Pneumonia Characteristics of Hospitalized Children Infected with Macrolide-Resistant Mycoplasma Pneumoniae

Abstract Background: To investigate the drug resistance and clinical characteristics of hospitalized children with drug-resistant Mycoplasma pneumoniae pneumonia (MRMP).Methods: Sixty patients with MPP admitted to the Second Pediatric Respiratory Ward of Shengjing Hospital, Affiliated to China Medical University from November 2016 to February 2017 were enrolled in the study.Results: Of these 53/60 (88.3%) patients had Mycoplasma pneumoniae nucleic acid identified by throat swab. 23S rRNA V region gene sequencing was performed, 47/49 (95.9%) had mutation sites, including 46 cases of A2063G, one case of A2064G, two cases of no mutation, and a final drug resistance rate of 95.9%. The summary characteristics of the 47 cases of drug-resistant MPP were based on 22 male and 25 female patients. The onset age was 6.9 ± 2.5 years and the total fever duration was 9.8 ± 3.7 days. The leukocyte count during the acute phase was (8,300 ± 4,200) cells/mm3, C-reactive Protein (CRP) was 18.2 (8.2–32.5) mg/L, neutrophil/lymphocyte ratio (NLR) was 2.1 (1.5–3.3), There was no significant difference between the acute phase and the convalescent phase for leukocyte count, P = 0.336. The NLR and CRP levels were significantly higher during the acute phase compared to the recovery period (P < 0.05). The level of lactate dehydrogenase (LDH) increased in 65.7% of patients, with a median of 248.5 (200.0–299.7) U/L. D-dimer levels were elevated in 59.4% of patients, with a median of 301.0 (188.5–545.0) mg/L. A total of 23/47 (48.9%) patients were diagnosed with severe MPP. The incidence of extra-pulmonary complications was 38.2%. Conclusions: In summary, MRMP patients had a fever of long duration, higher inflammatory index, higher LDH and D-dimer levels, and an increased incidence of extra-pulmonary complications.

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Mutations in domain V of Mycoplasma pneumoniae 23S rRNA are not associated with clinical characteristics of M. pneumoniae pneumonia in children: a case control study

10.21203/rs.2.23539/v1 ◽

2020 ◽

Author(s):

Huan Deng ◽

Yifan Zhu ◽

Jiamin Zhang ◽

Qiangquan Rong ◽

Yao Quan ◽

...

Keyword(s):

Mycoplasma Pneumoniae ◽

Lymphocyte Count ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Laboratory Data ◽

Point Mutations ◽

Community Acquired Pneumonia ◽

Pulmonary Complications ◽

23S Rrna ◽

Domain V

Abstract Background Mycoplasma pneumoniae (MP) is a common agent of community-acquired pneumonia in children and young adults that can lead to refractory or persistent Mycoplasma pneumoniae pneumonia (MPP). Macrolide-resistant MP harbors point mutations in domain V of 23S ribosomal Ribonucleic Acid (rRNA) with substitutions detected at positions 2063, 2064, 2067 and 2617. This study’s purpose is to investigate the prevalence and clinical characteristics of mutations in domain V of MP 23S rRNA. Methods We sequenced the 23S rRNA domain V of MP strains collected from children with MPP. Clinical and laboratory data were also obtained, including gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-Deoxyribonucleic Acid (DNA) load at enrollment, leukocyte count, neutrophil count, and lymphocyte count, immunomodulators treatment and pulmonary complications.Results Of 276 strains, 255 (92.39 %) harbored A to G transition at the position 2063 (A2063G), and 21 (7.61 %) were not mutated. There were no significant differences in gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-DNA load at enrollment, hospitalization days, lymphocyte count and pulmonary complications when patients were stratified based on the presence or absence of domain V mutations. We also found that children with refractory MPP experienced higher MP-DNA load than the non-refractory MPP, but the prevalence of domain V mutations was comparable.Conclusions We found that clinical MP strains harbored very high mutation rate in 23S rRNA domain V, especially A2063G mutation. However, these mutations were not associated with clinical symptoms, laboratory results, pulmonary complications and development of refractory pneumonia. Instead, MP-DNA load was significantly different between refractory and non-refractory MPP.

