 13 ). Routine macrolide resistance monitoring was not systematically in Europe and the United States, which may contribute to the under-detection of macrolide-resistant MP or reflect low levels of macrolide resistance reported ( 14 , 15 ).…”