Respiratory tract infections by Mycoplasma pneumoniae in children: a review of diagnostic and therapeutic measures

Ferwerda, Annemarie; Moll, Henriëtte A.; Groot, Ronald de

doi:10.1007/s004310100775

Cited by 128 publications

(161 citation statements)

References 62 publications

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“…The standard laboratory method for the diagnosis of M. pneumoniae as an etiological agent for LRTI and CAP has been culture or serology (9). PCR has been shown to be a better diagnostic test than conventional techniques (6,7,13,14,23,30), and Loens et al showed recently that NASBA is a good alternative as well (20).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of M. pneumoniae in adults with CAP and LRTI ranges from 1 to 30%, depending on the population studied and the diagnostic test used (19,22,27). M. pneumoniae is difficult to grow in cultures; therefore, clinical diagnosis relies mainly on serology and, in recent years, on molecular techniques (9). It is important to establish M. pneumoniae as the pathogen by laboratory diagnosis, as the clinical presentation is not significantly different from that seen with other pathogens causing CAP (29).…”

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confidence: 99%

“…PCR has been shown to offer the potential of increased sensitivity and rapidity compared to other diagnostic tests. For the diagnosis of M. pneumoniae infections, therefore, nucleic acid amplification techniques have been introduced in many diagnostic laboratories as a valuable test (9). Two targets are primarily used for M. pneumoniae amplification assays.…”

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confidence: 99%

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Comparison and Evaluation of Real-Time PCR, Real-Time Nucleic Acid Sequence-Based Amplification, Conventional PCR, and Serology for Diagnosis of Mycoplasma pneumoniae

Templeton¹,

Scheltinga²,

Graffelman³

et al. 2003

J Clin Microbiol

135

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Mycoplasma pneumoniae is a common cause of community-acquired pneumonia and lower-respiratory-tract infections. Diagnosis has traditionally been obtained by serological diagnosis, but increasingly, molecular techniques have been applied. However, the number of studies actually comparing these assays is limited. The development of a novel duplex real-time PCR assay for detection of M. pneumoniae in the presence of an internal control real-time PCR is described. In addition, real-time nucleic acid sequence-based amplification (NASBA) on an iCycler apparatus is evaluated. These assays were compared to serology and a conventional PCR assay for 106 clinical samples from patients with lower-respiratory-tract infection. Of the 106 samples, 12 (11.3%) were positive by all the molecular methods whereas serology with acute sample and convalescent samples detected 6 (5.6%) and 9 (8.5%), respectively. Clinical symptoms of the patients with Mycoplasmapositive results were compared to those of the other patients with lower-respiratory-tract infections, and it was found that the results for mean lower age numbers as well as the presence of chills, increased erythrocyte sedimentation rate, and raised C-reactive protein levels showed significant differences. Molecular methods are superior for diagnosis of M. pneumoniae, providing more timely diagnosis. In addition, using real-time methods involves less hands-on time and affords the ability to monitor the reaction in the same tube.

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Section: Discussionmentioning

confidence: 99%

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Comparison and Evaluation of Real-Time PCR, Real-Time Nucleic Acid Sequence-Based Amplification, Conventional PCR, and Serology for Diagnosis of Mycoplasma pneumoniae

Templeton¹,

Scheltinga²,

Graffelman³

et al. 2003

J Clin Microbiol

135

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“…It is responsible for at least 40% of cases of CA pneumonia (CAP) and as many as 18% of cases requiring hospitalization in children. 2 The diagnosis of MP infection is difficult and nonuniform, and serology and nucleic acid amplification (polymerase chain reaction) are mostly used. Few commercial serologic assays have been shown to have appropriate sensitivity and specificity.…”

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confidence: 99%

Treatment of Mycoplasma pneumoniae in Pediatric Lower Respiratory Infection

et al. 2014

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In this issue of Pediatrics, Biondi et al 1 present a rigorous systematic review and meta-analysis of the literature on the use of antibiotics to treat community-acquired (CA) lower respiratory infections (LRIs) secondary to Mycoplasma pneumoniae (MP). Consistent with previous studies, but on a larger scale, the evidence is deemed insufficient to support or refute such treatments for MP.The following comments, although largely addressed in the article, are intended to highlight the caution that is required on the part of the reader when attempting to implement these conclusions to everyday practice. In particular, we must point out that lack of evidence of efficacy is not evidence of inefficacy when addressing current treatment paradigms. The problems of this and previous studies lie in the lack of uniformity of diagnostic methods, complicated by the fact that mixed infections with other microorganisms often go undiagnosed and contaminate any analysis of treatment efficacy. The small number of studies and their heterogeneity add to our inability to conclude either way, and therefore statements about results of MP-oriented antibiotic treatment are difficult to substantiate, particularly when applied to individual cases.MP is a common cause of CA LRI, particularly in school-aged children and adolescents. It is responsible for at least 40% of cases of CA pneumonia (CAP) and as many as 18% of cases requiring hospitalization in children. 2The diagnosis of MP infection is difficult and nonuniform, and serology and nucleic acid amplification (polymerase chain reaction) are mostly used. Few commercial serologic assays have been shown to have appropriate sensitivity and specificity.3 Conversely, polymerase chain reaction may overestimate the incidence of MP and cost considerations limit its use. These factors frequently limit or delay diagnosis and introduce arbitrariness to therapeutic decisions.Even when the diagnosis is made, there is evidence that MP infections are often mixed; Korppi et al 4 reported .50% of MP CAP to be mixed infections, with Streptococcus pneumoniae identified in two-thirds of cases. MP may precede and intensify subsequent infections with various respiratory viruses and bacteria.5 Such data raise the question of how statements on efficacy of therapies for MP can be made when there is not even the knowledge of which organisms are being targeted.Patients with MP infections mostly recover spontaneously, and it is difficult to assess how intervention and the timing thereof within the course of the infection can be factored in when studying the results of therapies. In human studies, antibiotics have been shown to shorten the clinical course of MP infection, 6 but at the same time carriage of organisms in the upper respiratory tract may not be eliminated.7 It is therefore difficult to assess the effect of medication when organism eradication is not achieved, and thus the response of MP, unlike bacterial infections, is inherently more subtle and variable. Biondi

