Diagnosis Of Mycoplasma Pneumonia Research Articles

Development of a Rapid and Efficient RPA-CRISPR/Cas12a Assay for Mycoplasma pneumoniae Detection.

Mycoplasma pneumoniae (MP) is a one of most common pathogen in causing respiratory infection in children and adolescents. Rapid and efficient diagnostic methods are crucial for control and treatment of MP infections. Herein, we present an operationally simple, rapid and efficient molecular method for MP identification, which eliminates expensive instruments and specialized personnel. The method combines recombinase polymerase amplification (RPA) with clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated proteins (Cas) 12a-based detection, with an optimal procedure less than 1 h from sample to result including DNA extraction (25 min), RPA reaction (39°C for 15-20 min), CRISPR/Cas12a detection (37°C for 10 min) and visual detection by naked eyes (2 min). This diagnostic method shows high sensitivity (two copies per reaction) and no cross-reactivity against other common pathogenic bacteria. Preliminary evaluation using 201 clinical samples shows sensitivity of 99.1% (107/108), specificity of 100% (93/93) and consistency of 99.5% (200/201), compared with real-time PCR method. The above data demonstrate that our developed method is reliable for rapid diagnosis of MP. In conclusion, the RPA-CRISPR/Cas12a has a great potential to be as a useful tool for reliable and quick diagnosis of MP infection, especially in primary hospitals with limited conditions.

MYCOPLASMA PNEUMONIAE-INDUCED RHABDOMYOLYSIS AND PERI-MYOCARDITIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mycoplasma pneumoniae (MP) is a common cause of community acquired pneumonia with an incidence of 1-3 per 1000 cases annually [1]. However, extrapulmonary manifestations of MP in the adult population are rare [3]. The mechanism behind injury is predicted to be caused by bacterial inflammation and vascular occlusion combined with an autoinflammatory response [2]. We present a case of a 21-year-old Hispanic male with rhabdomyolysis and peri-myocarditis caused by MP. CASE PRESENTATION: A 21-year-old Hispanic male with a past medical history of Kawasaki disease presented complaining of constant chest pain for two days. He endorsed subjective fever, dark urine, and myalgias. He had previously visited an urgent care and was prescribed ibuprofen and cyclobenzaprine to no avail. On physical exam, the patient was afebrile and tachypneic. Cardiac exam revealed tachycardia with no rubs, murmurs, or gallops. Lung fields were clear to auscultation bilaterally. Chest pain was not reproducible upon palpation. The abdomen was soft, nondistended, and without organomegaly. Initial labs revealed leukocytosis, transaminitis, elevated d-dimer, elevated troponins, elevated C-reactive protein, and elevated creatinine kinase. Admission chest x-ray was without infiltrates, cardiomegaly, or pneumothorax. Initial electrocardiogram demonstrated ST elevations in inferolateral leads. Emergent cardiac catheterization demonstrated normal coronary anatomy. CTA of the chest was negative for pulmonary embolism and aortic dissection. Original echocardiogram demonstrated normal ejection fraction. Respiratory pathogen panel was positive for MP IgM. Treatment for MP-induced rhabdomyolysis and peri-myocarditis with intravenous fluids and azithromycin was initiated. He experienced a transient systolic heart failure, managed with Bilevel Positive Airway Pressure. The rapid clearance of bacteria with proper antibiotics allowed the stunned myocardium to recuperate within 72 hours. At which point the patient experienced rapid clinical improvement and was discharged home in stable condition. DISCUSSION: The diagnosis of MP is difficult due to its cellular structure, its ability to be missed on routine blood cultures, and its ability to cause extrapulmonary manifestation via autoimmune dysfunction [2]. The case demonstrates a patient with rhabdomyolysis and peri-myocarditis with positive MP IgM. The patient also experienced rapid clinical improvement with clearance of bacteria by antibiotic administration. Thus, we were able to diagnose another rare manifestation of a MP infection causing rhabdomyolysis and peri-myocarditis. CONCLUSIONS: MP is difficult to isolate and has the ability to present with myriad symptomatology. Although MP is difficult to diagnose, it is easily treated. Therefore, MP should be considered in young patients due to its increased incidence in the younger population and unique presentations. REFERENCE #1: Foy, H. M., Kenny, G. E., Cooney, M. K., & Allan, I. D. (1979). Long-Term Epidemiology of Infections with Mycoplasma pneumoniae. Journal of Infectious Diseases, 139(6), 681–687. https://doi.org/10.1093/infdis/139.6.681 REFERENCE #2: Narita, M. (2016). Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis. Frontiers in Microbiology, 7. https://doi.org/10.3389/fmicb.2016.00023 REFERENCE #3: Khan, F. Y., & Sayed, H. (2012). Rhabdomyolysis associated with Mycoplasma pneumoniae pneumonia. Hong Kong medical journal, 18(3), 247–249. DISCLOSURES: No relevant relationships by Taleb El-Masri, source=Web Response No relevant relationships by Alex Morizio, source=Web Response No relevant relationships by Tram Nguyen, source=Web Response No relevant relationships by Elena Tellez, source=Web Response No relevant relationships by Yaswanraj Yuvaraj, source=Web Response