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CBNAAT Based Identification and Demographic Pattern of Drug Resistant Mycobacterium Tuberculosis in South Kashmir, India- a One Year Retrospective Study

Microbiology Research Journal International ◽

10.9734/mrji/2021/v31i430308 ◽

2021 ◽

pp. 1-5

Author(s):

Rubeena Hakkak ◽

Saqib Rishi ◽

Javid Ahmed Bhat

Keyword(s):

Drug Resistance ◽

Mycobacterium Tuberculosis ◽

Retrospective Study ◽

State Level ◽

Prolonged Treatment ◽

Drug Resistant ◽

Average Percentage ◽

The World ◽

Mdr Tb ◽

Extra Pulmonary

India is the highest TB burden country in the world having an estimated incidence of 26.9 lakh cases in 2019. With a population of 1.32 billion, India has the highest burden of drug resistant TB (DR-TB) in the world. North zone of India is the second highest MDR-TB prevalent zone after the West zone of India. MDR TB treatment involves prolonged treatment with injectable second-line drugs, associated with more adverse effects, suboptimal treatment outcomes and higher risks of mortality compared to patients with drug-sensitive TB and those with lesser resistant forms of TB. Materials methods: This retrospective study was conducted in the department of Microbiology Government Medical College Anantnag, data was analyzed from March 2017 to February 2018. Non-sterile specimens were processed by Modified Petroff Method. Sterile specimens were concentrated by centrifugation and smear and cultures was inoculated from the sediment. CBNAAT assay was performed by Gene Xpert (Cepheid) 4 system according to the manufacturers’ recommendations. Results: Of the total 1497 clinically suspected tuberculosis specimens collected, 1370 (91.5%) were pulmonary and 127 (8.5%) were presumptive extra pulmonary tuberculosis received from different anatomical sites. Maximum clustering of cases was seen in 10-20 years age group. Out of the total 1497 samples 200 were CBNAAT confirmed Mycobacterium Tuberculosis positive samples. In which 155 were pulmonary and 45 were extra pulmonary. The average percentage positivity rate (i.e. percentage of MTB positive samples out of total samples tested) was 13.3% (200/1497). Rifampicin resistance (RR-TB) was seen in 5.5% (11/200) samples. Out of the samples detected positive (200): 155 were pulmonary samples and out of these 155 pulmonary samples 8 were found to be RR MTB 5.1% (8/155). Also out of the 200 positive samples 45 were extra pulmonary and out of these 45 extra pulmonary samples 3 were found to be RR MTB 6.6% (3/45). Conclusion: In this study we found that in our region 5.5% cases of TB were RR-TB, 3.2% were new cases and 13% RR-TB was seen in previously treated cases of MTB. The screening of drug resistance has to be expanded to offer universal DST including expanded DST .The second and most important activity is to strengthen drug resistance surveillance under the various national programs with inclusion of laboratories in the private sector as well. The state level regional studies also give us the opportunity to plan and execute intervention prioritization, based on the drug resistance trends observed.

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Mycoplasma pneumoniae 23S rRNA A2063G mutation does not influence chest radiography features in children with pneumonia

Journal of International Medical Research ◽

10.1177/0300060517716312 ◽

2017 ◽

Vol 46 (1) ◽

pp. 150-157 ◽

Cited By ~ 2

Author(s):

Huan Deng ◽

Jun Rui ◽

Deyu Zhao ◽

Feng Liu

Keyword(s):

Mycoplasma Pneumoniae ◽

Chest Radiography ◽

Pulmonary Complications ◽

23S Rrna ◽

Imaging Data ◽

Radiographic Findings ◽

Radiographic Features ◽

Before And After ◽

Domain V ◽

Inflammation Score

Objective To measure the rate of the A2063G mutation in the Mycoplasma pneumoniae ( M. pneumoniae) 23S rRNA domain V in children with pneumonia and to determine the correlation between radiographic findings and the presence of the A2063G mutation. Methods Patients who were hospitalized with a confirmed diagnosis of M. pneumoniae pneumonia were enrolled in this study. M. pneumoniae strains were collected for genotype analysis. Chest radiography was performed on all children prior to and following macrolide treatment. Clinical and imaging data were obtained. Results Of 211 patients, 195 (92.42%) harboured M. pneumoniae with the A2063G mutation. No significant differences were identified in inflammation score, chest radiography inflammation absorption grade before and after macrolide treatment, or pulmonary complications (atelectasis, hydrothorax, or pleuritis) prior to macrolide treatment when children were stratified based on the presence or absence of the A2063G mutation. Conclusions A high proportion of children with pneumonia harboured strains of M. pneumoniae with the A2063G mutation in the 23S rRNA domain V. However, no obvious chest radiographic features of M. pneumoniae pneumonia were associated with the A2063G variant.

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Hemostatic Alterations in Patients with Acute, Unilateral Vestibular Paresis

Otolaryngology ◽

10.1067/mhn.2001.114795 ◽

2001 ◽

Vol 124 (4) ◽

pp. 401-407 ◽

Cited By ~ 11

Author(s):

Bruno Fattori ◽

Andrea Nacci ◽

Augusto Casani ◽

Renza Cristofani ◽

Andrea Sagripanti

Keyword(s):

Prothrombin Time ◽

Acute Phase ◽

Plasma Levels ◽

Protein C ◽

Leukocyte Count ◽

Blood Parameters ◽

Ménière’S Disease ◽

Lipoprotein A ◽

D Dimer

OBJECTIVES: The etiopathogenesis of acute unilateral peripheral vestibulopathy (APV) still remains a matter of debate; ischemic changes in the circulation of the labyrinth may play a role. We consequently looked for possible hemostasis alterations in a group of patients with APV of an unknown nature. METHODS: We evaluated blood parameters known to be involved in circulation disorders, including total and HDL cholesterol, tryglycerides, apolipoprotein A and B, lipoprotein(a), homocysteine, folate, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, antithrombin III, protein C, protein S, activated protein C resistance, and anticardiolipin IgG and IgM antibodies. A series of 23 patients affected with APV were consecutively referred to our department, in the acute phase, before treatment, and in the follow-up phase after 4 to 6 weeks of pharmacologic washout. The aforementioned blood parameters were also measured in a series of 15 patients with Menière's disease. RESULTS: The patients with APV in the acute phase compared with the patients with Menière's disease in the acute phase exhibited increased plasma levels of fibrinogen (mean, 338.3 ± 135.9 SD vs 271.3 ± 69.8 SD mg/dL, P = 0.05), increased plasma levels of D-dimer (mean, 320 ± 207.8 SD vs 226.7 ± 138.7 SD NG/mL), enhanced plasma levels of lipoprotein(a) (41.4 ± 38.6 SD vs 16 ± 18.2 SD mg/dL, F = 5.67, P = 0.02), high leukocyte count (9.1 ± 2.7 SD vs 6.5 ± 1.3 SD x 10 3 /μL; F = 8.42, P < 0.006), and low serum folate concentration (5.3 ± 1.8 SD vs 7.1 ± 2.7 NG/mg; F = 4.34, P = 0.04). During follow-up the prothrombin time was prolonged (F = 4.34, P = 0.04) and leukocyte count decreased (F = 7.39, P < 0.019) in the APV patients, whereas fibrinogen, D-dimer, lipoprotein(a), and folate were unchanged. CONCLUSION: Our results provide evidence suggesting an involvement of the hemostatic system in APV.

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Mutations in domain V of Mycoplasma pneumoniae 23S rRNA and clinical characteristics of pediatric M. pneumoniae pneumonia in Nanjing, China

Journal of International Medical Research ◽

10.1177/03000605211016376 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110163

Author(s):

Changdi Xu ◽

Huan Deng ◽

Jiamin Zhang ◽

Yifan Zhu ◽

Qiangquan Rong ◽

...

