We compared the performances of three recently optimized real-time PCR assays derived from distinct genomic regions of Mycoplasma pneumoniae during an outbreak. Comprehensive evaluation established that a newly described toxin gene represents a superior target for detecting M. pneumoniae DNA in clinical specimens, although use of multiple targets may increase testing confidence.Mycoplasma pneumoniae accounts for approximately 15% to 20% of all community-acquired pneumonia cases and is a common cause of outbreaks (10,16,18). Outbreaks have been reported to occur in 3-to 7-year intervals, and although all age groups are susceptible, incidence rates vary with age and may occur more frequently in certain settings (10,16,17). M. pneumoniae infection spreads efficiently within households and close living quarters, with incubation periods as long as 3 weeks (17). The insidious nature of this infection and its protracted disease course make this agent a predominant cause of "walking pneumonia" that can persist within the population and cause community or institutional outbreaks. Upper-and lowerrespiratory-tract symptoms are often mild, resulting in tracheobronchitis, headache, and cough. Occasionally, severe cases with extrapulmonary involvement can result in hospitalization and death due to neurological disease, such as encephalitis (1,2,4,15,17). The high rate of morbidity and the occasional mortality reinforces the need for timely diagnosis for administering proper antibiotic treatment (7, 9).Conventional tests for detecting M. pneumoniae are fraught with limitations (3). M. pneumoniae culture can often take several weeks, requires special media and expertise, and is insensitive and prone to contaminants and inhibitors. Serological assays such as complement fixation and commercially available immunoglobulin detection kits are by nature retrospective, requiring paired serum samples from both acute and convalescent phases, and provide questionable specificity and sensitivity results. In sum, these approaches are impractical for a rapid diagnosis. A variety of nucleic acid-based tests based upon PCR have been developed for the rapid and sensitive detection of M. pneumoniae (5,11,13,14,16). The range of variables within each PCR study (specimen type, nucleic acid extraction and amplification procedures, target selection, definitions used in calculating data, etc.) makes it difficult to compare results and draw a single, comprehensive approach for reliable detection.Recent community outbreaks of M. pneumoniae infection underscore a need among public health departments and local hospitals for a rapid and reliable diagnostic assay (1,10,12,17,18). Moreover, this test should be highly specific and sensitive and should be evaluated in an outbreak setting. The aim of the current study was to evaluate the use of three recently optimized real-time PCR assays for the detection of M. pneumoniae in respiratory samples from a recent outbreak. To our knowledge, this is the first prospective and comparative study of real-time PCR targ...