Atypical Pneumonia

Sharma, Lokesh; Losier, Ashley; Tolbert, Thomas; Cruz, Charles S. Dela; Marion, Chad R.

doi:10.1016/j.ccm.2016.11.011

Cited by 67 publications

(52 citation statements)

References 100 publications

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“…The increasing empirical use of macrolides for pneumonia has been observed in high-income countries, such as the USA, due to their broader spectrum activity against atypical pneumonia caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis. [53][54][55] The increase in penicillin and erythromycin resistance could be due to acquisition of resistance determinants (eg, mefA in GPSC3 in the USA), the expansion of extant nonvaccine serotypes within a well established resistant lineage (eg, penicillin-resistant lineage GPSC5 replacing its major serotype composition from serotype 23F to 35B/D in South Africa), or simply a clonal expansion of a non-vaccine-type lineage with antimicrobial resistance (eg, penicillin and macrolide resistant GPSC59 in the USA). Additionally, this study revealed differences in resistance prevalence within a single lineage between countries, indicating that some surviving lineages could acquire antibiotic resistance determinants adaptive to the local antibiotic selective pressure.…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study

Gladstone

Tonder

et al. 2019

The Lancet Infectious Diseases

201

184

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Background Invasive pneumococcal disease remains an important health priority owing to increasing disease incidence caused by pneumococci expressing non-vaccine serotypes. We previously defined 621 Global Pneumococcal Sequence Clusters (GPSCs) by analysing 20 027 pneumococcal isolates collected worldwide and from previously published genomic data. In this study, we aimed to investigate the pneumococcal lineages behind the predominant serotypes, the mechanism of serotype replacement in disease, as well as the major pneumococcal lineages contributing to invasive pneumococcal disease in the post-vaccine era and their antibiotic resistant traits. Methods We whole-genome sequenced 3233 invasive pneumococcal disease isolates from laboratory-based surveillance programmes in Hong Kong (n=78), Israel (n=701), Malawi (n=226), South Africa (n=1351), The Gambia (n=203), and the USA (n=674). The genomes represented pneumococci from before and after pneumococcal conjugate vaccine (PCV) introductions and were from children younger than 3 years. We identified predominant serotypes by prevalence and their major contributing lineages in each country, and assessed any serotype replacement by comparing the incidence rate between the pre-PCV and PCV periods for Israel, South Africa, and the USA. We defined the status of a lineage as vaccine-type GPSC (≥50% 13-valent PCV [PCV13] serotypes) or non-vaccine-type GPSC (>50% non-PCV13 serotypes) on the basis of its initial serotype composition detected in the earliest vaccine period to measure their individual contribution toward serotype replacement in each country. Major pneumococcal lineages in the PCV period were identified by pooled incidence rate using a random effects model. Findings The five most prevalent serotypes in the PCV13 period varied between countries, with only serotypes 5, 12F, 15B/C, 19A, 33F, and 35B/D common to two or more countries. The five most prevalent serotypes in the PCV13 period varied between countries, with only serotypes 5, 12F, 15B/C, 19A, 33F, and 35B/D common to two or more countries. These serotypes were associated with more than one lineage, except for serotype 5 (GPSC8). Serotype replacement was mainly mediated by expansion of non-vaccine serotypes within vaccine-type GPSCs and, to a lesser extent, by increases in non-vaccine-type GPSCs. A globally spreading lineage, GPSC3, expressing invasive serotypes 8 in South Africa and 33F in the USA and Israel, was the most common lineage causing non-vaccine serotype invasive pneumococcal disease in the PCV13 period. We observed that same prevalent non-vaccine serotypes could be associated with distinctive lineages in different countries, which exhibited dissimilar antibiotic resistance profiles. In non-vaccine serotype isolates, we detected significant increases in the prevalence of resistance to penicillin (52 [21%] of 249 vs 169 [29%] of 575, p=0•0016) and erythromycin (three [1%] of 249 vs 65 [11%] of 575, p=0•0031) in the PCV13 period compared with the pre-PCV period. Interpretation Globally spreading line...