Keyword(s):

Hospital Stay ◽

Mycoplasma Pneumoniae ◽

Ribosomal Rna ◽

Clinical Characteristics ◽

Laboratory Data ◽

Pulmonary Complications ◽

23S Rrna ◽

High Prevalence ◽

Domain V ◽

23S Ribosomal Rna

Objective To investigate the prevalence of mutations in domain V of Mycoplasma pneumoniae (MP) 23S ribosomal RNA (rRNA) and the clinical characteristics of pediatric MP pneumonia (MPP) in Nanjing, China. Methods Domain V of 23S rRNA was sequenced in MP strains collected from children diagnosed with MPP in Nanjing. Clinical and laboratory data were obtained. Results Among the 276 MP strains, 255 (92.39%) harbored mutations, primarily A2063G in domain V of MP 23S rRNA. When children were stratified according to the presence or absence of mutations, no significant differences were found in sex, age, the MP DNA load at enrollment, lymphocyte counts, pulmonary complications, immunomodulator levels, fever duration, the duration of fever after macrolide therapy, and hospital stay. The prevalence of refractory MPP in the two groups was similar. Children with refractory MPP exhibited higher MP DNA loads than those with non-refractory MPP. Conclusions Despite the high prevalence of the A2063G mutation in domain V of MP 23S rRNA, mutations were not associated with the clinical characteristics of MPP. The MP DNA load significantly differed between refractory and non-refractory MPP.

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The Level of D-Dimer Is Positively Correlated With the Severity of Mycoplasma pneumoniae Pneumonia in Children

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.687391 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yan Zheng ◽

Lingling Hua ◽

Qiannan Zhao ◽

Mengyao Li ◽

Meixia Huang ◽

...

Keyword(s):

Antibiotic Therapy ◽

Mycoplasma Pneumoniae ◽

Laboratory Data ◽

Clinical Manifestations ◽

Pulmonary Complications ◽

Normal Group ◽

Fever Hospital ◽

Duration Of Treatment ◽

Group D ◽

D Dimer

ObjectiveMycoplasma pneumoniae pneumonia (MPP) is an important disease in children. Studies have demonstrated that the levels of D-dimer are elevated in some children with MPP, especially those with thrombotic complications. However, the potential association between MPP and D-dimer remains unclear. In our study, we sought to explore the relationship between the levels of plasma D-dimer and clinical characteristics of MPP patients.MethodsRetrospective analysis was conducted on 356 patients who were hospitalized in our hospital for MPP between January 1, 2017, and December 31, 2019. According to the peak value of D-dimer, patients were divided into three groups: the normal group (D-dimer<0.55 mg/L), the mild-moderately elevated group (D-dimer 0.55–5.5 mg/L) and the severely elevated group (D-dimer >5.5 mg/L). The demographic and clinical information, radiological findings, laboratory data, and treatments of patients were compared among different groups.Results106 patients were in the normal group, 204 patients were in the mild-moderately elevated group, and 46 patients were in the severely elevated group. More severe clinical and radiographic manifestations, longer length of fever, hospital stay and antibiotic therapy duration, higher incidences of extra-pulmonary complications, refractory MPP (RMPP), severe MPP (SMPP) were found in the elevated group, when compared with the normal group (P<0.01). Meanwhile, we found that the percentage of neutrophil (N%) and CD8+ lymphocyte (CD8+%), C-reactive protein (CRP), lactate dehydrogenase (LDH), interleukin (IL)-6, IL-10, and interferon-gamma (IFN-γ) trended higher with increasing D-dimer, whereas the percentage of lymphocyte (L%) and prealbumin (PAB) trended lower (P<0.01). In addition, the proportions of patients requiring oxygen therapy, glucocorticoid, bronchoscopy, immunoglobulin use, thoracentesis, or ICU admission were significantly higher in the severely elevated group than those in the other two groups (P<0.01). Correlation analysis showed that N%, L%, CRP, LDH, IL-10, length of fever, length of stay, and length of antibiotic therapy had strong correlations with the level of D-dimer.ConclusionsMPP patients with higher levels of D-dimer had more severe clinical manifestations and needed longer duration of treatment, which might be closely related to the severity of lung inflammation after MP infection.

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Mutations in domain V of Mycoplasma pneumoniae 23S rRNA are not associated with clinical characteristics of M. pneumoniae pneumonia in children: a case control study

10.21203/rs.2.23539/v2 ◽

2020 ◽

Author(s):

Huan Deng ◽

Yifan Zhu ◽

Jiamin Zhang ◽

Qiangquan Rong ◽

Yao Quan ◽

...

Keyword(s):

Mycoplasma Pneumoniae ◽

Lymphocyte Count ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Laboratory Data ◽

Point Mutations ◽

Community Acquired Pneumonia ◽

Pulmonary Complications ◽

23S Rrna ◽

Domain V

Abstract Background Mycoplasma pneumoniae (MP) is a common agent of community-acquired pneumonia in children and young adults that can lead to refractory or persistent Mycoplasma pneumoniae pneumonia (MPP). Macrolide-resistant MP harbors point mutations in domain V of 23S ribosomal Ribonucleic Acid (rRNA) with substitutions detected at positions 2063, 2064, 2067 and 2617. This study aims to investigate the prevalence and clinical characteristics of mutations in domain V of MP 23S rRNA. Methods We sequenced the 23S rRNA domain V of MP strains collected from children with MPP. Clinical and laboratory data were also obtained, including gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-Deoxyribonucleic Acid (DNA) load at enrollment, leukocyte count, neutrophil, and lymphocyte count, immunomodulators treatment and pulmonary complications. Results Of 276 strains, 255 (92.39 %) harbored A to G transition at the position 2063 (A2063G), and 21 (7.61 %) were not mutated. There were no significant differences in gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-DNA load at enrollment, hospitalization days, lymphocyte count and pulmonary complications when patients were stratified based on the presence or absence of domain V mutations. We also found that children with refractory MPP experienced higher MP-DNA load than the non-refractory MPP, but the prevalence of domain V mutations was no statistical difference. Conclusions We found that clinical MP strains harbored very high mutation rate in 23S rRNA domain V, especially A2063G mutation. However, these mutations were not associated with clinical symptoms, laboratory results, pulmonary complications and development of refractory MPP. Instead, MP-DNA load was significantly different between refractory and non-refractory MPP.

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Emergence of Macrolide-Resistant Mycoplasma pneumoniae during an Outbreak in a Primary School: Clinical Characterization of Hospitalized Children

Pathogens ◽

10.3390/pathogens10030328 ◽

2021 ◽

Vol 10 (3) ◽

pp. 328

Author(s):

Daniel Hubert ◽

Roger Dumke ◽

Stefan Weichert ◽

Sybille Welker ◽

Tobias Tenenbaum ◽

...

Keyword(s):

Mycoplasma Pneumoniae ◽

Case Series ◽

Community Acquired Pneumonia ◽

Hospitalized Patients ◽

Macrolide Resistance ◽

23S Rrna ◽

Hospitalized Children ◽

First Case ◽

Potential Link

Mycoplasma pneumoniae (M. pneumoniae) is a common causative pathogen of community-acquired pneumonia. Here, we report the development of macrolide resistance during a school outbreak of severe M. pneumoniae infections in southwest Germany. We conducted a case series to assess the clinical and laboratory characteristics of hospitalized children with M. pneumonia infection and the prevalence of macrolide-resistant M. pneumoniae (MRMP) in this patient group. We retrospectively analyzed 23 children with serologically (19 patients) and/or PCR (eight patients) confirmed M. pneumoniae infection between October 2019 and December 2019. Most of the 15 hospitalized patients had lower respiratory tract infection (n = 10) and required oxygen therapy (83%). The median length of hospitalization was 7 days (range 3–10 days). In 8/15 patients (53.3%) azithromycin and in 4/15 (26.6%) clarithromycin treatment was applied. However, among the five patients for which extended molecular characterization was performed, sequencing of 23S rRNA revealed no mutation only in the first case, but development of macrolide resistance A2058G in four subsequent cases. Hence, we identified a cluster of hospitalized patients with emerging MRMP. Further studies are warranted to confirm a potential link between macrolide resistance and disease severity.