Comparative characteristics of typical and atypical (Mycoplasma) pneumonia in children

Aim: To compare the features of clinical-anamnestic and laboratory-instrumental data and treatment of children with typical and atypical (Mycoplasma) forms of pneumonia.Materials and methods. A comparative analysis was carried out of 1 70 case histories of children in hospital with a verified diagnosis of pneumonia in 2020. The basis for the diagnosis of Mycoplasma pneumonia was a positive PCR result of a smear of the posterior pharyngeal wall. The resulting data was constructed using Microsoft Excel 2007.Results. Mycoplasma pneumonia is specific for older schoolchildren; characterized by: prolonged course (73.5%), long-term preservation of an unproductive cough (75.7%), mild intoxication (68.6%) and catarrhal syndromes (54.3%), gradual onset (76.6%), severe lymphocytosis up to 55%, segmental or polysegmental damage to the lung tissue (92.7%).

Application of CT images based on the optimal atlas segmentation algorithm in the clinical diagnosis of Mycoplasma Pneumoniae Pneumonia in Children.

Objective:Use of optimal Atlas segmentation algorithm to study the imaging signs of mycoplasma pneumonia with multi-slice spiral CT (HRCT), and to explore the value of HRCT in the diagnosis and efficacy in evaluation of mycoplasma pneumonia in children.Methods:The study retrospectively analyzed 72 patients diagnosed with mycoplasma pneumonia in our hospital from January 2017 to January 2019. The imaging data and clinical data of 72 patients were collected. The optimal Atlas segmentation algorithm was used to analyze the characteristics of CT examination, and the value of CT in the diagnosis of mycoplasma pneumonia and the evaluation of curative effect was summarized.Results:Among all patients, 37 cases were unilateral lesions, 35 cases were bilateral lesions, 19 cases were in the left upper lobe, 24 cases were in the left lower lobe, 21 cases were in the right upper lobe, 13 cases were in the right middle lobe, 25 The lesion was located in the right lower lobe. The main CT findings of the lesions before treatment were large patchy, spot-shaped shadows, and strip-shaped or ground-glass shadows. After treatment, the main CT findings of the lesions were reduced lesion density and reduced lesion range.Conclusion:CT can clearly show the pulmonary lesions of mycoplasma pneumonia, and its unique imaging signs can improve the clinical diagnosis accuracy. In addition, CT scans can evaluate the treatment effect according to the changes in the characteristics of the lesion, which has important value for the evaluation of the effect for clinical diagnosis and efficacy evaluation of mycoplasma pneumonia.

Early Diagnosis of Mycoplasma pneumoniae in Children: Simultaneous Amplification and Testing (SAT) Is the Key.

