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

Pathogens ◽  
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.

Clinical outcomes and macrolide resistance in Mycoplasma pneumoniae infection in Scotland, UK

2013 ◽  
Vol 62 (12) ◽  
pp. 1876-1882 ◽  
Author(s):  
Graeme D. Ferguson ◽  
Naomi J. Gadsby ◽  
Sarah S. Henderson ◽  
Alison Hardie ◽  
Pota Kalima ◽  
...  
Keyword(s):  
Critical Care ◽  
Mycoplasma Pneumoniae ◽  
Hospital Setting ◽  
Case Series ◽  
Macrolide Resistance ◽  
23S Rrna ◽  
Resistance Testing ◽  
Rrna Gene ◽  
First Case ◽  
The Uk

Mycoplasma pneumoniae has a cyclical, epidemic pattern of infection and the most recent epidemic occurred in Europe in 2011. Macrolides are recommended for the treatment of M. pneumoniae respiratory tract infection, but macrolide resistance has been reported at low levels in Europe. The aim of the study was to examine the clinical impact of the recent M. pneumoniae epidemic in a hospital setting in Scotland and to determine whether macrolide-resistant strains are present. Data were analysed retrospectively for 307 patients with M. pneumoniae respiratory infection diagnosed in 2010 and 2011 in Edinburgh, UK. Genotypic macrolide resistance testing was also carried out in 32 patients in whom resistance was considered most likely, based on their clinical picture. We found that 175 patients (59 %) were admitted to hospital, 20 (7 %) were admitted to critical care and 97 (38 %) required oxygen. All 48 adult patients (100 %) were admitted to hospital, compared with 127 children (51 %). Adults were also more likely to require oxygen [odds ratio (OR) 4.964, P<0.001, 95 % confidence interval (CI) 2.129–11.803] and to be admitted to critical care (OR 4.909, P = 0.001, 95 % CI 1.735–13.829), compared with children. Macrolide resistance conferred by the 23S rRNA gene mutation was found in samples from 6 out of 32 patients (19 %) in the subset tested. The results suggest that the recent M. pneumoniae epidemic was associated with a significant burden of hospital admission locally. The study also describes the first case series of macrolide-resistant M. pneumoniae in the UK, indicating that macrolide resistance surveillance is warranted in preparation for the next epidemic.

scholarly journals A study of community-acquired Mycoplasma pneumoniae in Yantai, China

2018 ◽  
Vol 49 (2) ◽  
pp. 160-163
Author(s):  
Hong-Xia Yu ◽  
Mao-Mao Zhao ◽  
Zeng-Hui Pu ◽  
Yuan-Rong Ju ◽  
Yan Liu
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Macrolide Resistance ◽  
23S Rrna ◽  
Diagnostic Tools ◽  
Rrna Gene ◽  
Resistance Mutations ◽  
First Line ◽  
Tract Infections

Introduction: Community-acquired pneumonia (CAP) is a global disease responsible for a large number of deaths, with significant economic impact. As diagnostic tools have increased in sensitivity, understanding of the etiology of CAP has begun to change. Mycoplasma pneumoniae is one of the major pathogens causing CAP. Macrolides and related antibiotics are first-line treatments for M. pneumoniae. Macrolide resistance has been spreading for 15 years and now occurs in worldwide. We undertook the first study on macrolide resistance of M. pneumoniae in Yantai. This may be helpful to determine the appropriate therapy for CAP in this population. Objective: To investigate the rate and mechanism of macrolide resistance in Yantai. Methods: Pharyngeal swab samples were collected from adult CAP patients. Samples were assayed by polymerase chain reaction (PCR) and cultivated to test for M. pneumoniae. Nested PCR was used to specifically amplify M. pneumoniae 23S rRNA gene fragments containing mutations, and amplicons were analyzed by CE-SSCP for macrolide resistance mutations. Results were confirmed by sequencing. Twenty-seven strains of M. pneumoniae were isolated and the activities of nine antibiotics against M. pneumoniae were tested in vitro. Results: Out of 128 samples tested, 27 were positive for M. pneumoniae. Mycoplasma 100% macrolides resistance to Mycoplasma pneumoniae. The mechanism of macrolides resistance was A2063G point mutation in the sequence directly binding to macrolides in the 23S rRNA V domain in vitro. The mean pyretolytic time for the fluoroquinolone group was 4.7 ±2.9 d, which was significantly shorter than 8.2 ±4.1 d for the azithromycin group. Conclusions: Macrolides are not the first-line treatment for M. pneumoniae respiratory tract infections in Yantai.

scholarly journals Differences in the Frequency of 23S rRNA Gene Mutations in Mycoplasma pneumoniae between Children and Adults with Community-Acquired Pneumonia: Clinical Impact of Mutations Conferring Macrolide Resistance

2012 ◽  
Vol 56 (12) ◽  
pp. 6393-6396 ◽  
Author(s):  
Soo Jin Yoo ◽  
Hyo-Bin Kim ◽  
Sang-Ho Choi ◽  
Sang-Oh Lee ◽  
Sung-Han Kim ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Pediatric Patients ◽  
Gene Mutations ◽  
Community Acquired Pneumonia ◽  
Clinical Impact ◽  
Macrolide Resistance ◽  
23S Rrna ◽  
Rrna Gene ◽  
Content Type ◽  
23S Rrna Gene

ABSTRACTWe investigated the frequency and clinical significance of macrolide resistance in adult and pediatric patients with community-acquired pneumonia from aMycoplasma pneumoniaeinfection. The frequency of the A2063G mutation in the 23S rRNA gene was significantly higher in children than in adults (61.3% [19/31] and 13.3% [8/60], respectively;P< 0.001). Patients with macrolide-resistantM. pneumoniaeinfections showed a longer duration of fever (P= 0.021) and required a longer duration of antibiotic treatment (P= 0.007).

scholarly journals Macrolide resistance and molecular typing of Mycoplasma pneumoniae infections during a 4 year period in Spain

2020 ◽  
Vol 75 (10) ◽  
pp. 2752-2759 ◽  
Author(s):  
Belén Rivaya ◽  
Elena Jordana-Lluch ◽  
Gema Fernández-Rivas ◽  
Sònia Molinos ◽  
Roi Campos ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Variable Number Tandem Repeat ◽  
Respiratory Viruses ◽  
Variable Number ◽  
Community Acquired Pneumonia ◽  
Macrolide Resistance ◽  
23S Rrna ◽  
Resistance Pattern ◽  
Molecular Tools ◽  
Resistance Detection

Abstract Background Mycoplasma pneumoniae (MP) causes community-acquired pneumonia affecting mainly children, and tends to produce cyclic outbreaks. The widespread use of macrolides is increasing resistance rates to these antibiotics. Molecular tools can help in diagnosis, typing and resistance detection, leading to better patient management. Objectives To assess the MP genotypes and resistance pattern circulating in our area while comparing serological and molecular diagnosis of MP. Methods Molecular and serological diagnosis of MP was performed in 821 samples collected in Badalona (Barcelona, Spain) from 2013 to 2017. Multiple locus variable number tandem repeat analysis (MLVA) and macrolide resistance detection by pyrosequencing were performed in those cases positive by PCR. Presence of respiratory viruses and relevant clinical data were also recorded. Results MP was detected in 16.8% of cases by PCR, with an overall agreement with serology of 76%. Eleven different MLVA types were identified, with 4-5-7-2 (50.1%) and 3-5-6-2 (29.2%) being the most abundant, with the latter showing a seasonal increase during the study. A total of 8% of the strains harboured a point substitution associated with macrolide resistance, corresponding mainly to an A2063G 23S rRNA mutation and directly related to previous macrolide therapy. Analysis of respiratory viruses showed viral coinfections in most cases. Conclusions Serological and molecular tools combined could improve MP diagnosis and the analysis of its infection patterns. Macrolide resistance is associated with previous therapy. Given that MP pneumonia usually resolves spontaneously, it should be reconsidered whether antibiotic treatment is suitable for all cases.

scholarly journals Increased Macrolide Resistance of Mycoplasma pneumoniae in Pediatric Patients with Community-Acquired Pneumonia

2007 ◽  
Vol 52 (1) ◽  
pp. 348-350 ◽  
Author(s):  
Miyuki Morozumi ◽  
Satoshi Iwata ◽  
Keiko Hasegawa ◽  
Naoko Chiba ◽  
Reiko Takayanagi ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Pediatric Patients ◽  
Community Acquired Pneumonia ◽  
Macrolide Resistance ◽  
23S Rrna ◽  
Resistant Strains ◽  
Domain V

ABSTRACT Among 380 Mycoplasma pneumoniae isolates from 3,678 pediatric patients with community-acquired pneumonia, 50 macrolide-resistant strains had an A2063G transition in domain V of the 23S rRNA, whereas 5 had an A2064G transition. These resistant strains increased rapidly from April 2002 to December 2006.

scholarly journals 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

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.

scholarly journals Effect of 23S rRNA gene mutations in Mycoplasma pneumoniae on severity of community-­acquired pneumonia in young adult patients treated at the Smolensk military hospital

2020 ◽  
Vol 22 (4) ◽  
pp. 306-312
Author(s):  
O.V. Ivanova ◽  
Inna A. Edelstein ◽  
O.I. Romashov ◽  
Roman S. Kozlov
Keyword(s):  
Young Adult ◽  
Mycoplasma Pneumoniae ◽  
Gene Mutations ◽  
Community Acquired Pneumonia ◽  
Adult Patients ◽  
23S Rrna ◽  
Military Hospital ◽  
Rrna Gene ◽  
Resistant Genotype ◽  
23S Rrna Gene

Objective. To evaluate effect of 23S rRNA gene mutations in Mycoplasma pneumoniae on severity of community-acquired pneumonia (CAP) in young adult patients. Materials and Methods. A total of 42 case histories of young adult patients with CAP treated at the Smolensk military hospital over the period of 25 October 2017 to 25 December 2019 were reviewed. «AmpliSens® Mycoplasma pneumoniae/Chlamydophila pneumoniae-FL» real-time PCR kit was used to detect M. pneumoniae from nasopharyngeal swabs collected prior to antimicrobial therapy. Testing for 23S rRNA gene mutations conferring macrolide resistance was performed by real-time PCR melt curve analysis (patent no. 2646123) and confirmed by DNA sequencing. Results. All patients had a clinical picture of non-severe CAP on hospital admission. All patients were treated with standard doses of azithromycin or clarithromycin. No respiratory failure or any other complications were observed. Macrolide-resistant genotype of M. pneumoniae was detected in 4 (9.5%) patients. Clinical, laboratory and radiological resolution of pneumonia in all cases occurred on day 10– 16, regardless of the presence of macrolide-resistant genotype. Conclusions. There were no differences in clinical course of severity between CAP caused by M. pneumoniae with 23S rRNA gene mutation and CAP caused by wild-type M. pneumoniae The presence of mutations in the 23S rRNA gene of M. pneumoniae did not worsen the clinical course of CAP.

scholarly journals First Description of Macrolide-Resistant Mycoplasma pneumoniae in Adults with Community-Acquired Pneumonia in Italy

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Daniela Loconsole ◽  
Anna Lisa De Robertis ◽  
Rosanna Mallamaci ◽  
Anna Sallustio ◽  
Anna Morea ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Variable Number Tandem Repeat ◽  
Point Mutations ◽  
Cross Sectional Study ◽  
Variable Number ◽  
Community Acquired Pneumonia ◽  
23S Rrna ◽  
Cross Sectional ◽  
South Italy ◽  
Multiple Loci

Background. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). This cross-sectional study aimed to determine the prevalence of macrolide-resistant M. pneumoniae strains in a convenience series of 234 adult hospitalised and nonhospitalised subjects with a diagnosis of CAP in January 2013 to April 2015 in South Italy. Methods. Respiratory samples were subjected to real-time PCR. In M. pneumoniae-positive samples, domain V of 23S rRNA was sequenced to detect resistance-conferring point mutations. P1 major adhesion protein typing and multiple loci variable-number tandem repeat analysis (MLVA) were also performed. Results. Of the 234 samples, 15 (6.4%) were positive for M. pneumoniae. Three of these had a macrolide-resistant genotype: two and one had A2063G and A2064G mutations, respectively. Fourteen of the 15 strains were subtyped: half had subtype 1 and half had subtype 2. Eight strains underwent MLVA profiling: one each had the J, A, and Z type. The remainder was unclassifiable. Conclusions. This novel discovery of macrolide-resistant M. pneumoniae strains in adults with CAP in Italy suggests that there may be increasing circulation of these strains in the population. To facilitate rapid optimization of the antibiotic strategy in Italy, macrolide resistance should be monitored by a surveillance system that is based on molecular methods.

scholarly journals Reply to: “Characterization of acute acro-ischemic lesions in non-hospitalized patients: A case series of 132 patients during the COVID-19 outbreak”

2020 ◽  
Vol 83 (3) ◽  
pp. e237-e239
Author(s):  
Giuseppe Ruggiero ◽  
Fabio Arcangeli ◽  
Torello Lotti ◽  
Orsola Ametrano ◽  
Cosimo Ruggiero ◽  
...  
Keyword(s):  
Case Series ◽  
Hospitalized Patients

First Detection and Characterization of Macrolide-Resistant Mycoplasma pneumoniae from People with Community-Acquired Pneumonia in Iran

2020 ◽  
Vol 26 (3) ◽  
pp. 245-250 ◽  
Author(s):  
Narjes Noori Goodarzi ◽  
Mohammad Reza Pourmand ◽  
Maryam Arfaatabar ◽  
Ghasem Azimi ◽  
Ensieh Masoorian ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Community Acquired Pneumonia
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