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“…It has been suggested that the most sensitive and prompt method of diagnosis in children is a combination of URT PCR and acute-phase serum immunoglobulin M (IgM) enzyme immunoassay (4,11). However, concerns exist about the potential inability to distinguish between URT carriage of M. pneumoniae versus active disease in children with PCR-positive URT specimens in the setting of pneumonia (6).…”

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Diagnostic Utility and Clinical Significance of Naso- and Oropharyngeal Samples Used in a PCR Assay To Diagnose Mycoplasma pneumoniae Infection in Children with Community-Acquired Pneumonia

et al. 2004

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PCR assays of naso-and oropharyngeal samples among hospitalized children appear equally effective for the diagnosis of serologically confirmed community-acquired mycoplasmal pneumonia. However, the combination of results from both sites yields optimal sensitivity (57%), specificity (98%), and positive (92%) and negative (82%) predictive values when compared with Mycoplasma pneumoniae enzyme-linked immunosorbent assay.Controversy exists over the role of PCR assays performed on upper respiratory tract (URT) samples for the diagnosis of mycoplasmal pneumonia. It has been suggested that the most sensitive and prompt method of diagnosis in children is a combination of URT PCR and acute-phase serum immunoglobulin M (IgM) enzyme immunoassay (4, 11). However, concerns exist about the potential inability to distinguish between URT carriage of M. pneumoniae versus active disease in children with PCR-positive URT specimens in the setting of pneumonia (6). Furthermore, the optimal site and method of sampling the URT for the detection of M. pneumoniae by PCR are not established in children.Patients. We report on 21 children with serologically proven M. pneumoniae infection and 42 approximately matched M. pneumoniae seronegative controls selected from 154 consecutively enrolled children hospitalized with clinically and radiologically confirmed lower respiratory infections, as described previously (8, 9). The Institutional Review Board of the University of Texas Southwestern Medical Center at Dallas approved the protocol.Laboratory detection of M. pneumoniae. M. pneumoniae enzyme-linked immunosorbent assays (ELISA) were performed by the Diagnostic Mycoplasma Laboratory at The University of Alabama at Birmingham. The assay was considered positive if the IgM was Ն1:10 or if there was Ն4-fold rise in IgG titer (1). Twenty-one of 154 children (13.6%) had serologically proven acute mycoplasmal pneumonia. Forty-two approximately matched M. pneumoniae seronegative control subjects were selected from the same study population.Both nasopharyngeal (Np) and oropharyngeal (Op) swabs were obtained within 24 h of admission by using dacron-tipped swabs (Fisher Scientific). Swab tips were placed in 200-l PCR buffer and stored at Ϫ70°C. Upon thawing, 25 l of protease solution was added, and samples were lysed in Buffer AL (QIAamp blood kit; QIAGEN GmbH) and sonicated at 37°C. Bacterial DNA was extracted by centrifuge columns (QIAGEN GmbH). Single-step DNA amplification was performed with a programmable thermal cycler (GeneAmp PCR system 9600; Perkin-Elmer Cetus, Norwalk, Conn.), based on a method modified from that of Williamson et al. (7,12 ). The 100-l reaction mixture consisted of 40 l of DNA eluent and 60 l of HotStarTaq DNA polymerase master mix (QIAGEN GmbH). The published primer sequences targeted the highly conserved region of the 16S rDNA gene of M. pneumoniae and amplified a unique 290-bp region (12). A 10-l volume of amplified product was separated by electrophoresis in polyacrylamide gel and visualized under UV light after ethidium...

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Respiratory tract infections by Mycoplasma pneumoniae in children: a review of diagnostic and therapeutic measures

Abstract: The most sensitive and rapid test to diagnose a Mycoplasma pneumoniae infection in children is a combination of nasopharyngeal polymerase chain reaction and IgM enzyme immunoassay. The treatment of choice in children is a macrolide.

Cited by 128 publications

References 62 publications

Comparison and Evaluation of Real-Time PCR, Real-Time Nucleic Acid Sequence-Based Amplification, Conventional PCR, and Serology for Diagnosis of Mycoplasma pneumoniae

Comparison and Evaluation of Real-Time PCR, Real-Time Nucleic Acid Sequence-Based Amplification, Conventional PCR, and Serology for Diagnosis of Mycoplasma pneumoniae

Treatment of Mycoplasma pneumoniae in Pediatric Lower Respiratory Infection

Diagnostic Utility and Clinical Significance of Naso- and Oropharyngeal Samples Used in a PCR Assay To Diagnose Mycoplasma pneumoniae Infection in Children with Community-Acquired Pneumonia

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