Objective: The effective diagnosis of Mycoplasma pneumoniae (MP) pneumonia (MPP) in children has been hampered by the difficulty of achieving an early diagnosis. The simultaneous amplification and testing (SAT) has the potential for early diagnosis of MP in children.Methods: Of the 1,180 children enrolled in this study, 169 were MPP antibody (Ab) seroconversion positive, 641 showed MPP positivity with a single Ab test, and 370 were MPP negative. Sera and pharyngeal swabs were collected for antibody testing and SAT detection, respectively, on admission. When the samples were Ab negative, the paired -Ab test was requested for MP 7 days later.Results: Using the Ab results as the diagnostic standard, the sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) for SAT were 72.8, 95.1, 97.0, and 61.5%, respectively. SAT had superior diagnostic value in the MPP group who had undergone Ab seroconversion (sensitivity: 82.2%; NPV: 92.1%) and in the short-course group also (sensitivity: 81.0%; NPV: 81.3%). Good agreement was observed between SAT and the paired-Ab results (kappa value = 0.79; P < 0.001), but there was a lack of consistency between SAT and the single-Ab test results on admission (kappa value = 0.54, P < 0.001).Conclusions: SAT is a rapid, sensitive, and specific method for MP diagnosis in pediatric patients. Our results indicate its value as an effective diagnostic tool for detecting MPP at the initial stage of an infection.

Increased risk of ankylosing spondylitis after Mycoplasma pneumonia

This study aimed to investigate the relationship between Mycoplasma pneumonia (MP) infection and new development of ankylosing spondylitis (AS).Using data from the Taiwan National Health Insurance Research Database, we included a total of 116,084 patients with newly diagnosed MP between 2000 and 2012. The control cohort consisted of patients who did not have MP, matched 1:4 by age, sex, and index year. The follow-up period was defined as the time from the initial diagnosis of MP to the date of diagnosis of AS, censoring, or 31 December 2013. Cox proportional hazards regression analysis was used to analyze the risk of autoimmune diseases by sex, age, and comorbidities, with hazard ratios (HRs) and 95% confidence intervals (CIs).The eligible study participants included 116,084 patients in the MP group and 464,336 patients in the comparison group. The incidence rates of AS in the MP group and comparison groups were 1.49 and 0.74 per 1,000,000-person years, respectively. The adjusted HR of AS for the MP group was 2.45 (95% CI = 1.02−5.90) compared to the control group after adjustment for age, sex, and all covariates.MP remained an independent risk factor for developing AS in terms of sex, age, and comorbidities.

Diagnosis of mycoplasma pneumoniae by loop-mediated isothermal amplification: systematic review and meta-analysis

BackgroundA novel method, termed loop-mediated isothermal amplification (LAMP), was developed by Notomi et al. (2000). Individually published results have been reported that this technology has been successfully applied to the detection of a variety of pathogens. However, the overall diagnostic accuracy of LAMP for Mycoplasma pneumoniae (MP) remains unclear. A meta-analysis was therefore performed to review the accuracy of LAMP for Mycoplasma pneumoniae.MethodsCochrane Library and PubMed were systematically searched and checked for studies using LAMP for detecting mycoplasma pneumoniae. We used PCR as a reference standard to evaluate the quality of the studies eligible for inclusion in the meta-analysis. Then, the data from the studies were extracted by two independent assessors. Meta-DiSc 1.4 software was utilized to test the heterogeneity of sensitivity (SEN), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnosis odds ratio (DOR). The pooled analysis results were plotted, and the summary receiver operating characteristic (SROC) curve was plotted by calculating the area under the curve (AUC). Generated pooled summary estimates (95% CIs) were calculated for the overall accuracy, and a bivariate meta-regression model was used for the meta-analysis.ResultsSeven studies with nine fourfold tables were included in this meta-analysis. The pooled SEN and SPE for diagnosing Mycoplasma pneumoniae were 0.90 (95% CI: 0.87–0.93) and 0.98 (95% CI: 0.96–0.99), respectively. The PLR was 31.25 (95% CI: 14.83–65.87), NLR 0.10 (95% CI: 0.05–0.22), DOR 399.32 (95% CI: 172.01–927.00), and AUC 0.9892.ConclusionsIn conclusion, compared with PCR, LAMP is a valuable alternative method for Mycoplasma pneumoniae diagnosis in clinic with high sensitivity and specificity. However, more evidence is required to confirm that LAMP can fully replace other methods in the clinical diagnosis of MP.

Increased risk of rheumatoid arthritis among patients with Mycoplasma pneumonia: A nationwide population-based cohort study in Taiwan.

