Community Outbreak of<i>Mycoplasma pneumoniae</i>Infection: School‐Based Cluster of Neurologic Disease Associated with Household Transmission of Respiratory Illness

Walter, Nicholas D.; Grant, Gavin B.; Bandy, Utpala; Alexander, Nicole; Winchell, Jonas M.; Jordan, Hannah; Sejvar, James J.; Hicks, Lauri A.; Gifford, David; Alexander, Nicole T.; Thurman, Kathleen A.; Schwartz, Stephanie; Dennehy, Penelope H.; Khetsuriani, Nino; Fields, Barry S.; Dillon, Michael; Erdman, Dean D.; Whitney, Cynthia G.; Moore, Matthew R.

doi:10.1086/592281

Cited by 58 publications

(35 citation statements)

References 41 publications

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“…More than 40% of outbreaks were associated with an educational institution, which reflects the fact that M. pneumoniae is a leading cause of CAP in children and adolescents (24). Transmission of M. pneumoniae infections between family members is common (8,25,26); multiple cases within a household were documented in approximately one-third of the clusters or outbreaks in this investigation, although evidence of household transmission was not evaluated in all of the clusters and outbreaks.…”

Section: Discussionmentioning

confidence: 82%

Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

2015

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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 M ycoplasma pneumoniae is a common respiratory pathogen in adults and children worldwide and is a leading cause of community-acquired pneumonia (CAP). The majority of infections are self-limiting, and empirical treatment without pathogen-specific diagnostic testing is common in the primary care setting. In fact, the current treatment guidelines do not recommend diagnostic testing for suspected CAP of atypical bacterial etiology in adults in the outpatient setting unless a change in the patient treatment regimen is anticipated (1). The recommendation to perform diagnostic testing for M. pneumoniae infection in children is classified as a weak recommendation and likely not routinely performed, in part due to a lack of available diagnostic tests in the primary care setting and at state and local public health laboratories (2). The estimates of the actual number of cases occurring annually are inexact due to the lack of systematic surveillance and reporting. Although historically noted to occur in 3-to 7-year cycles, outbreaks of M. pneumoniae are common and may last for several months as a result of the long incubation period and prolonged carriage after resolution of symptoms (3-5).Excessive or inappropriate antibiotic use provides selective pressure for the development of antimicrobial resistance. In M. pneumoniae infections, macrolide resistance is an emerging threat worldwide, and in some parts of the world, Ͼ90% of M. pneumoniae infections are caused by resistant strains (6, 7). In the United States, the incidence of infection with macrolide-resistant M. pneumoniae strains is not well defined, although the trait has been consistently reported over the past decade (8-10). Macrolide-resistant M. pneumoniae infection has been associated with increased febrile period, increased duration of persistent cough, and extended antibiotic therapy compared to macrolide-sensitive strains (11-16).Methods for molecular typing of M. pneumoniae strains have been developed, including discrimination of two major types and variants based on the sequence of the P1 adhesion molecule gene and identification of multiple types using multilocus variablenumber tandem-repeat analysis (MLVA) to examine four or five polymorphic loci. Despite development of these sophisticated typing methods, character...

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Section: Discussionmentioning

confidence: 82%

Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

2015

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“…pneumoniae causes numerous outbreaks in closed or semiclosed settings such as kindergartens, primary schools, middle schools, and universities (9)(10)(11)(12)(13). In China, M. pneumoniae infection is not a notifiable disease, so the prevalence of M. pneumoniae infection in schools is unclear.…”

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confidence: 99%

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

Wang

Yang

et al. 2016

Antimicrob Agents Chemother

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

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“…[1,2] In the northern hemisphere Mp infections have increasingly been reported in outbreaks. [5][6][7] A central nervous system (CNS) invasion by Mp is diagnosed based on serology, culture or polymerase chain reaction (PCR) from the cerebrospinal fluid (CSF), and after excluding other causes. [8,9] Up to one-third of patients with Mp infection may have ear infection, but PCR has been positive from middle ear fluid in rare cases.…”

Section: Introductionmentioning

confidence: 99%

Meningoencephalitis and otitis media in a child withMycoplasma pneumoniaeinfection

Pelkonen

Sarajuuri

Rautanen

et al. 2017

Acta Oto-Laryngologica Case Reports

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We report on a previously healthy 11-year-old male presenting with meningoencephalitis and otitis media. Computed tomography demonstrated opacification of the right middle ear and mastoid ear cells, but no destructive changes. Anti-Mycoplasma pneumoniae IgG and IgM were positive in serum and at high concentrations in cerebrospinal fluid (CSF), and its nucleic acid was detected in the middle ear fluid and in a throat swab, but not in CSF. EEG showed generalized slowing and right temporal sharp waves. Brain MRI imaging remained normal. After a 3-week treatment with doxycycline and a tympanostomy tube, the patient recovered, and no long-term neurological sequelae have appeared. Diagnostics and pathogenetic mechanisms in meningoencephalitis caused by M. pneumoniae are discussed. ARTICLE HISTORY

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Community Outbreak ofMycoplasma pneumoniaeInfection: School‐Based Cluster of Neurologic Disease Associated with Household Transmission of Respiratory Illness

Cited by 58 publications

References 41 publications

Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013

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

Meningoencephalitis and otitis media in a child withMycoplasma pneumoniaeinfection

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