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Section: Discussionmentioning

confidence: 99%

Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study

Gladstone

Tonder

et al. 2019

The Lancet Infectious Diseases

201

184

View full text Add to dashboard Cite

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“…Current clinical guidelines have categorized pneumonia into four types: community acquired (CAP), healthcare associated, hospital acquired [1] and ventilator associated [ 2 ]. Among these, CAP is identified as infection in a patient with no recent contact with the healthcare system [ 3 ]. Mycoplasma pneumoniae , Chlamydia pneumoniae and Legionella pneumophila are the most common bacterial agents of atypical CAP [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…L. pneumophila mainly affects elderly people and more often men than women. This bacterium is rarely differentiated from other atypical pneumonia because it presents similar clinical signs and symptoms [ 3 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Frequency of Mycoplasma pneumoniae, Legionella pneumophila and Chlamydia spp. among patients with atypical pneumonia in Tehran

Goodarzi

Pourmand

Rajabpour

et al. 2020

New Microbes and New Infections

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Mycoplasma pneumoniae , Legionella pneumophila and Chlamydia pneumoniae are the most common bacterial agents, which account for 15–40%, 2–15% and 5–10% of atypical community-acquired pneumonia (CAP) respectively. These agents are mostly associated with infection in the outpatient setting. The aim of this study was to evaluate the frequency of these pathogens among patients with CAP attending outpatient clinics in Tehran. A cross-sectional study was carried out of 150 patients attending to educational hospitals in Tehran with CAP. M. pneumoniae , L. pneumophila and Chlamydia spp. were detected by PCR assay, targeting the P1 adhesion gene, macrophage infectivity potentiator ( mip ) gene and 16S rRNA gene respectively from throat swabs obtained from each patient. A total of 86 (57.3%) of 150 patients were women; median age was 50 years (interquartile range, 35–65 years). M. pneumoniae , L. pneumophila and Chlamydia spp. were detected in 37 (24.7%), 25 (16.7%) and 11 (7.3%) patients respectively; of these, 66 patients (44%) were infected at least by one of these three pathogens. The frequency of L. pneumophila was significantly higher among patients over 60 years old (p 0.03). Coinfection was detected in seven patients (4.7%); six were infected by M. pneumoniae and L. pneumophila , and only one was infected by L. pneumophila and Chlamydia spp. M. pneumoniae was the most prevalent agent of atypical CAP, and L. pneumophila was more likely to infect elderly rather than younger people. Further studies on the prevalence of CAP and its aetiologic agents are needed to improve the diagnosis and treatment of CAP patients.

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“…The white blood cell counts of viral infection is normal in most cases, as well as M. pneumoniae infection. It is difficult to distinguish M. pneumoniae from virus-induced LRTI (Sharma et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Distribution characteristics of serum β2-microglobulin between viral and bacterial lower respiratory tract infections: a retrospective study

Cai¹,

Xu²,

Zhou³

et al. 2020

PeerJ

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Background Lower respiratory tract infection (LRTI) is one of the leading cause of death in children under 5 years old around the world between 1980 and 2016. Distinguishing between viral and bacterial infection is challenging when children suffered from LRTI in the absence of pathogen detection. The aim of our study is to analyze the difference of serum β2-microglobulin (β2-MG) between viral LRTI and bacterial LRTI in children. Methods This retrospective study included children with LRTI caused by a single pathogen from Yancheng Third People’s Hospital, Yancheng, China, between January 1, 2016 and December 31, 2019. Participants were divided into the younger group (1 year old ≤ age < 3 years old) and the older group (3 years old ≤ age < 5 years old) for subgroup analysis. Results A total of 475 children with LRTI caused by common respiratory pathogens were identified. In the younger group as well as the older group, the serum level of β2-MG in respiratory syncytial virus, influenza A virus and influenza B virus groups were significantly increased compared to that in the Mycoplasma pneumoniae group. Compared with Streptococcus pneumoniae infection group, the serum β2-MG level of respiratory syncytial virus, influenza A virus and influenza B virus groups were significantly higher in children between 1 and 3 years old. Conclusions The serum β2-MG may distinguish viral infection from bacterial infection in children with LRTI.

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Atypical Pneumonia

Cited by 67 publications

References 100 publications

Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study

Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study

Frequency of Mycoplasma pneumoniae, Legionella pneumophila and Chlamydia spp. among patients with atypical pneumonia in Tehran

Distribution characteristics of serum β2-microglobulin between viral and bacterial lower respiratory tract infections: a retrospective study

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