ObjectiveAn association between Mycoplasma pneumonia (MP) and rheumatoid arthritis (RA) had been reported in animal studies for decades. However, clinical evidence for this association is lacking. Therefore, this study aimed to provide epidemiologic evidence to clarify the relationship between MP and development of RA.MethodsThis 13-year nationwide, population-based, retrospective cohort study analyzed the risk of RA in a cohort of MP patients. We cross linked and compared the database of those with catastrophic illnesses to make sure the diagnoses of RA are correctly labeled. We selected 116,053 hospitalized patients diagnosed with MP between 2000 and 2012 from the Taiwan National Health Insurance Research Database and 464,212 matched controls at a 1:4 ratio by age, gender, and index year, in relation to the risk of developing RA. The follow-up period referred to the initial diagnosis of MP until the date of RA diagnosis, censoring of RA, or 31st December 2013. The Cox proportional hazard model was used to analyze the association between MP and incidence of RA among patients with different potential risks.ResultsThe adjusted hazard ratio (HR) for incidental RA in the MP group was 1.37 (95% confidence interval CI = 0.87–2.16), compared to non-MP controls. Stratified analysis revealed that the adjusted HR was 3.05 (95% CI = 1.16–7.99, p = 0.02) in a subgroup of patients over the age of 65.The adjusted HR of RA for the MP group among aged ≦19 years and ≥ 65 years was 3.19 (95% CI = 1.04.9.76) and 4.14 (95% CI = 1.27,13.4) within the first 2 years of follow-up.ConclusionThis cohort study demonstrated that patients with MP had a higher risk of developing RA, especially in the first 2 years, in those aged younger than 19 and over 65.

The role of D-dimer in detection and diagnosis of mycoplasma pneumonia

Objective To investigate the role of D-dimer in the diagnosis and evaluation of mycoplasma pneumonia. Methods The positive rate and concentration of D-dimer in mycoplasma pneumonia, bacterial pneumonia, viral pneumonia and healthy controls were detected and compared.The positive rate and concentration of D-dimer in patients with systemic inflammatory response syndrome (SIRS) and without SIRS were observed.Changes of D-dimer concentration in patients with mycoplasma pneumonia before and 2 weeks after treatment were observed. Results Compared with bacterial pneumonia group (16.7%), the viral pneumonia group (20.0%) and healthy control group (0.0%), the positive rate of D-dimer in mycoplasma pneumonia group (41.6%) was significantly higher (χ2=5.625, 4.158, 17.308, all P<0.05). The positive rate of mycoplasma pneumonia group with SIRS (64.0%) was significantly higher than that in other groups (χ2=17.308, P<0.05). The D-dimer levels of the mycoplasma pneumonia group [(324.4±125.3)μg/L], bacterial pneumonia group[(282.3±95.4)μg/L ] and viral pneumonia group[(293.1±92.3)μg/L ]were significantly higher than that in the healthy controls[(72.9±22.4)μg/L ](t=10.878, 11.704, 12.698, all P<0.05). The concentration of D-dimer[(381.4±129.4)μg/L] in the mycoplasma pneumonia group with SIRS was significantly higher than that in the other groups(t=2.668, P<0.05). Compared with before treatment, the concentration of D-dimer after treatment in the two groups was significantly lower[(129.3±65.3)μg/L, (89.7±28.6)μg/L](t=2.582, P<0.05). Conclusion The level of D-dimer in children with mycoplasma pneumonia was significantly increased, and the severity of the disease could be reflected. Key words: Mycoplasma pneumonia; Diagnosis

Community-Acquired Pneumonia Caused by Mycoplasma pneumoniae: How Physical and Radiological Examination Contribute to Successful Diagnosis.

Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia (CAP), particularly in young adults. Vital signs are usually normal except for temperature. On physical examination, general appearance is normal compared with that of typical pneumonia such as pneumococcal pneumonia patients. Mycoplasma sometimes causes ear infections such as otitis media. It is important to distinguish between typical pneumonia and atypical pneumonia such as mycoplasma pneumonia because having the right diagnosis allows for the use of the correct antibiotic to treat CAP while preventing development of drug-resistant bacteria and also decreasing medical cost. The symptoms and diagnosis of mycoplasma pneumonia is multi-fold. Auscultation of patients can demonstrate trace late inspiratory crackles or normal alveolar sounds; however, bilateral polyphonic wheezes can sometimes be heard because of bronchiolitis. With regard to radiological findings, a chest radiogragh often shows bilateral reticulonodular or patchy consolidation in both lower lobes. Pleural effusion is rarely observed in adult cases. Immunocompetent patients tend to reveal more extensive shadowing compared with immunocompromised patients. As serological diagnostic methods are not able to offer 100% reliable diagnosis, integration of physical and radiological examination is crucial to accurately diagnose mycoplasma pneumonia. Herein, I review the typical findings from physical examination and imaging patterns of patients with mycoplasma pneumonia.

Clinical utility of loop-mediated isothermal amplification for rapid diagnosis of Mycoplasma pneumoniae in children

Loop-mediated isothermal amplification (LAMP) is a cost-effective and rapid method for identifying Mycoplasma pneumoniae (MP). We investigated the utility of the LAMP assay in diagnosing MP pneumonia among children in a clinical setting. In this prospective study, the cause of community-acquired pneumonia was evaluated in 111 patients for whom MP was the suspected pathogen. All participants were patients at a city hospital in Japan between April 2012 and September 2012. Throat swabs for the LAMP assay were obtained at admission, and paired serum samples to measure antibody titres to MP by particle agglutination were obtained at admission and during convalescence. Overall, 45 of 111 (41 %) patients had a fourfold or greater increase in MP titres and received a diagnosis of MP pneumonia. Among them, 43 (96 %) patients (median age, 9 years) were positive on the LAMP assay and had a fourfold or greater increase in MP titres. The median interval from fever onset to collection of throat swabs was 7 days (range, 4-10 days). As compared with paired serum titres, the LAMP assay enabled quicker diagnosis of MP (median interval, 13 vs. 7 days), thereby allowing early initiation of appropriate antimicrobial therapy.

Advanced and Conventional Molecular Techniques in the Diagnosis of Mycoplasma Pneumoniae in Patients with Pneumoniae

Advanced and Conventional Molecular Techniques in the Diagnosis of Mycoplasma Pneumoniae in Patients with Pneumoniae

Factors associated with various clinical manifestations ofMycoplasmapneumonia in children

Purpose: Mycoplasma pneumonia (MP) is a major cause of community-acquired pneumonia in children and young adults. We aimed to investigate the factors that may influence on the clinical manifestations of MP in children. Methods: A total of 109 admitted children from October 2011 to February 2012 were prospectively enrolled with physical examination and laboratory tests (complete blood count, C-reactive protein [CRP], and particle agglutinin assay). The diagnosis of MP was made when there was an infiltration on the chest X-ray and the particle agglutination test was once over 1:640 or showed 4-fold increase in serial tests. They were grouped by age, fever duration after treatment, presence of pleural effusion and wheezing. Results: Preschool children showed shorter duration of fever (P=0.001), more wheezing (P 3 days) and pleural effusion were developed in children with higher CRP (P=0.018 and P=0.007). Wheezing has been developed in children with younger age (P=0.007). Conclusion: Younger age was a risk factor to develop wheezing in MP and prolonged fever and pleural effusion were more likely to develop in children with higher CRP.

Clinical sigrificance of C-reactive protein testing for mycoplasma pneumonia

Objective To explore the dinical significance of C-reactive protein(CRP) testing for diagnosis and treatment of children with bronchial pneumonia.Methods 341 samples of children with acute respiratory infections were detected with CRP quantitative analysis and CRP level and CRP positive rates were compared with 150 heahhy children as control specimens.Results According to diagnostic criteria,128 cases of bacterial pneumonia were found in 341 patients,accounting for 37.54％,CRP positive rate was 95.31％ ; 151 cases of mycoplasma pneumonia,accounting for 44.28％,CRP positive rate was 31.13 ％ ; and 62 cases of viral pneumonia,accounting for 18.18％,CRP positive rate was 6.45 ％.CRP levels,CRP-positive rates of bacterial pneumonia,mycoplasma pneumonia,viral pneumonia compared with the control group were significantly different ( P ＜ 0.01 ).Conclusion CRP of mycoplasma pneumonia increased significantly than viral pneumonia,thus CRP could be used as an important secondary pathogen detection indicators for identification and diagnosis of mycoplasma pneumonia. Key words: Pneumonia, mycoplasma; C-reactive protein ; Child

Frequency ofMycoplasma pneumoniaeAntibodies in Children Living on Jeju Island

Background: Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. Currently, no study exists regarding the frequency of the mycoplasmal antibody on Jeju Island. The aim of the present study was to investigate the frequency of mycoplasmal antibody among children living on Jeju Island. Methods: From March 2009 to February 2011, the frequency of mycoplasmal antibody among 1580 pediatric ( 1:40, 20.8% in an antibody titer >1:320, and 10.7% in an antibody titer >1:640. The positive rates of each antibody titer were lowest in children under the age of 6 months, and the positive rates increased gradually with age until 4 years, where the frequency showed a “plateau.” There were minor cyclic increases of positive rate (>1:320, >1:640) every three months from August 2009 to June 2010, and there was a major increase of positive rate (>1:320, >1:640) from July 2010 to January 2011. However, there was no positive rate cyclic pattern of mycoplasmal antibody in the lower titer (>1:40) patients. Conclusion: The frequency of mycoplasmal antibody titer is lowest under the age of 6 months. The positive rates rise gradually with age until the age of 4 years. The present study showed minor peaks of mycoplasmal antibody titer every three months and a major peak of mycoplasmal antibody titer. The results can be helpful for the interpretation and diagnosis of MP among pediatric patients on Jeju Island. (Korean J Clin Microbiol 2012;15:32-36)

Amplification of 16S rDNA by nested PCR for measurement of Mycoplasma pneumoniae DNA over time: clinical application

Mycoplasma pneumoniae (MP) is the most common atypical pathogen that causes respiratory infections in children. Such infections are typically treated by macrolide antibiotics, but the duration of treatment is variable. In this study, we used nested PCR to amplify the 16S rDNA (16S rRNA gene) of MP at different stages of MP pneumonia (MPP) in 100 children who were admitted for lower respiratory tract infections and diagnosed with MPP. Our results indicate that the median duration of MP-DNA positivity was 5 weeks, and 78 % of cases tested positive for 3-6 weeks. Patients with severe disease were positive for MP-DNA for a significantly longer time (median of 6 weeks) than those with mild disease (median of 4 weeks). Thirty-one patients with severe disease who received intravenous immunoglobulin were MP-DNA positive for significantly less time than patients with severe disease who did not receive this treatment. The duration of MP-DNA positivity was prolonged when MP antibody levels were high and treatment was started at a later stage. Therefore, nested PCR can be used for early diagnosis of MP and the duration of MP-DNA reflects the clinical stage of MPP. Early treatment of MPP and the administration of intravenous immunoglobulin during the acute phase of severe MPP shorten the duration of MP-DNA positivity.

Extensive Bilateral Airspace Consolidation

Pneumonia caused by Mycoplasma pneumoniae is usually a mild and self-limited infection. Chest films usually show patch consolidation or interstitial infiltration in the lung. We recently encountered a case of fulminant Mycoplasma pneumonia which showed rapidly progressing extensive bilateral airspace consolidation with pleural effusion. A previously healthy 19-year-old female college student was admitted to the hospital because of fever and dry cough. Chest X-ray showed large areas of airspace consolidation in both lung with pleural effusion and rapid progression of the lung lesion. The diagnosis of Mycoplasma pneumonia was made from the serologic test. Here we report a case of Mycoplasma pneumonia showing unusual manifestation.

Measurement of IgM antibodies in the diagnosis of mycoplasma pneumonia

The sera of 30 patients with complement-fixing antibodies to Mycoplasma pneumoniae (titres larger than or equal to 32) were treated with staphylococcal protein A. This procedure effectively removed 90 to 95% of the IgG antibodies. The Mycoplasma-specific antibodies in the treated sera could then be measured by a complement fixation test. This provides a useful test for distinguishing serological responses to recent Mycoplasma pneumoniae infections from anamnestic responses due to past exposure to Mycoplasma pneumoniae.