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Association of Variables of Coagulation, Fibrinolysis and Acute-phase with Atherosclerosis in Coronary and Peripheral Arteries and those Arteries Supplying the Brain

Thrombosis and Haemostasis ◽

10.1055/s-0038-1653783 ◽

1995 ◽

Vol 73 (03) ◽

pp. 374-379 ◽

Cited By ~ 140

Author(s):

Jürgen Heinrich ◽

Helmut Schulte ◽

Rainer Schönfeld ◽

Ekkehart Köhler ◽

Gerd Assmann

Keyword(s):

Acute Phase ◽

Coronary Atherosclerosis ◽

Plasminogen Activator Inhibitor ◽

Arterial Disease ◽

Plasma Fibrinogen ◽

Base Line ◽

Peripheral Arteries ◽

Brain Vessels ◽

The Brain ◽

D Dimer

SummaryWe investigated the vessel status of coronary and peripheral arteries and those arteries supplying the brain in 929 consecutive male patients admitted to a coronary rehabilitation unit. The severity of coronary atherosclerosis was scored using coronary angiography. Changes in extracranial brain vessels and manifest cerebrovascular disease (CVD) were determined by B-mode ultrasound and Doppler examination. Peripheral arterial disease (PAD) was diagnosed using base-line and stress oscillography. We assessed variables of coagulation, fibrinolysis, and the acute phase response.There was a significant increase in plasma fibrinogen, plasminogen, d-dimer and C-reactive protein (CRP) with increasing severity of coronary heart disease. Compared to men with unaffected arteries, men with 3 diseased coronary arteries had 58% greater d-dimer concentrations. Patients with CVD and PAD, respectively, also had significantly higher fibrinogen, d-dimer and CRP concentrations. We did not find an association between plasminogen activator inhibitor activity and the severity of coronary atherosclerosis.In conclusion, plasma fibrinogen, d-dimer and CRP concentrations were significantly related to atherosclerosis in the coronary, peripheral and extracranial brain arteries.

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Candida auris and Nosocomial Infection

Current Drug Targets ◽

10.2174/1389450120666190924155631 ◽

2020 ◽

Vol 21 (4) ◽

pp. 365-373 ◽

Cited By ~ 1

Author(s):

Sweety Dahiya ◽

Anil K. Chhillar ◽

Namita Sharma ◽

Pooja Choudhary ◽

Aruna Punia ◽

...

Keyword(s):

Drug Resistance ◽

Pathogenic Fungus ◽

Control Measures ◽

Whole Genome Sequence ◽

Whole Genome ◽

Drug Resistant ◽

Candida Auris ◽

Preventive Control ◽

Identification Techniques ◽

Sensitivity Profile

The existence of the multi-drug resistant (MDR) pathogenic fungus, Candida auris came to light in 2009. This particular organism is capable of causing nosocomial infections in immunecompromised persons. This pathogen is associated with consistent candidemia with high mortality rate and presents a serious global health threat. Whole genome sequence (WGS) investigation detected powerful phylogeographic Candida auris genotypes which are specialized to particular geological areas indicating dissemination of particular genotype among provinces. Furthermore, this organism frequently exhibits multidrug-resistance and displays an unusual sensitivity profile. Identification techniques that are commercialized to test Candida auris often show inconsistent results and this misidentification leads to treatment failure which complicates the management of candidiasis. Till date, Candida auris has been progressively recorded from several countries and therefore its preventive control measures are paramount to interrupt its transmission. In this review, we discussed prevalence, biology, drug-resistance phenomena, virulence factors and management of Candida auris infections.

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