Prevalence and association of mycoplasma infection in the development of coronary artery disease / Prevalência e associação de infecção por micoplasma no desenvolvimento de doença arterial coronariana

Abstract Coronary heart disease (CHD) has been associated with significant morbidity and mortality worldwide. Although remain controversial, several studies have demonstrated the association of M. pneumoniae infections with atherosclerosis. We evaluated the possible association of mycoplasma infections in patients diagnosed with atherosclerosis by ELISA and PCR methods. