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Chen Y, Jia X, Gao Y, Ren X, Du B, Zhao H, Feng Y, Xue G, Cui J, Gan L, Feng J, Fan Z, Fu T, Xu Z, Yu Z, Yang Y, Zhao S, Huang L, Ke Y, Cao L, Yan C, Yuan J. Increased macrolide resistance rate of Mycoplasma pneumoniae correlated with epidemic in Beijing, China in 2023. Front Microbiol 2024; 15:1449511. [PMID: 39171272 PMCID: PMC11337199 DOI: 10.3389/fmicb.2024.1449511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/22/2024] [Indexed: 08/23/2024] Open
Abstract
We collected respiratory specimens from 128 pediatric patients diagnosed with pneumonia in Beijing in late 2023. Mycoplasma pneumoniae was detected in 77.3% (99/128) patients, with 36.4% (4/11), 82.9% (34/41), 80.3% (61/76) in children aged less than 3 years, 3-6 years, over 7 years, respectively. Mycoplasma pneumoniae (M. pneumoniae) was characterized using P1 gene typing, MLVA typing and sequencing of domain V of the 23S rRNA gene. P1 gene type 1 (P1-1; 76.1%, 54/71) and MLVA type 4-5-7-2 (73.7%, 73/99) were predominant. MLVA identified a new genotype: 3-4-6-2. Macrolide resistance-associated mutations were detected in 100% of samples, with A2063G accounting for 99% and A2064G for 1%. The positive rate of M. pneumoniae was higher compared to previous reports, especially in children less than 3 years, suggesting a M. pneumoniae epidemic showing a younger age trend occurred in late 2023 in Beijing, China. Higher proportions of macrolide-resistant M. pneumoniae, P1-1 and 4-5-7-2 genotype M. pneumoniae indicated increased macrolide resistance rate and genotyping shift phenomenon, which might be attributable to this epidemic. Additionally, complete clinical information from 73 M. pneumoniae pneumonia inpatients were analyzed. The incidence of severe M. pneumoniae pneumonia was 56.2% (41/73). Mycoplasma pneumoniae pneumonia patients exhibited longer duration of fever, with a median value of 10.0 days (IQR, 8.0-13.0), and higher incidence of complications (74.0%, 54/73). However, in this cohort, we found that the severity of M. pneumoniae pneumonia, co-infection, or complications were not associated with M. pneumoniae P1 gene or MLVA types. Clinicians should be aware that patients infected with macrolide-resistant M. pneumoniae exhibited more severe clinical presentations.
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Affiliation(s)
- Yujie Chen
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Xinyu Jia
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yagang Gao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Xue Ren
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Bing Du
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Jinghua Cui
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Lin Gan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Junxia Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Zheng Fan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Tongtong Fu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Ziying Xu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Zihui Yu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yang Yang
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Shuo Zhao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Lijuan Huang
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yuehua Ke
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Ling Cao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Jing Yuan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
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Song Z, Jia G, Luo G, Han C, Zhang B, Wang X. Global research trends of Mycoplasma pneumoniae pneumonia in children: a bibliometric analysis. Front Pediatr 2023; 11:1306234. [PMID: 38078315 PMCID: PMC10704248 DOI: 10.3389/fped.2023.1306234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia (MPP), attributable to Mycoplasma pneumoniae (MP), represents a predominant form of community-acquired pneumonia in pediatric populations, thereby posing a significant threat to pediatric health. Given the burgeoning volume of research literature associated with pediatric MPP in recent years, it becomes imperative to undertake a bibliometric analysis aimed at delineating the current research landscape and emerging trends, thereby furnishing a framework for subsequent investigations. METHODS A comprehensive literature search targeting pediatric MPP was conducted in the Web of Science Core Collection. After the removal of duplicate entries through Endnote software, the remaining articles were subject to scientometric analysis via Citespace software, VOSviewer software and R language, focusing on variables such as publication volume, contributing nations, institutions and authors, references and keywords. RESULTS A total of 1,729 articles pertinent to pediatric MPP were included in the analysis. China and the United States emerged as the nations with the highest publication output. Italian scholar Susanna Esposito and Japanese scholar Kazunobu Ouchi were the most influential authors in the domain of pediatric MPP. Highly-cited articles primarily focused on the epidemiological investigation of pediatric MPP, the clinical characteristics and treatment of macrolide-resistant MPP, and biomarkers for refractory Mycoplasma pneumoniae pneumonia (RMPP). From the corpus of 1,729 articles, 636 keywords were extracted and categorized into ten clusters: Cluster #0 centered on molecular-level typing of macrolide-resistant strains; Cluster #1 focused on lower respiratory tract co-infections; Clusters #2 and #6 emphasized other respiratory ailments caused by MP; Cluster #3 involved biomarkers and treatment of RMPP; Clusters #4 and #9 pertained to extrapulmonary complications of MPP, Clusters #5 and #7 addressed etiological diagnosis of MPP, and Cluster #8 explored pathogenic mechanisms. CONCLUSIONS The past few years have witnessed extensive attention directed towards pediatric MPP. Research in pediatric MPP principally revolves around diagnostic techniques for MP, macrolide resistance, complications of MPP, treatment and diagnosis of RMPP, and elucidation of pathogenic mechanisms. The present study provides pediatric clinicians and researchers with the research status and focal points in this field, thereby guiding the orientation of future research endeavors.
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Affiliation(s)
- Zhe Song
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangyuan Jia
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangzhi Luo
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chengen Han
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Baoqing Zhang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Wang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Guo P, Mei S, Wang Y, Zheng X, Li L, Cheng Y. Molecular typing of Mycoplasma pneumoniae and its correlation with macrolide resistance in children in Henan of China. Indian J Med Microbiol 2023; 46:100435. [PMID: 37945129 DOI: 10.1016/j.ijmmb.2023.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND/PURPOSE As a major causative pathogen of community-acquired pneumonia, Mycoplasma pneumoniae (M. pneumoniae) can cause both upper and lower respiratory tract inflammation as well as extrapulmonary syndromes, especially in infants and the elderly. The emergence of macrolide-resistance has significant effects on the treatment of relevant diseases in children. This study aimed to analyze the genotypes and the macrolide resistance-associated mutations in M. pneumoniae sampled from the pediatric patients in Henan, China. METHODS A segment of gene on the 23S rRNA was amplified and sequenced to detect the mutations related to macrolide resistance. Molecular typing was performed by the method named multiple locus variable-number tandem repeat analysis (MLVA) for macrolide-susceptible and macrolide-resistant specimens. RESULTS Among the M. pneumoniae-positive samples, 95.7% (111/116) had macrolide-resistant mutation, and all of them consisted of the A2063G mutation. There were only two MLVA types identified in this study, type 4-5-7-2 (51/92, 55.4%) and type 3-5-6-2 (41/92, 44.6%). CONCLUSION There was no correlation between MLVA types and macrolide resistance (P > 0.05).
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Affiliation(s)
- Pengbo Guo
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, China.
| | - Shiyue Mei
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, China.
| | - Yanhong Wang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, China.
| | - Xuan Zheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, China.
| | - Lifeng Li
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, China; Henan International Joint Laboratory of Children's Infectious Disease, China.
| | - Yibing Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, China.
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Wang N, Xu X, Xiao L, Liu Y. Novel mechanisms of macrolide resistance revealed by in vitro selection and genome analysis in Mycoplasma pneumoniae. Front Cell Infect Microbiol 2023; 13:1186017. [PMID: 37284499 PMCID: PMC10240068 DOI: 10.3389/fcimb.2023.1186017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
Mycoplasma pneumoniae is an important pathogen causing upper and lower respiratory tract infections in children and other age groups. Macrolides are the recommended treatments of choice for M. pneumoniae infections. However, macrolide resistance in M. pneumoniae is increasing worldwide, which complicates the treatment strategies. The mechanisms of macrolide resistance have been extensively studied focusing on the mutations in 23S rRNA and ribosomal proteins. Since the secondary treatment choice for pediatric patients is very limited, we decided to look for potential new treatment strategies in macrolide drugs and investigate possible new mechanisms of resistance. We performed an in vitro selection of mutants resistant to five macrolides (erythromycin, roxithromycin, azithromycin, josamycin, and midecamycin) by inducing the parent M. pneumoniae strain M129 with increasing concentrations of the drugs. The evolving cultures in every passage were tested for their antimicrobial susceptibilities to eight drugs and mutations known to be associated with macrolide resistance by PCR and sequencing. The final selected mutants were also analyzed by whole-genome sequencing. Results showed that roxithromycin is the drug that most easily induces resistance (at 0.25 mg/L, with two passages, 23 days), while with midecamycin it is most difficult (at 5.12 mg/L, with seven passages, 87 days). Point mutations C2617A/T, A2063G, or A2064C in domain V of 23S rRNA were detected in mutants resistant to the 14- and 15-membered macrolides, while A2067G/C was selected for the 16-membered macrolides. Single amino acid changes (G72R, G72V) in ribosomal protein L4 emerged during the induction by midecamycin. Genome sequencing identified sequence variations in dnaK, rpoC, glpK, MPN449, and in one of the hsdS (MPN365) genes in the mutants. Mutants induced by the 14- or 15-membered macrolides were resistant to all macrolides, while those induced by the 16-membered macrolides (midecamycin and josamycin) remained susceptible to the 14- and 15-membered macrolides. In summary, these data demonstrated that midecamycin is less potent in inducing resistance than other macrolides, and the induced resistance is restrained to the 16-membered macrolides, suggesting a potential benefit of using midecamycin as a first treatment choice if the strain is susceptible.
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Affiliation(s)
- Na Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
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Jiang TT, Sun L, Wang TY, Qi H, Tang H, Wang YC, Han Q, Shi XQ, Bi J, Jiao WW, Shen AD. The clinical significance of macrolide resistance in pediatric Mycoplasma pneumoniae infection during COVID-19 pandemic. Front Cell Infect Microbiol 2023; 13:1181402. [PMID: 37249975 PMCID: PMC10213390 DOI: 10.3389/fcimb.2023.1181402] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background Mycoplasma pneumoniae (MP) is a commonly occurring pathogen causing community-acquired pneumonia (CAP) in children. The global prevalence of macrolide-resistant MP (MRMP) infection, especially in Asian regions, is increasing rapidly. However, the prevalence of MRMP and its clinical significance during the COVID-19 pandemic is not clear. Methods This study enrolled children with molecularly confirmed macrolide-susceptible MP (MSMP) and MRMP CAP from Beijing Children's Hospital Baoding Hospital, Capital Medical University between August 2021 and July 2022. The clinical characteristics, laboratory findings, chest imaging presentations, and strain genotypes were compared between patients with MSMP and MRMP CAP. Results A total of 520 hospitalized children with MP-CAP were enrolled in the study, with a macrolide resistance rate of 92.7%. Patients with MRMP infection exhibited more severe clinical manifestations (such as dyspnea and pleural effusion) and had a longer hospital stay than the MSMP group. Furthermore, abnormal blood test results (including increased LDH and D-dimer) were more common in the MRMP group (P<0.05). Multilocus variable-number tandem-repeat analysis (MLVA) was performed on 304 samples based on four loci (Mpn13-16), and M3562 and M4572 were the major types, accounting for 74.0% and 16.8% of the strains, respectively. The macrolide resistance rate of M3562 strains was up to 95.1%. Conclusion The prevalence of MRMP strains in hospitalized CAP patients was extremely high in the Baoding area, and patients infected with MRMP strains exhibited more severe clinical features and increased LDH and D-dimer. M3562 was the predominant resistant clone.
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Affiliation(s)
- Ting-ting Jiang
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
| | - Lin Sun
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Disease, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tian-yi Wang
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
| | - Hui Qi
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Disease, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - He Tang
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
| | - Ya-cui Wang
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Disease, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Qian Han
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
| | - Xiao-qing Shi
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
| | - Jing Bi
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
| | - Wei-wei Jiao
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Disease, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - A-dong Shen
- Baoding Key Laboratory for Precision Diagnosis and Treatment of Infectious Diseases in Children, Baoding Hospital of Beijing Children’s Hospital, Capital Medical University, Baoding, Hebei, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Disease, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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The Association between Mycoplasma pneumoniae Genotype and Cutaneous Disease. Microorganisms 2023; 11:microorganisms11010205. [PMID: 36677497 PMCID: PMC9860771 DOI: 10.3390/microorganisms11010205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Mycoplasma pneumoniae (Mp) can cause several extrapulmonary manifestations, most frequently dermatological ones. It is largely unknown whether Mp genotype determines Mp-induced cutaneous disease. The aim of our study was to assess the association between Mp genotype and this clinical outcome. We performed a retrospective study of children referred with signs of acute Mp infection from 1 January 2014 to 31 December 2014. We compared the characteristics of children presenting as cutaneous disease, upper (URTI) and lower respiratory tract infection (LRTI). In addition, we separately analyzed the data of patients presenting with Mp-induced cutaneous disease. We evaluated data from 435 patients (mean age 7.3 years, SD 3.4 years; 52.0% boys) who had Mp PCR-positive pharyngeal swab, P1 genotype and/or multilocus variable-number tandem-repeat analysis (MLVA) genotype defined and no viral co-detection, presenting as cutaneous disease (38/435), URTI (46/435) or LRTI (351/435). The majority of patients had urticarial (55%, 21/38) or maculopapular eruptions (37%, 14/38). We found no association between Mp genotype and clinical outcome of cutaneous disease, nor any specific dermatological presentation. In the group with cutaneous disease, 18% (7/38) required hospital admission because of rash. We found that infection with MLVA-3,6,6,2 strains was more common in admitted patients than in outpatients (40% vs. 4%, p = 0.017) and significantly affected the likelihood of hospital admission in a logistic regression model. The results of our cohort study suggest that Mp genotype does not determine Mp-induced cutaneous disease or a specific dermatological presentation. Nevertheless, infections with certain MLVA strains could induce more severe cutaneous disease requiring hospitalization.
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Leng M, Yang J, Zhou J. The molecular characteristics, diagnosis, and treatment of macrolide-resistant Mycoplasma pneumoniae in children. Front Pediatr 2023; 11:1115009. [PMID: 36937963 PMCID: PMC10017863 DOI: 10.3389/fped.2023.1115009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
The purpose of this study is to review the molecular characteristics, the diagnosis, and treatment of the widespread infection of macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae; MRMP) in children, thus providing a better knowledge of this infection and presenting the associated problems. Single point mutations in the V region of the 23S rRNA gene of M. pneumoniae genome are associated with macrolide resistance. P1-1, MLVA4-5-7-2, and ST3 are usually the predominated genetic types in the M. pneumoniae epidemics. The short-term two times serological IgM (or together with IgG) test in the acute stage can be used for confirmation. Combined serological testing and PCR might be a more prudent method to reduce macrolide consumption and antibiotic selective pressure in a clinical setting. Molecular methods for the detection of single-nucleotide mutations in the V region of the 23S rRNA gene can be used for the diagnosis of MRMP. The routine use of macrolide for the treatment of macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections can get good effect, but the effects are limited for severe MRMP infections. Additional corticosteroids may be required for the treatment of severe MRMP infections in children in China during the era of MRMP.
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Wang N, Zhang H, Yin Y, Xu X, Xiao L, Liu Y. Antimicrobial Susceptibility Profiles and Genetic Characteristics of Mycoplasma pneumoniae in Shanghai, China, from 2017 to 2019. Infect Drug Resist 2022; 15:4443-4452. [PMID: 35983294 PMCID: PMC9379117 DOI: 10.2147/idr.s370126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The current study investigated the recent genetic characteristics and antimicrobial susceptibility profiles of Mycoplasma pneumoniae (M. pneumoniae) in Shanghai, becoming a clinical reference for treating M. pneumoniae infection in Shanghai. Methods Clinical strains were isolated from nasopharyngeal aspirates of the pediatric patients in Shanghai from 2017 to 2019. Nine antimicrobial agents of three antimicrobial classes macrolides, fluoroquinolones and tetracyclines, against M. pneumoniae isolates were investigated using the broth microdilution method. The mechanism of macrolide resistance was analyzed by evaluating the sequences of the 23S rRNA gene and the ribosomal protein genes L4 and L22. Molecular genotyping was undergone to classify the P1 subtypes and the multi-locus variable-number tandem-repeat analysis (MLVA) types. Results A total of 72 isolates were resistant to macrolides (MICs > 64 mg/L for erythromycin) based on the A2063G mutation in the 23S rRNA gene. These strains were susceptible to tetracyclines and fluoroquinolones. P1 type 1 (166/182, 91.2%) and MLVA type 4-5-7-2 (165/182, 90.7%) were the dominant subtypes. MLVA type was associated with the P1 subtypes. The distribution of the P1 subtypes and MLVA types did not change over time. The macrolide-resistant rate in P1 type 2 and MLVA type 3-5-6-2 strains were increased during the three-year study. The 5-loci MLVA typing scheme revealed the clonal expansion of MLVA type 3-4-5-7-2 strains which are macrolide-resistant in 2019. Conclusion Macrolide resistance in M. pneumoniae in Shanghai is very high and is evolving among certain subtypes. Cautions should be taken for the possible clonal spreading of macrolide-resistant genotypes within this populated region.
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Affiliation(s)
- Na Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.,Department of Medical Oncology, Shanghai Cancer Center, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hong Zhang
- Department of Clinical Laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, 200062, People's Republic of China
| | - Yihua Yin
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
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Mycoplasma pneumoniae multilocus variable-number tandem-repeat analysis genotypes are associated with inflammatory biomarker levels in children with lower respiratory tract infections. Eur J Clin Microbiol Infect Dis 2022; 41:1099-1105. [PMID: 35767121 PMCID: PMC9244052 DOI: 10.1007/s10096-022-04467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2022] [Indexed: 01/08/2023]
Abstract
The multilocus variable-number tandem-repeat analysis (MLVA) typing method is commonly used in Mycoplasma pneumoniae (M. pneumoniae) epidemiology. It remains unknown if clinical manifestations of lower respiratory tract infections (LRTI) in children differ between different MLVA genotypes. We aimed to determine if specific M. pneumoniae MLVA genotypes indicate the severity of LRTI in children. We performed a retrospective study of children younger than 18 years with signs of acute M. pneumoniae LRTI from January 1, 2009, to December 31, 2014. All patients who were PCR-positive for M. pneumoniae from pharyngeal swabs and had MLVA genotype successfully defined were included in the study. We compared the epidemiological and clinical data of children infected with different MLVA genotypes. In total, 429 patients (mean age 7.4 years, SD 3.4 years; 54% boys) met the study inclusion criteria. We compared the data of patients infected with the three most common MLVA types: MLVA-3,5,6,2 (86/429), MLVA-3,6,6,2 (71/429) and MLVA-4,5,7,2 (256/429). MLVA-3,5,6,2-infected patients over 5 years of age presented with a significantly higher median C-reactive protein level (34 vs 23 vs 19 mg/L, p = .008) and a higher median white blood cell count (9.4 vs 7.9 vs 8.5 × 109/L, p = .040) compared to MLVA-3,6,6,2- and MLVA-4,5,7,2-infected patients. No such difference was observed in the group of younger than 5 years. The results from our large cohort indicate that different MLVA genotypes may have different pathogenic potential and that children with MLVA-3,5,6,2 LRTI may present with higher inflammatory marker levels in comparison with other MLVA types.
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Dumke R. Molecular Tools for Typing Mycoplasma pneumoniae and Mycoplasma genitalium. Front Microbiol 2022; 13:904494. [PMID: 35722324 PMCID: PMC9203060 DOI: 10.3389/fmicb.2022.904494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Mycoplasma pneumoniae and Mycoplasma genitalium are cell wall-less bacteria with strongly reduced genome content and close phylogenetic relatedness. In humans, the only known natural host, the microorganisms colonize the respiratory or genitourinary mucosa and may cause a broad range of clinical presentations. Besides fundamental differences in their tissue specificity, transmission route, and ability to cause prevalence peaks, both species share similarities such as the occurrence of asymptomatic carriers, preferred populations for infection, and problems with high rates of antimicrobial resistance. To further understand the epidemiology of these practically challenging bacteria, typing of strains is necessary. Since the cultivation of both pathogens is difficult and not performed outside of specialized laboratories, molecular typing methods with adequate discriminatory power, stability, and reproducibility have been developed. These include the characterization of genes containing repetitive sequences, of variable genome regions without the presence of repetitive sequences, determination of single and multi-locus variable-number tandem repeats, and detection of single nucleotide polymorphisms in different genes, respectively. The current repertoire of procedures allows reliable differentiation of strains circulating in different populations and in different time periods as well as comparison of strains occurring subsequently in individual patients. In this review, the methods for typing M. pneumoniae and M. genitalium, including the results of their application in different studies, are summarized and current knowledge regarding the association of typing data with the clinical characteristics of infections is presented.
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Affiliation(s)
- Roger Dumke
- TU Dresden, Institute of Medical Microbiology and Virology, Dresden, Germany
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Association of Tandem Repeat Number Variabilities in Subunit S of the Type I Restriction-Modification System with Macrolide Resistance in Mycoplasma pneumoniae. J Clin Med 2022; 11:jcm11030715. [PMID: 35160167 PMCID: PMC8836594 DOI: 10.3390/jcm11030715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 01/04/2023] Open
Abstract
Mycoplasma pneumoniae is one of the major pathogens responsible for pneumonia in children. Modern molecular genetics has advanced both the management and the epidemiologic study of this disease. Despite these advancements, macrolide resistance remains a global threat in the management of M. pneumoniae infection, for which the genetic background remains unrevealed. In this study, the result of whole genome analysis of 20 sequence type 3 (ST3) M. pneumoniae strains were examined to investigate the gene(s) associated with macrolide resistance. Overall, genetic similarities within M. pneumoniae, and especially ST3, were very high (over 99.99 %). Macrolide resistant ST3 strains shared 20 single nucleotide polymorphisms, of which one gene (mpn085) was found to be associated with resistance. BLAST comparison of M. pneumoniae revealed regular tandem repeat number variabilities between macrolide-susceptible and resistant strains for genes coding the Type I restriction-modification (R-M) system of subunit S (HsdS). Of the ten known HsdS genes, macrolide resistance was determined by the unique tandem repeat of mpn085 and mpn285. In conclusion, the use of whole genome sequencing (WGS) to target macrolide resistance in M. pneumoniae indicates that the determinant of macrolide resistance is variabilities in the tandem repeat numbers of the type I R-M system in subunit S.
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12
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Rivaya B, Jordana-Lluch E, Fernández-Rivas G, Molinos S, Campos R, Méndez-Hernández M, Matas L. Macrolide resistance and molecular typing of Mycoplasma pneumoniae infections during a 4 year period in Spain. J Antimicrob Chemother 2021; 75:2752-2759. [PMID: 32653897 PMCID: PMC7678890 DOI: 10.1093/jac/dkaa256] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Belén Rivaya
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Jordana-Lluch
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gema Fernández-Rivas
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sònia Molinos
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roi Campos
- Paediatric Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Lurdes Matas
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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13
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Multiple-locus variable-number tandem-repeat analysis (MLVA) of macrolide-susceptible and -resistant Mycoplasma pneumoniae in children in Taiwan. J Formos Med Assoc 2020; 119:1539-1545. [DOI: 10.1016/j.jfma.2019.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/30/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022] Open
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14
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Molecular Characterization of Mycoplasma pneumoniae Isolates in the United States from 2012 to 2018. J Clin Microbiol 2020; 58:JCM.00710-20. [PMID: 32817226 PMCID: PMC7512161 DOI: 10.1128/jcm.00710-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/06/2020] [Indexed: 12/25/2022] Open
Abstract
Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. There are limited data in the United States on the molecular epidemiological characteristics of M. pneumoniae. We collected 446 M. pneumoniae-positive specimens from 9 states between August 2012 and October 2018. Culture, antimicrobial susceptibility testing, P1 subtyping, and multilocus VNTR (variable-number tandem repeats) analysis (MLVA) were performed to characterize the isolates. Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. There are limited data in the United States on the molecular epidemiological characteristics of M. pneumoniae. We collected 446 M. pneumoniae-positive specimens from 9 states between August 2012 and October 2018. Culture, antimicrobial susceptibility testing, P1 subtyping, and multilocus VNTR (variable-number tandem repeats) analysis (MLVA) were performed to characterize the isolates. Macrolide-resistant M. pneumoniae (MRMp) was detected in 37 (8.3%) specimens. P1 subtype 2 (P1-2) was the predominant P1 subtype (59.8%). P1 subtype distribution did not change significantly chronologically or geographically. The macrolide resistance rate in P1 subtype 1 (P1-1) samples was significantly higher than that in P1-2 (12.9% versus 5.5%). Six P1-2 variants were identified, including two novel types, and variant 2c was predominant (64.6%). P1-2 variants were distributed significantly differently among geographic regions. Classical P1-2 was more frequent in lower respiratory tract specimens and had longer p1 trinucleotide repeats. Classical P1-2 was most common in MRMp (35.7%), while variant 2c was most common in macrolide-susceptible M. pneumoniae (67.5%). Fifteen MLVA types were identified; 3-5-6-2 (41.7%), 4-5-7-2 (35.3%), and 3-6-6-2 (16.6%) were the major types, and four MLVA clusters were delineated. The distribution of MLVA types varied significantly over time and geographic location. The predominant MLVA type switched from 4-5-7-2 to 3-5-6-2 in 2015. MLVA type was associated with P1 subtypes and P1-2 variant types but not with macrolide resistance. To investigate the M. pneumoniae genotype shift and its impact on clinical presentations, additional surveillance programs targeting more diverse populations and prolonged sampling times are required.
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15
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Ramien ML. Reactive infectious mucocutaneous eruption: Mycoplasma pneumoniae-induced rash and mucositis and other parainfectious eruptions. Clin Exp Dermatol 2020; 46:420-429. [PMID: 32918499 DOI: 10.1111/ced.14404] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 12/21/2022]
Abstract
Mycoplasma pneumoniae-induced rash and mucositis is the most accurate diagnosis for patients with blistering mucocutaneous disease provoked by an infection. Recent literature suggests expansion of the name is required, as other infections have caused a clinically similar presentation. This review provides a concise update on current understanding of M. pneumoniae-induced rash and mucositis and other reactive infectious mucocutaneous eruptions.
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Affiliation(s)
- M L Ramien
- Division of Community Medicine, Department of Pediatrics, University of Calgary Cummings School of Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada.,Division of Dermatology, Department of Medicine, University of Calgary Cummings School of Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
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16
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Eschenauer GA, Xiao L, Waites KB, Crabb DM, Ratliff AE, Gandhi TN, Riddell J, Kaul DR. Macrolide-resistant Mycoplasma pneumoniae pneumonia in transplantation: Increasingly typical? Transpl Infect Dis 2020; 22:e13318. [PMID: 32386104 DOI: 10.1111/tid.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/01/2022]
Abstract
Mycoplasma pneumoniae is one of the most common bacterial causes of pneumonia. Macrolide-resistant M pneumoniae (MRMP) was documented in 7.5% of isolates in the United States. Resistance portends poor outcomes to macrolide therapy, yet patients respond well to fluoroquinolones or tetracyclines such as minocycline. However, MRMP may be under-appreciated because M pneumoniae generally causes relatively mild infections in non-immunosuppressed adults that may resolve without effective therapy and because microbiological confirmation and susceptibility are not routinely performed. We report two cases of pneumonia due to MRMP in kidney transplant recipients. Both patients required hospital admission, worsened on macrolide therapy, and rapidly defervesced on doxycycline or levofloxacin. In one case, M pneumoniae was only identified by multiplex respiratory pathogen panel analysis of BAL fluid. Macrolide resistance was confirmed in both cases by real-time PCR and point mutations associated with macrolide resistance were identified. M pneumoniae was isolated from both cases, and molecular genotyping revealed the same genotype. In conclusion, clinicians should be aware of the potential for macrolide resistance in M pneumoniae, and may consider non-macrolide-based therapy for confirmed or non-responding infections in patients who are immunocompromised or hospitalized.
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Affiliation(s)
- Gregory A Eschenauer
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna M Crabb
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy E Ratliff
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tejal N Gandhi
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - James Riddell
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Daniel R Kaul
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
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17
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Yan C, Yang H, Sun H, Zhao H, Feng Y, Xue G, Li S, Cui J, Ni S. Diversity in Genotype Distribution of Mycoplasma pneumoniae Obtained from Children and Adults. Jpn J Infect Dis 2020; 73:14-18. [PMID: 31474699 DOI: 10.7883/yoken.jjid.2019.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore whether there was any specific genotype responsible for the high prevalence of Mycoplasma pneumoniae infection in children. A total of 247 M. pneumoniae-DNA positive clinical specimens including 200 from children and 47 from adults, collected in Beijing, China, during the same period, were analyzed. We performed P1-restriction fragment length polymorphism analysis (RFLP), multi-locus variable number tandem repeat analysis (MLVA) and detected the macrolide resistance-associated mutations in 23S rRNA of the clinical specimens. In the present study, we observed P1 genotype 1 and MLVA type M4-5-7-2 accounted for the majority of the cases across all ages in Beijing. Macrolide resistance-associated mutants of M. pneumoniae were also at a high level with 90.5% (181/200) in children and 76.6% (36/47) in adults. However, more diverse genotypes and a higher prevalence of macrolide resistance-associated mutations were found in the pediatric specimens. Further investigations are warranted to help to explain the difference of morbidity and molecular characteristics across the demographic spectrum.
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Affiliation(s)
- Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Huijuan Yang
- Department of Clinical Laboratory, Beijing Puren Hospital
| | - Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Shaoli Li
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Jinghua Cui
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Shanshan Ni
- Department of Bacteriology, Capital Institute of Pediatrics
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18
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Voronina EN, Gordukova MA, Turina IE, Mishukova OV, Dymova MA, Galeeva EV, Korsunskiy AA, Filipenko ML. Molecular characterization of Mycoplasma pneumoniae infections in Moscow from 2015 to 2018. Eur J Clin Microbiol Infect Dis 2019; 39:257-263. [PMID: 31655931 DOI: 10.1007/s10096-019-03717-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess which Mycoplasma pneumoniae genotypes were present in Moscow during the years 2015-2018 and whether the proportion between detected genotypes changed over time. We were also interested in the presence of macrolide resistance (MR)Mycoplasma pneumoniae. We performed multilocus variable-number tandem-repeat (VNTR) analysis (MLVA), SNP typing, and mutation typing in the 23S rRNA gene from 117 M. pneumoniae clinical isolates. Our analysis suggests two major MLVA types: 4572 and 3562. In 2017-2018, MLVA type 4572 gradually became predominant. In general, the SNP type range is the same as described earlier for European countries. The analysis of MR mutations showed that 7% of the isolates had an A2063G mutation in the 23S rRNA gene with no isolates carrying an A2064G mutation. In 2017-2018, MLVA type 4572 (SNP type 1) begins to spread in Moscow, which was widespread globally, especially in Asian countries. SNP typing of our sample showed higher discriminatory power than MLVA typing.
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Affiliation(s)
- Elena N Voronina
- Laboratory of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Lavrentjeva, 8, Novosibirsk, Russia, 630090. .,Department of Molecular Biology, Novosibirsk State University, Pirogova, 2, Novosibirsk, Russia, 630090.
| | - Maria A Gordukova
- Moscow City Pediatric G. Speransky Clinical Hospital, No. 9, Shmitovsky Proezd 29, Moscow, Russia, 123317
| | - Irina E Turina
- The Federal State Autonomous Educational Institution of Higher Education "The I.M. Sechenov First Moscow State Medical University" of the Ministry of Health of the Russian Federation , Pogodinskaya St. 1, Moscow, Russia, 119991
| | - Olga V Mishukova
- Laboratory of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Lavrentjeva, 8, Novosibirsk, Russia, 630090
| | - Maya A Dymova
- Laboratory of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Lavrentjeva, 8, Novosibirsk, Russia, 630090
| | - Elena V Galeeva
- Moscow City Pediatric G. Speransky Clinical Hospital, No. 9, Shmitovsky Proezd 29, Moscow, Russia, 123317
| | - Anatoliy A Korsunskiy
- Moscow City Pediatric G. Speransky Clinical Hospital, No. 9, Shmitovsky Proezd 29, Moscow, Russia, 123317.,The Federal State Autonomous Educational Institution of Higher Education "The I.M. Sechenov First Moscow State Medical University" of the Ministry of Health of the Russian Federation , Pogodinskaya St. 1, Moscow, Russia, 119991
| | - Maxim L Filipenko
- Laboratory of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Lavrentjeva, 8, Novosibirsk, Russia, 630090.,Department of Molecular Biology, Novosibirsk State University, Pirogova, 2, Novosibirsk, Russia, 630090
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19
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Alishlash AS, Atkinson TP, Schlappi C, Leal SM, Waites KB, Xiao L. Mycoplasma pneumoniae Carriage With De Novo Macrolide-Resistance and Breakthrough Pneumonia. Pediatrics 2019; 144:peds.2019-1642. [PMID: 31488697 DOI: 10.1542/peds.2019-1642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 11/24/2022] Open
Abstract
Mycoplasma pneumoniae pneumonia is prevalent in children and can be followed by upper airway carriage for months. Treatment of M pneumoniae pneumonia with macrolides is widespread and can lead to the development of macrolide resistance. The clinical consequences of chronic M pneumoniae carriage are unknown. In this article, we describe a child with acute lymphoblastic leukemia who developed macrolide-susceptible M pneumoniae pneumonia confirmed by nasopharyngeal secretions polymerase chain reaction and culture with good response to azithromycin. Five months later, the patient developed another M pneumoniae pneumonia that was diagnosed with positive macrolide-resistant M pneumoniae polymerase chain reaction and culture from the bronchoalveolar lavage. The child responded well to fluoroquinolones and eventually was discharged from the hospital. The M pneumoniae recovered from the second pneumonia is a novel strain and is genetically identical to the M pneumoniae that caused the first pneumonia, apart from the macrolide-resistance 23S ribosomal RNA gene. Both isolates are identical in both P1 (subtype 2 with a novel variant, 2bv) and multiple-locus variable number tandem repeat analysis type (53662). This is indicative of chronic M pneumoniae carriage with de novo macrolide-resistance mutation and subsequent breakthrough pneumonia that is reported for the first time here. Children with immunosuppression may be at increased risk of life-threatening macrolide-resistant pneumonia after M pneumoniae carriage. Further studies are required to evaluate the impact of this phenomenon. This will then guide strategies to limit the associated morbidity, such as testing for macrolide resistance, treatment of M pneumoniae pneumonia in high-risk children with bactericidal antibiotics (such as fluoroquinolones), and possibly eradication protocols of M pneumoniae carriage to prevent subsequent life-threatening infections.
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Affiliation(s)
| | | | | | | | | | - Li Xiao
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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20
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Noori Goodarzi N, Pourmand MR, Arfaatabar M, Azimi G, Masoorian E, Rahimi Foroushani A, Aminharati F, Heidarzadeh S, Baghani A. First Detection and Characterization of Macrolide-Resistant Mycoplasma pneumoniae from People with Community-Acquired Pneumonia in Iran. Microb Drug Resist 2019; 26:245-250. [PMID: 31545147 DOI: 10.1089/mdr.2019.0223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Increasing macrolide resistance of Mycoplasma pneumoniae strains is becoming a public health concern worldwide. Nevertheless, no comprehensive genomic background of circulating isolates is available in our region. We aimed to study the genetic diversity of this microorganism using the multiple-locus variable-number tandem-repeat analysis method and to investigate the relationships between MLVA types and macrolide susceptibility profiles of the isolates. Materials and Methods: A total of 270 patients attending Tehran general university hospitals were included in this study. One throat swab was taken from each patient. M. pneumoniae was identified using culture and PCR assay. Macrolide resistance was determined using the broth microdilution method. The MLVA was performed by amplification of four variable-number tandem-repeat loci. Results: Of 270 specimens, M. pneumoniae was detected in 25.2% (n = 68) and 21.8% (n = 59) samples using PCR and culture, respectively. Approximately 56.9% of isolates were resistant to macrolides. Fifty-one of 59 M. pneumoniae isolates were divided into 6 distinct MLVA types. Conclusion: The macrolide-resistant M. pneumoniae (MRMP) rate in this study was relatively high and most of the MRMP isolates were assigned into the type 4/5/7/2. Since a significant association between MLVA type 4/5/7/2 and macrolide resistance of M. pneumoniae isolates was observed, further monitoring of genetic diversity of MRMP isolates might facilitate better understanding of epidemiology of this microorganism. Besides surveillance of the antibiotic susceptibility might be helpful to make necessary reconsiderations on guidelines for treatment of M. pneumoniae infection.
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Affiliation(s)
- Narjes Noori Goodarzi
- Department of Pathobiology, School of Public Health and Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Pourmand
- Department of Pathobiology, School of Public Health and Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Arfaatabar
- Department of Pathobiology, School of Public Health and Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Azimi
- Department of Internal Medicine, Shahid Mostafa Khomeini Hospital, Shahed University, Tehran, Iran
| | - Ensieh Masoorian
- Department of Pathobiology, School of Public Health and Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Aminharati
- Department of Pathobiology, School of Public Health and Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Heidarzadeh
- Department of Microbiology and Virology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Akram Baghani
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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21
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Yan C, Xue G, Zhao H, Feng Y, Li S, Cui J, Ni S, Sun H. Molecular and clinical characteristics of severe Mycoplasma pneumoniae pneumonia in children. Pediatr Pulmonol 2019; 54:1012-1021. [PMID: 31119869 DOI: 10.1002/ppul.24327] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/25/2019] [Accepted: 03/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To analyze the molecular and the clinical characteristics of Mycoplasma pneumoniae (Mp) pneumonia (MPP) and to explore the related factors predicting severe MPP (SMPP). METHODS A total of 423 pediatric cases of MPP were retrospectively analyzed, in 2013-2017, in Beijing, China. Clinical information was collected from the medical records. Mp-positive specimens were characterized using P1 typing and multiple locus variable-number tandem repeat analysis (MLVA). The macrolide resistance-associated mutations were also detected. RESULTS The predominant genotype was P1-1 (88.2%) and M4-5-7-2 (87.5%), whereas percentages of type P1-2 and M3-5-6-2 increased across the 5-year period. The mutation rate of genotype M4-5-7-2 (365/370, 98.6%) was significantly higher than that of the genotype M3-5-6-2 (15/48, 32.25%; P = 0.000). Overall, 180 (42.6%) of the 423 Mp-positive patients were coinfected with other pathogens. Respiratory syncytial virus coinfection (24/180, 13.3%) was more common in cases typed M3-5-6-2 (4/23, 17.4%) than that of M4-5-7-2 (20/155, 12.9%; P = 0.038). Pleural effusion accounted for 52.6% (169/321) of the observed complications. In the mono-infection cases, cases typed M3-5-6-2 (56%, 14/25) were significantly (P = 0.020) associated with pleural effusion compared with those typed M4-5-7-2 (32.6%, 70/215); 84% (21/25) of specimens typed M3-5-6-2 were diagnosed as SMPP, whereas 63.7% (137/215) of specimens typed M4-5-7-2 were diagnosed as SMPP (P = 0.043). CONCLUSIONS In our study, we proposed for the first time that the mono-infection patients with Mp typed M3-5-6-2 appear to have a higher risk for progressing to SMPP. MLVA typing can provide hints on the clinical characteristics of Mpp.
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Affiliation(s)
- Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Shaoli Li
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Jinghua Cui
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Shanshan Ni
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
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22
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Molecular Typing of Mycoplasma pneumoniae Strains in Sweden from 1996 to 2017 and the Emergence of a New P1 Cytadhesin Gene, Variant 2e. J Clin Microbiol 2019; 57:JCM.00049-19. [PMID: 30918047 PMCID: PMC6535615 DOI: 10.1128/jcm.00049-19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/21/2019] [Indexed: 01/03/2023] Open
Abstract
Mycoplasma pneumoniae causes respiratory infections, such as community-acquired pneumonia (CAP), with epidemics recurring every 3 to 7 years. In 2010 and 2011, many countries experienced an extraordinary epidemic peak. Mycoplasma pneumoniae causes respiratory infections, such as community-acquired pneumonia (CAP), with epidemics recurring every 3 to 7 years. In 2010 and 2011, many countries experienced an extraordinary epidemic peak. The cause of these recurring epidemics is not understood, but decreasing herd immunity and shifts in the strains’ antigenic properties have been suggested as contributing factors. M. pneumoniae PCR-positive samples were collected between 1996 and 2017 from four neighboring counties inhabited by 12% of Sweden’s population. A total of 578 isolates were characterized directly from 624 clinical samples using P1 typing by sequencing and multilocus variable number tandem repeat analysis (MLVA). A fluorescence resonance energy transfer (FRET)-PCR approach was also used to detect mutations associated with macrolide resistance in the 23S rRNA gene. Through P1 typing, the strains were classified into type 1 and type 2, as well as variants 2a, 2b, 2c, and a new variant found in nine of the strains, denoted variant 2e. Twelve MLVA types were distinguished, and 3-5-6-2 (42.4%), 4-5-7-2 (37.4%), and 3-6-6-2 (14.9%) predominated. Several P1 and MLVA types cocirculated each year, but type 2/variant 2 strains and MLVA types 3-5-6-2 and 4-5-7-2 predominated during the epidemic period comprising the peak of 2010 and 2011. In 2016 and 2017, type 1 became more common, and MLVA type 4-5-7-2 predominated. We also found that 0.2% (1/578) of the strains carried a macrolide resistance-associated mutation, indicating a very low prevalence of macrolide resistance in this region of Sweden.
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23
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First Description of Macrolide-Resistant Mycoplasma pneumoniae in Adults with Community-Acquired Pneumonia in Italy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7168949. [PMID: 31008110 PMCID: PMC6441498 DOI: 10.1155/2019/7168949] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/03/2019] [Indexed: 12/28/2022]
Abstract
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.
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Carrim M, Wolter N, Benitez AJ, Tempia S, du Plessis M, Walaza S, Moosa F, Diaz MH, Wolff BJ, Treurnicht FK, Hellferscee O, Dawood H, Variava E, Cohen C, Winchell JM, von Gottberg A. Epidemiology and Molecular Identification and Characterization of Mycoplasma pneumoniae, South Africa, 2012-2015. Emerg Infect Dis 2019; 24:506-513. [PMID: 29460736 PMCID: PMC5823326 DOI: 10.3201/eid2403.162052] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 2012-2015, we tested respiratory specimens from patients with severe respiratory illness (SRI), patients with influenza-like illness (ILI), and controls in South Africa by real-time PCR for Mycoplasma pneumoniae, followed by culture and molecular characterization of positive samples. M. pneumoniae prevalence was 1.6% among SRI patients, 0.7% among ILI patients, and 0.2% among controls (p<0.001). Age <5 years (adjusted odd ratio 7.1; 95% CI 1.7-28.7) and HIV infection (adjusted odds ratio 23.8; 95% CI 4.1-138.2) among M. pneumonia-positive persons were associated with severe disease. The detection rate attributable to illness was 93.9% (95% CI 74.4%-98.5%) in SRI patients and 80.7% (95% CI 16.7%-95.6%) in ILI patients. The hospitalization rate was 28 cases/100,000 population. We observed the macrolide-susceptible M. pneumoniae genotype in all cases and found P1 types 1, 2, and a type 2 variant with multilocus variable number tandem repeat types 3/6/6/2, 3/5/6/2, and 4/5/7/2.
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Xue G, Li M, Wang N, Zhao J, Wang B, Ren Z, Yan C, Wu C, Liu Y, Sun H, Xu M, Sun H. Comparison of the molecular characteristics of Mycoplasma pneumoniae from children across different regions of China. PLoS One 2018; 13:e0198557. [PMID: 30138360 PMCID: PMC6107135 DOI: 10.1371/journal.pone.0198557] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
Previous molecular characterization of Mycoplasma pneumoniae in China focused only on one or two cities. In this study, we characterized 835 samples from patients suspected to be infected with M. pneumoniae; these samples were collected in 2016 from pediatric patients from different regions of China. Multiple locus variable number tandem repeat analysis (MLVA), P1-restriction fragment length polymorphism (RFLP) analysis, and sequencing of the domain V of 23S rRNA were performed to compare genotype distribution across different locations. Two-hundred-and-thirteen samples tested positive for M. pneumoniae by PCR. P1 types were identified in 154 samples: 78.6% were type I and 21.4% were type II. Type I was the most prevalent genotype in five locations, except Nanjing where type II was the most common type (p < 0.01). Five distinct MLVA types were identified in the 172 samples. Genotype M4-5-7-2 was predominant at all locations, except Nanjing where type 3-5-6-2 was the most common (p < 0.01). Macrolide resistance-associated mutations were identified in 186 (76.3%) samples. The resistance rate differed with the location. This study showed that genotypes and macrolide resistance rate differed across China. The most prevalent genotype in China remains M4-5-7-2/P1-1. The resistance rate decreased, along with changes to the M4-5-7-2 genotype.
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Affiliation(s)
- Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Ming Li
- Department of Respiratory Medicine, Kunming Children’s Hospital, Kunming, China
| | - Na Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Xinjiang Institute of Pediatrics, People’s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang, China
| | - Bei Wang
- Department School of Public Health, Southeast University, Nanjing, China
| | - Zhimin Ren
- Department of Pediatrics, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Chengqing Wu
- Department of Respiratory Medicine, Kunming Children’s Hospital, Kunming, China
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - He Sun
- Xinjiang Institute of Pediatrics, People’s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang, China
| | - Min Xu
- Department School of Public Health, Southeast University, Nanjing, China
| | - Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
- * E-mail:
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Suzuki Y, Seto J, Shimotai Y, Itagaki T, Katsushima Y, Katsushima F, Ikeda T, Mizuta K, Hongo S, Matsuzaki Y. Multiple-Locus Variable-Number Tandem-Repeat Analysis of Mycoplasma pneumoniae Isolates between 2004 and 2014 in Yamagata, Japan: Change in Molecular Characteristics during an 11-year Period. Jpn J Infect Dis 2017; 70:642-646. [PMID: 29093323 DOI: 10.7883/yoken.jjid.2017.276] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multiple-locus variable-number tandem-repeat analysis (MLVA) typing was performed for Mycoplasma pneumoniae strains isolated between 2004 and 2014 in Yamagata, Japan. The results were examined by considering the combination of the P1 type and prevalence of macrolide resistance-associated mutations. Four-locus (Mpn13-16) MLVA classified 347 strains into 9 MLVA types, including 3 major types: 3-5-6-2, 4-5-7-2, and 4-5-7-3. All type 3-5-6-2 strains (77 strains) were P1 type 2 variants (2a or 2c), while types 4-5-7-2 (181 strains) and 4-5-7-3 (75 strains) were P1 type 1. MLVA type 4-5-7-2 strains circulated and were dominant until 2010, accounting for 88.4% of the 121 strains isolated between 2004 and 2010. The prevalence of types 4-5-7-3 and 3-5-6-2 strains increased rapidly in 2011 and 2012, respectively, resulting in cocirculation of 3 MLVA types, including type 4-5-7-2, between 2011 and 2013. The prevalence of macrolide resistance-associated mutations in MLVA types 4-5-7-2, 4-5-7-3, and 3-5-6-2 strains was 59.7% (108/181), 25.3% (19/75), and 0% (0/77), respectively. Because the prevalence of macrolide resistance-associated mutations differed by current MLVA types in Yamagata, continued surveillance combined with molecular typing and identification of macrolide resistance-associated mutations is necessary.
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Affiliation(s)
- Yu Suzuki
- Department of Microbiology, Yamagata Prefectural Institute of Public Health.,Department of Infectious Diseases, Yamagata University Faculty of Medicine
| | - Junji Seto
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Yoshitaka Shimotai
- Department of Infectious Diseases, Yamagata University Faculty of Medicine
| | | | | | | | - Tatsuya Ikeda
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Katsumi Mizuta
- Department of Microbiology, Yamagata Prefectural Institute of Public Health
| | - Seiji Hongo
- Department of Infectious Diseases, Yamagata University Faculty of Medicine
| | - Yoko Matsuzaki
- Department of Infectious Diseases, Yamagata University Faculty of Medicine
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Kogoj R, Praprotnik M, Mrvič T, Korva M, Keše D. Genetic diversity and macrolide resistance of Mycoplasma pneumoniae isolates from two consecutive epidemics in Slovenia. Eur J Clin Microbiol Infect Dis 2017; 37:99-107. [PMID: 28948376 DOI: 10.1007/s10096-017-3106-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/07/2017] [Indexed: 11/26/2022]
Abstract
Two nationwide Mycoplasma pneumoniae epidemics occurred in Slovenia between 2006 and 2016. The aim of this study was to assess which M. pneumoniae genotypes were present in our area during the selected timeframe, whether the origin of the epidemics was monoclonal or polyclonal and whether the proportion between detected genotypes changed over time. We were also interested in the presence of macrolide resistance (MR) and whether it could be linked to specific genotypes. We performed pyrosequencing of the P1 gene and multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA) typing from 872 M. pneumoniae isolates obtained from respiratory tract infections (RTI)-suffering patients. Additionally, isolates were tested for the presence of MR implicated mutations in the 23S rRNA gene. The MLVA typing results revealed that three main genotypes, MLVA-3,5,6,2, MLVA-3,6,6,2 and MLVA-4,5,7,2, were constantly present and occasionally joined by less abundant, short-lived genotypes, which were detected mostly, but not exclusively, during epidemics. We also noticed a switch in abundance from MLVA-3,5,6,2 and MLVA-3,6,6,2, which dominated in the first epidemic (77.0%; 97/126), to MLVA-4,5,7,2 (71.6%; 428/598), which dominated in the second. Similar to this finding, the dominant P1 type also shifted from type 2 to type 1, although a complete P1 type shift was not observed, since both types remained in circulation. MR was detected in 0.8% (7/872) of M. pneumoniae isolates. Our results seem to suggest that MR remains sporadic in Slovenia at this point in time and that both recent epidemics were polyclonal in nature and, possibly, to some extent, fuelled by the P1 type dominance change.
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Affiliation(s)
- R Kogoj
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia
| | - M Praprotnik
- Division of Paediatrics, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva ulica 20, 1000, Ljubljana, Slovenia
| | - T Mrvič
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1000, Ljubljana, Slovenia
| | - M Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia
| | - D Keše
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia.
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Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev 2017; 30:747-809. [PMID: 28539503 PMCID: PMC5475226 DOI: 10.1128/cmr.00114-16] [Citation(s) in RCA: 380] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mycoplasma pneumoniae is an important cause of respiratory tract infections in children as well as adults that can range in severity from mild to life-threatening. Over the past several years there has been much new information published concerning infections caused by this organism. New molecular-based tests for M. pneumoniae detection are now commercially available in the United States, and advances in molecular typing systems have enhanced understanding of the epidemiology of infections. More strains have had their entire genome sequences published, providing additional insights into pathogenic mechanisms. Clinically significant acquired macrolide resistance has emerged worldwide and is now complicating treatment. In vitro susceptibility testing methods have been standardized, and several new drugs that may be effective against this organism are undergoing development. This review focuses on the many new developments that have occurred over the past several years that enhance our understanding of this microbe, which is among the smallest bacterial pathogens but one of great clinical importance.
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Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China, and Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | | | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Diaz MH, Desai HP, Morrison SS, Benitez AJ, Wolff BJ, Caravas J, Read TD, Dean D, Winchell JM. Comprehensive bioinformatics analysis of Mycoplasma pneumoniae genomes to investigate underlying population structure and type-specific determinants. PLoS One 2017; 12:e0174701. [PMID: 28410368 PMCID: PMC5391922 DOI: 10.1371/journal.pone.0174701] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/13/2017] [Indexed: 11/28/2022] Open
Abstract
Mycoplasma pneumoniae is a significant cause of respiratory illness worldwide. Despite a minimal and highly conserved genome, genetic diversity within the species may impact disease. We performed whole genome sequencing (WGS) analysis of 107 M. pneumoniae isolates, including 67 newly sequenced using the Pacific BioSciences RS II and/or Illumina MiSeq sequencing platforms. Comparative genomic analysis of 107 genomes revealed >3,000 single nucleotide polymorphisms (SNPs) in total, including 520 type-specific SNPs. Population structure analysis supported the existence of six distinct subgroups, three within each type. We developed a predictive model to classify an isolate based on whole genome SNPs called against the reference genome into the identified subtypes, obviating the need for genome assembly. This study is the most comprehensive WGS analysis for M. pneumoniae to date, underscoring the power of combining complementary sequencing technologies to overcome difficult-to-sequence regions and highlighting potential differential genomic signatures in M. pneumoniae.
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Affiliation(s)
- Maureen H. Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heta P. Desai
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shatavia S. Morrison
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alvaro J. Benitez
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bernard J. Wolff
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jason Caravas
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Timothy D. Read
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Deborah Dean
- Center for Immunobiology and Vaccine Research, University of California San Francisco Benioff Children’s Hospital Oakland Research Institute, Oakland, California, United States of America
- Joint Graduate Program in Bioengineering, University of California San Francisco and University of California Berkeley, Oakland, California, United States of America
| | - Jonas M. Winchell
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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30
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Sun H, Xue G, Yan C, Li S, Zhao H, Feng Y, Wang L. Changes in Molecular Characteristics of Mycoplasma pneumoniae in Clinical Specimens from Children in Beijing between 2003 and 2015. PLoS One 2017; 12:e0170253. [PMID: 28107399 PMCID: PMC5249184 DOI: 10.1371/journal.pone.0170253] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/30/2016] [Indexed: 11/23/2022] Open
Abstract
The molecular characteristics of 480 Mycoplasma pneumoniae polymerase chain reaction-positive specimens (331 were previously reported and 149 were newly reported) collected from pediatric patients in Beijing, China, between 2003 and 2015 were analyzed. Genotype M4-5-7-2/P1 were the most prevalent across the 13-year study period, although the isolation and mutation rates for this genotype varied between the periods 2003-2007, 2008-2013, and 2014-2015. In addition, there was a close association between the M4-5-7-2 genotype and macrolide resistance.
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Affiliation(s)
- Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Shaoli Li
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
| | - Liqiong Wang
- Department of Bacteriology, Capital Institute of Pediatrics, Chaoyang District, Beijing, China
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31
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Zhang J, Song X, Ma MJ, Xiao L, Kenri T, Sun H, Ptacek T, Li S, Waites KB, Atkinson TP, Shibayama K, Dybvig K, Feng Y. Inter- and intra-strain variability of tandem repeats in Mycoplasma pneumoniae based on next-generation sequencing data. Future Microbiol 2016; 12:119-129. [PMID: 27728978 DOI: 10.2217/fmb-2016-0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM To characterize inter- and intra-strain variability of variable-number tandem repeats (VNTRs) in Mycoplasma pneumoniae to determine the optimal multilocus VNTR analysis scheme for improved strain typing. METHODS Whole genome assemblies and next-generation sequencing data from diverse M. pneumoniae isolates were used to characterize VNTRs and their variability, and to compare the strain discriminability of new VNTR and existing markers. RESULTS We identified 13 VNTRs including five reported previously. These VNTRs displayed different levels of inter- and intra-strain copy number variations. All new markers showed similar or higher discriminability compared with existing VNTR markers and the P1 typing system. CONCLUSION Our study provides novel insights into VNTR variations and potential new multilocus VNTR analysis schemes for improved genotyping of M. pneumoniae.
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Affiliation(s)
- Jing Zhang
- Department of Pathogenic Biology, Chongqing Medical University, Chongqing, China.,Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Xiaohong Song
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA.,Department of Pharmacology, Sichuan University, Chengdu, Sichuan, China
| | | | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Tsuyoshi Kenri
- Department of Bacteriology II, National Institute of Infectious Diseases, Musashimurayama, Tokyo, Japan
| | - Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Travis Ptacek
- Department of Microbiology, University of Alabama at Birmingham, AL, USA
| | - Shaoli Li
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, AL, USA
| | | | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Musashimurayama, Tokyo, Japan
| | - Kevin Dybvig
- Department of Microbiology, University of Alabama at Birmingham, AL, USA
| | - Yanmei Feng
- Department of Pulmonary Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Li S, Sun H, Liu F, Feng Y, Zhao H, Xue G, Yan C. Two case reports: Whole genome sequencing of two clinical macrolide-resistant Mycoplasma pneumoniae isolates with different responses to azithromycin. Medicine (Baltimore) 2016; 95:e4963. [PMID: 27661056 PMCID: PMC5044926 DOI: 10.1097/md.0000000000004963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cases of macrolide-resistant Mycoplasma pneumoniae have increased rapidly since 2000, especially in Asia. Patients infected with macrolide-resistant M pneumoniae usually present with severe M pneumoniae pneumonia. The aim of this study was to identify indicators for whether children at an early stage of M pneumoniae infection develop mild or severe pneumonia. CASE SUMMARY Herein, we retrospectively reviewed 2 pediatric cases caused by macrolide-resistant M pneumoniae, but with markedly different severity of pneumonia. First, we compared the clinical courses of the patients, then isolated the pathogens and tested their response to macrolides, then finally, carried out whole genome sequencing of these isolates. Despite the difference in clinical presentation of the infection, both isolates exhibited a high level of resistance to macrolide antibiotics. Analysis of clinical data showed that the erythrocyte sedimentation rate in blood samples of the patients in the early stages of disease varied greatly. Genome sequence analysis revealed single nucleotide polymorphisms mainly focused on adhesin P1, which is involved in the pathogenicity of M pneumoniae. CONCLUSION The differences of erythrocyte sedimentation rate in the early stage of M pneumoniae pneumonia and mutations in P1 protein may help us to distinguish between severe or mild disease after infection with macrolide-resistant M pneumoniae. These findings could lead to the development of screening assays that will allow us to distinguish severe or mild M pneumoniae pneumonia early.
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Affiliation(s)
- Shaoli Li
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics
- Correspondence: Hongmei Sun, Department of Bacteriology, Capital Institute of Pediatrics, No. 2 Ya bao Road, Beijing 100020, China (e-mail: )
| | - Fei Liu
- Microbial Genome Research Center, CAS Key Lab of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics
| | - Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics
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Comparison of Molecular Characteristics of Mycoplasma pneumoniae Specimens Collected from the United States and China. J Clin Microbiol 2016; 53:3891-3. [PMID: 26400785 DOI: 10.1128/jcm.02468-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae-positive clinical specimens obtained from the United States and China during the same period were studied for their molecular characteristics. We found much more diverse genotypes and a lower prevalence of macrolide resistance in the U.S. specimens. Data from the study also showed an association of the resistance with certain genotypes.
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Pereyre S, Goret J, Bébéar C. Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment. Front Microbiol 2016; 7:974. [PMID: 27446015 PMCID: PMC4916212 DOI: 10.3389/fmicb.2016.00974] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022] Open
Abstract
Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults. These infections occur both endemically and epidemically worldwide. M. pneumoniae lacks cell wall and is subsequently resistant to beta-lactams and to all antimicrobials targeting the cell wall. This mycoplasma is intrinsically susceptible to macrolides and related antibiotics, to tetracyclines and to fluoroquinolones. Macrolides and related antibiotics are the first-line treatment of M. pneumoniae respiratory tract infections mainly because of their low MIC against the bacteria, their low toxicity and the absence of contraindication in young children. The newer macrolides are now the preferred agents with a 7-to-14 day course of oral clarithromycin or a 5-day course of oral azithromycin for treatment of community-acquired pneumonia due to M. pneumoniae, according to the different guidelines worldwide. However, macrolide resistance has been spreading for 15 years worldwide, with prevalence now ranging between 0 and 15% in Europe and the USA, approximately 30% in Israel and up to 90–100% in Asia. This resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides. Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens. Because this resistance has clinical outcomes such as longer duration of fever, cough and hospital stay, alternative antibiotic treatment can be required, including tetracyclines such as doxycycline and minocycline or fluoroquinolones, primarily levofloxacin, during 7–14 days, even though fluoroquinolones and tetracyclines are contraindicated in all children and in children < 8 year-old, respectively. Acquired resistance to tetracyclines and fluoroquinolones has never been reported in M. pneumoniae clinical isolates but reduced susceptibility was reported in in vitro selected mutants. This article focuses on M. pneumoniae antibiotic susceptibility and on the development and the evolution of acquired resistance. Molecular detection of resistant mutants and therapeutic options in case of macrolide resistance will also be assessed.
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Affiliation(s)
- Sabine Pereyre
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. BordeauxBordeaux, France; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRABordeaux, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de BordeauxBordeaux, France
| | - Julien Goret
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. BordeauxBordeaux, France; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRABordeaux, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de BordeauxBordeaux, France
| | - Cécile Bébéar
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. BordeauxBordeaux, France; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRABordeaux, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de BordeauxBordeaux, France
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Diaz MH, Winchell JM. The Evolution of Advanced Molecular Diagnostics for the Detection and Characterization of Mycoplasma pneumoniae. Front Microbiol 2016; 7:232. [PMID: 27014191 PMCID: PMC4781879 DOI: 10.3389/fmicb.2016.00232] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/15/2016] [Indexed: 12/12/2022] Open
Abstract
Over the past decade there have been significant advancements in the methods used for detecting and characterizing Mycoplasma pneumoniae, a common cause of respiratory illness and community-acquired pneumonia worldwide. The repertoire of available molecular diagnostics has greatly expanded from nucleic acid amplification techniques (NAATs) that encompass a variety of chemistries used for detection, to more sophisticated characterizing methods such as multi-locus variable-number tandem-repeat analysis (MLVA), Multi-locus sequence typing (MLST), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), single nucleotide polymorphism typing, and numerous macrolide susceptibility profiling methods, among others. These many molecular-based approaches have been developed and employed to continually increase the level of discrimination and characterization in order to better understand the epidemiology and biology of M. pneumoniae. This review will summarize recent molecular techniques and procedures and lend perspective to how each has enhanced the current understanding of this organism and will emphasize how Next Generation Sequencing may serve as a resource for researchers to gain a more comprehensive understanding of the genomic complexities of this insidious pathogen.
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Affiliation(s)
| | - Jonas M. Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, AtlantaGA, USA
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Dumke R, Schnee C, Pletz MW, Rupp J, Jacobs E, Sachse K, Rohde G, Group CAPNETZS. Mycoplasma pneumoniae and Chlamydia spp. infection in community-acquired pneumonia, Germany, 2011-2012. Emerg Infect Dis 2015; 21:426-34. [PMID: 25693633 PMCID: PMC4344269 DOI: 10.3201/eid2103.140927] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011-2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1.4%). M. pneumoniae P1 type 1 predominated, and levels of macrolide resistance were low (3.1%). Quarterly rates of M. pneumoniae-positive samples ranged from 1.5% to 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year. M. pneumoniae-positive patients were younger and more frequently female, had fewer co-occurring conditions, and experienced milder disease than did patients who tested negative. Clinicians should be aware of the epidemiology of these pathogens in CAP.
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Lluch-Senar M, Cozzuto L, Cano J, Delgado J, Llórens-Rico V, Pereyre S, Bebear C, Serrano L. Comparative "-omics" in Mycoplasma pneumoniae Clinical Isolates Reveals Key Virulence Factors. PLoS One 2015; 10:e0137354. [PMID: 26335586 PMCID: PMC4559472 DOI: 10.1371/journal.pone.0137354] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/14/2015] [Indexed: 01/21/2023] Open
Abstract
The human respiratory tract pathogen M. pneumoniae is one of the best characterized minimal bacterium. Until now, two main groups of clinical isolates of this bacterium have been described (types 1 and 2), differing in the sequence of the P1 adhesin gene. Here, we have sequenced the genomes of 23 clinical isolates of M. pneumoniae. Studying SNPs, non-synonymous mutations, indels and genome rearrangements of these 23 strains and 4 previously sequenced ones, has revealed new subclasses in the two main groups, some of them being associated with the country of isolation. Integrative analysis of in vitro gene essentiality and mutation rates enabled the identification of several putative virulence factors and antigenic proteins; revealing recombination machinery, glycerol metabolism and peroxide production as possible factors in the genetics and physiology of these pathogenic strains. Additionally, the transcriptomes and proteomes of two representative strains, one from each of the two main groups, have been characterized to evaluate the impact of mutations on RNA and proteins levels. This study has revealed that type 2 strains show higher expression levels of CARDS toxin, a protein recently shown to be one of the major factors of inflammation. Thus, we propose that type 2 strains could be more toxigenic than type 1 strains of M. pneumoniae.
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Affiliation(s)
- Maria Lluch-Senar
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
- * E-mail: (MLS); (LS)
| | - Luca Cozzuto
- Bioinformatics Unit, Centre for Genomic Regulation (CRG) and UPF, Dr. Aiguader 88, Barcelona, Spain
| | - Jaime Cano
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
| | - Javier Delgado
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
| | - Verónica Llórens-Rico
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
| | - Sabine Pereyre
- Univ. Bordeaux, INRA, USC-EA3671 Mycoplasmal and Chlamydial Infections in Humans, Bordeaux, France
- Bacteriology department, Bordeaux University Hospital, Bordeaux, France
| | - Cécile Bebear
- Univ. Bordeaux, INRA, USC-EA3671 Mycoplasmal and Chlamydial Infections in Humans, Bordeaux, France
- Bacteriology department, Bordeaux University Hospital, Bordeaux, France
| | - Luis Serrano
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr. Aiguader 88, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
- * E-mail: (MLS); (LS)
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Emergence of Macrolide-Resistant Mycoplasma pneumoniae in Hong Kong Is Linked to Increasing Macrolide Resistance in Multilocus Variable-Number Tandem-Repeat Analysis Type 4-5-7-2. J Clin Microbiol 2015; 53:3560-4. [PMID: 26338857 DOI: 10.1128/jcm.01983-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/24/2015] [Indexed: 11/20/2022] Open
Abstract
Macrolide-resistant Mycoplasma pneumoniae (MRMP) is rapidly emerging in Asia, but information on the temporal relationship between the increase in macrolide resistance and changes in strain types is scarce. Between 2011 and 2014, M. pneumoniae infection was diagnosed by PCR as part of routine care in a health care region in Hong Kong. Testing was initiated by clinicians, mainly in patients with suspected M. pneumoniae pneumonia. Specimens positive for M. pneumoniae were retrospectively investigated by macrolide resistance genotyping and a four-locus (Mpn13 to -16) multilocus variable-number tandem-repeat analysis (MLVA) scheme. The overall percentage of M. pneumoniae-positive specimens was 17.9%, with annual rates ranging from 9.8% to 27.2%. The prevalence of MRMP had rapidly increased from 13.6% in 2011 to 30.7% in 2012, 36.6% in 2013, and 47.1% in 2014 (P = 0.038). Two major MLVA types, 4-5-7-2 and 3-5-6-2, accounted for 75% to 85% of the infections each year. MLVA types 4-5-7-2 and 3-5-6-2 predominated among macrolide-resistant and macrolide-sensitive groups, respectively. The increase in MRMP was mainly caused by increasing macrolide resistance in the prevalent MLVA type 4-5-7-2, changing from 25.0% in 2011 to 59.1% in 2012, to 89.7% in 2013, and to 100% in 2014 (P < 0.001). In conclusion, increasing MRMP in Hong Kong was linked to a single MLVA type, which was both prevalent and increasingly resistant to macrolides.
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Jacobs E, Ehrhardt I, Dumke R. New insights in the outbreak pattern of Mycoplasma pneumoniae. Int J Med Microbiol 2015; 305:705-8. [PMID: 26319941 DOI: 10.1016/j.ijmm.2015.08.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Since a well-documented incidence peak in 2011/12 in European countries, infections due to the cell wall-less bacterium Mycoplasma pneumoniae have gained the increased attention of clinicians, microbiologists and health authorities. Despite the mild or asymptomatic clinical course of most M. pneumoniae infections, the microorganism is responsible for severe interstitial pneumonia and extra-pulmonary complications. Here, we report the time-dependence of 5545 notified cases of laboratory-confirmed M. pneumoniae disease in Saxony from 2001 until June 2014 as measured by serodiagnosis. In parallel, from 2003 until 2012 467 M. pneumoniae-positive respiratory samples or isolated strains were analysed by molecular typing based on sequence differences in the main P1 adhesin of M. pneumoniae. The epidemiological data showed a prolonged outbreak especially in the period 2011-2013. The typing of circulating strains during the outbreak did not support predominance of one of the two major P1 subtypes (mean proportion of subtype 1: 57%) or a change of one to the other subtype during the endemic situation before and during the outbreak period. From the last major outbreak in Europe, we conclude that the notification of M. pneumoniae-positive cases, which is legally required only in Saxony, should be expanded to the whole country, to optimise awareness of this human pathogen and to reflect upon antibiotic therapy.
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Affiliation(s)
- Enno Jacobs
- Institute for Medical Microbiology and Hygiene, Consulting Laboratory for Mycoplasma, Technical University of Dresden, Germany.
| | - Ingrid Ehrhardt
- Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Saxony, Division Medical Microbiology and Hygiene, Dresden, Germany
| | - Roger Dumke
- Institute for Medical Microbiology and Hygiene, Consulting Laboratory for Mycoplasma, Technical University of Dresden, Germany
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Molecular Epidemiology of Mycoplasma pneumoniae: Genotyping Using Single Nucleotide Polymorphisms and SNaPshot Technology. J Clin Microbiol 2015. [PMID: 26202117 DOI: 10.1128/jcm.01156-15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Molecular typing of Mycoplasma pneumoniae is an important tool for identifying grouped cases and investigating outbreaks. In the present study, we developed a new genotyping method based on single nucleotide polymorphisms (SNPs) selected from the whole-genome sequencing of eight M. pneumoniae strains, using the SNaPshot minisequencing assay. Eight SNPs, localized in housekeeping genes, predicted lipoproteins, and adhesin P1 genes were selected for genotyping. These SNPs were evaluated on 140 M. pneumoniae clinical isolates previously genotyped by multilocus variable-number tandem-repeat analysis (MLVA-5) and adhesin P1 typing. This method was also adapted for direct use with clinical samples and evaluated on 51 clinical specimens. The analysis of the clinical isolates using the SNP typing method showed nine distinct SNP types with a Hunter and Gaston diversity index (HGDI) of 0.836, which is higher than the HGDI of 0.583 retrieved for the MLVA-4 typing method, where the nonstable Mpn1 marker was removed. A strong correlation with the P1 adhesin gene typing results was observed. The congruence was poor between MLVA-5 and SNP typing, indicating distinct genotyping schemes. Combining the results increased the discriminatory power. This new typing method based on SNPs and the SNaPshot technology is a method for rapid M. pneumoniae typing directly from clinical specimens, which does not require any sequencing step. This method is based on stable markers and provides information distinct from but complementary to MLVA typing. The combined use of SNPs and MLVA typing provides powerful discrimination of strains.
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41
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Diaz MH, Benitez AJ, Cross KE, Hicks LA, Kutty P, Bramley AM, Chappell JD, Hymas W, Patel A, Qi C, Williams DJ, Arnold SR, Ampofo K, Self WH, Grijalva CG, Anderson EJ, McCullers JA, Pavia AT, Wunderink RG, Edwards KM, Jain S, Winchell JM. Molecular Detection and Characterization of Mycoplasma pneumoniae Among Patients Hospitalized With Community-Acquired Pneumonia in the United States. Open Forum Infect Dis 2015; 2:ofv106. [PMID: 26284257 PMCID: PMC4536330 DOI: 10.1093/ofid/ofv106] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
We report molecular characteristics of M. pneumoniae in respiratory specimens from children and adults hospitalized with CAP. The P1 type 1 genotype and MLVA type 4/5/7/2 predominated, but proportions of types differed between children and adults. Macrolide resistance was rare. Background. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). The molecular characteristics of M pneumoniae detected in patients hospitalized with CAP in the United States are poorly described. Methods. We performed molecular characterization of M pneumoniae in nasopharyngeal/oropharyngeal swabs from children and adults hospitalized with CAP in the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, including P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide susceptibility genotyping. Results. Of 216 M pneumoniae polymerase chain reaction-positive specimens, 40 (18.5%) were obtained from adults and 176 (81.5%) from children. P1 type distribution differed between adults (64% type 1 and 36% type 2) and children (84% type 1, 13% type 2, and 3% variant) (P < .05) and among sites (P < .01). Significant differences in the proportions of MLVA types 4/5/7/2 and 3/5/6/2 were also observed by age group (P < .01) and site (P < .01). A macrolide-resistant genotype was identified in 7 (3.5%) specimens, 5 of which were from patients who had recently received macrolide therapy. No significant differences in clinical characteristics were identified among patients with various strain types or between macrolide-resistant and -sensitive M pneumoniae infections. Conclusions. The P1 type 1 genotype and MLVA type 4/5/7/2 predominated, but there were differences between children and adults and among sites. Macrolide resistance was rare. Differences in strain types did not appear to be associated with differences in clinical outcomes. Whole genome sequencing of M pneumoniae may help identify better ways to characterize strains.
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Affiliation(s)
| | | | | | | | | | - Anna M Bramley
- Influenza Division , Centers for Disease Control and Prevention , Atlanta, Georgia
| | | | - Weston Hymas
- University of Utah Health Sciences Center , Salt Lake City
| | - Anami Patel
- Le Bonheur Children's Hospital ; University of Tennessee Health Science Center
| | - Chao Qi
- Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Derek J Williams
- Vanderbilt University School of Medicine , Nashville, Tennessee ; Vanderbilt Vaccine Research Program , Nashville
| | - Sandra R Arnold
- Le Bonheur Children's Hospital ; University of Tennessee Health Science Center
| | - Krow Ampofo
- University of Utah Health Sciences Center , Salt Lake City
| | - Wesley H Self
- Vanderbilt University School of Medicine , Nashville, Tennessee
| | | | | | - Jonathan A McCullers
- Le Bonheur Children's Hospital ; University of Tennessee Health Science Center ; St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center , Salt Lake City
| | | | - Kathryn M Edwards
- Vanderbilt University School of Medicine , Nashville, Tennessee ; Vanderbilt Vaccine Research Program , Nashville
| | - Seema Jain
- Influenza Division , Centers for Disease Control and Prevention , Atlanta, Georgia
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Chalker VJ, Pereyre S, Dumke R, Winchell J, Khosla P, Sun H, Yan C, Vink C, Bébéar C. International Mycoplasma pneumoniae typing study: interpretation of M. pneumoniae multilocus variable-number tandem-repeat analysis. New Microbes New Infect 2015; 7:37-40. [PMID: 26236493 PMCID: PMC4501435 DOI: 10.1016/j.nmni.2015.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/05/2015] [Accepted: 05/15/2015] [Indexed: 10/29/2022] Open
Abstract
Typing of Mycoplasma pneumoniae by multiple-locus variable-number tandem repeat analysis (MLVA) is increasingly in use. However, no specific internationally agreed guidance is available. Thirty M. pneumoniae DNA samples including serial dilutions of a type strain were sent to six international laboratories to perform MLVA and results were compared. Good correlation was observed, indicating that this methodology can be robustly performed in multiple sites. However, differences due to interpretation of fragment size, repeat sequence identification and repeat numbering led to inconsistency in the final profiles assigned by laboratories. We propose guidelines for interpreting M. pneumoniae MLVA typing and assigning the number of repeats.
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Affiliation(s)
| | - S Pereyre
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, France ; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Institut National de la Recherche Agronomique, Bordeaux, France
| | - R Dumke
- TU Dresden, Medical Faculty Carl Gustav Carus, Institute of Medical Microbiology and Hygiene, Dresden, Germany
| | - J Winchell
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - P Khosla
- Public Health England Colindale, London, UK
| | - H Sun
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - C Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - C Vink
- Erasmus MC-Sophia Children's Hospital, Laboratory of Pediatrics, Rotterdam, The Netherlands
| | - C Bébéar
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, France ; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Institut National de la Recherche Agronomique, Bordeaux, France
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Diaz MH, Benitez AJ, Winchell JM. Investigations of Mycoplasma pneumoniae infections in the United States: trends in molecular typing and macrolide resistance from 2006 to 2013. J Clin Microbiol 2015; 53:124-30. [PMID: 25355769 PMCID: PMC4290910 DOI: 10.1128/jcm.02597-14] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently, pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve with empirical antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae infections that were supported by the Centers for Disease Control and Prevention (CDC) between 2006 and 2013. We examined 199 M. pneumoniae-positive specimens collected during this time period in order to identify trends in antimicrobial resistance and circulating types. Overall, macrolide resistance was identified in approximately 10% of M. pneumoniae infections occurring during this time period. Typing of strains revealed cocirculation of multiple multilocus variable-number tandem-repeat analysis (MLVA) and P1 types throughout this period, including diversity in types detected within individual outbreaks. Three MLVA types (4572, 3562, and 3662) accounted for 97% of the infections during the study period. A systematic surveillance program is necessary to understand the burden of M. pneumoniae disease in the United States, facilitate case and outbreak identification, and inform appropriate therapeutic and infection control strategies.
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Affiliation(s)
- Maureen H Diaz
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alvaro J Benitez
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kubota H, Okuno R, Hatakeyama K, Uchitani Y, Sadamasu K, Hirai A, Kai A. Molecular Typing of Mycoplasma pneumoniae Isolated from Pediatric Patients in Tokyo, Japan. Jpn J Infect Dis 2015; 68:76-8. [DOI: 10.7883/yoken.jjid.2014.336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hiroaki Kubota
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health
| | - Rumi Okuno
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health
| | - Kaoru Hatakeyama
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health
| | - Yumi Uchitani
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health
| | - Kenji Sadamasu
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health
| | - Akihiko Hirai
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health
| | - Akemi Kai
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health
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45
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A single-tube multiple-locus variable-number tandem-repeat analysis of Mycoplasma pneumoniae clinical specimens by use of multiplex PCR-capillary electrophoresis. J Clin Microbiol 2014; 52:4168-71. [PMID: 25232156 DOI: 10.1128/jcm.02178-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this study, we developed a single-tube multiple-locus variable-number tandem-repeat (VNTR) analysis (MLVA) assay to type Mycoplasma pneumoniae directly from respiratory samples collected from children with respiratory infections. The multiplex PCR included four fluorescently primed VNTRs (Mpn13, Mpn14, Mpn15, and Mpn16) and was carried out in a single tube. A total of 137 M. pneumoniae-positive specimens, collected in 2013 from Beijing, China, were divided among four types (M4-5-7-2, M4-5-6-2, M3-5-6-2, and M5-5-7-2) using the amended MLVA system. The most prevalent genotype was M4-5-7-2. No correlation was found between macrolide resistance in the M. pneumoniae samples and the MLVA types. To our knowledge, this is the first study to type and analyze M. pneumoniae clinical specimens using multiplex PCR-capillary electrophoresis in a single tube. This novel low-cost method can be used to rapidly type M. pneumoniae clinical specimens directly and shows great potential for monitoring outbreaks of M. pneumoniae.
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46
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Waller JL, Diaz MH, Petrone BL, Benitez AJ, Wolff BJ, Edison L, Tobin-D'Angelo M, Moore A, Martyn A, Dishman H, Drenzek CL, Turner K, Hicks LA, Winchell JM. Detection and characterization of Mycoplasma pneumoniae during an outbreak of respiratory illness at a university. J Clin Microbiol 2014; 52:849-53. [PMID: 24371236 PMCID: PMC3957776 DOI: 10.1128/jcm.02810-13] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/20/2013] [Indexed: 01/14/2023] Open
Abstract
An outbreak at a university in Georgia was identified after 83 cases of probable pneumonia were reported among students. Respiratory specimens were obtained from 21 students for the outbreak investigation. The TaqMan array card (TAC), a quantitative PCR (qPCR)-based multipathogen detection technology, was used to initially identify Mycoplasma pneumoniae as the causative agent in this outbreak. TAC demonstrated 100% diagnostic specificity and sensitivity compared to those of the multiplex qPCR assay for this agent. All M. pneumoniae specimens (n=12) and isolates (n=10) were found through genetic analysis to be susceptible to macrolide antibiotics. The strain diversity of M. pneumoniae associated with this outbreak setting was identified using a variety of molecular typing procedures, resulting in two P1 genotypes (types 1 [60%] and 2 [40%]) and seven different multilocus variable-number tandem-repeat analysis (MLVA) profiles. Continued molecular typing of this organism, particularly during outbreaks, may enhance the current understanding of the epidemiology of M. pneumoniae and may ultimately lead to a more effective public health response.
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Affiliation(s)
- Jessica L. Waller
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen H. Diaz
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brianna L. Petrone
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alvaro J. Benitez
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard J. Wolff
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Edison
- Georgia Department of Public Health, Atlanta, Georgia, USA
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ashley Moore
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Audrey Martyn
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Hope Dishman
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | - Kim Turner
- Fulton County Department of Health and Wellness, Atlanta, Georgia, USA
| | - Lauri A. Hicks
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M. Winchell
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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47
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Molecular characterizations of PCR-positive Mycoplasma pneumoniae specimens collected from Australia and China. J Clin Microbiol 2014; 52:1478-82. [PMID: 24574282 DOI: 10.1128/jcm.03366-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae is an important cause of community-acquired pneumonia (CAP). In this study, M. pneumoniae strains in PCR-positive specimens collected from patients in Sydney, Australia (30 samples), and Beijing, China (83 samples), were characterized using multilocus variable-number tandem-repeat (VNTR) analysis (MLVA), P1-restriction fragment length polymorphism (RFLP) analysis, and sequencing of domain V of the 23S rRNA gene to compare genotype distribution and macrolide resistance rates between locations. Eighteen distinct MLVA types were identified in specimens from Sydney, of which 10 were known (types E, G, J, M, N, P, U, V, S, and X) and 8 previously unknown. Strains were equally distributed between P1-RFLP type 1 and type 2 variants. Among samples from Beijing, MLVA types E, G, J, P, U, X, and Z and four new types were identified. Most specimens belonged to P1-RFLP type 1. A nomenclature based on five VNTR loci is proposed to designate MLVA patterns. Macrolide resistance-associated mutations were identified in only 1 of 30 specimens (3.3%) from Sydney and 71 of 83 (85.5%) from Beijing (P<0.05). This study demonstrated that although multiple individual M. pneumoniae strains were circulating in Beijing, the genotypes were less diverse than those in Sydney. However, the greatest regional difference was in the incidence of macrolide resistance, which may reflect differences in antibiotic use and/or measures in resistance control.
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48
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Qu J, Yu X, Liu Y, Yin Y, Gu L, Cao B, Wang C. Specific multilocus variable-number tandem-repeat analysis genotypes of Mycoplasma pneumoniae are associated with diseases severity and macrolide susceptibility. PLoS One 2013; 8:e82174. [PMID: 24367502 PMCID: PMC3867324 DOI: 10.1371/journal.pone.0082174] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/30/2013] [Indexed: 12/02/2022] Open
Abstract
Clinical relevance of multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) in patients with community-acquired pneumonia (CAP) by Mycoplasma pneumoniae (M. pneumoniae) is unknown. A multi-center, prospective study was conducted from November 2010 to April 2012. Nine hundred and fifty-four CAP patients were consecutively enrolled. M. pneumoniae clinical isolates were obtained from throat swabs. MLVA typing was applied to all isolates. Comparison of pneumonia severity index (PSI) and clinical features among patients infected with different MLVA types of M. pneumoniae were conducted. One hundred and thirty-six patients were positive with M. pneumoniae culture. The clinical isolates were clustered into 18 MLVA types. One hundred and fourteen (88.3%) isolates were resistant to macrolide, covering major MLVA types. The macrolide non-resistant rate of M. pneumoniae isolates with Mpn13-14-15-16 profile of 3-5-6-2 was significantly higher than that of other types (p≤0.001). Patients infected with types U (5-4-5-7-2) and J (3-4-5-7-2) had significantly higher PSI scores (p<0.001) and longer total duration of cough (p = 0.011). Therefore it seems that there is a correlation between certain MLVA types and clinical severity of disease and the presence of macrolide resistance.
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Affiliation(s)
- Jiuxin Qu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Xiaomin Yu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yingmei Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yudong Yin
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
- * E-mail: .
| | - Chen Wang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Hospital, China Ministry of Health, Beijing
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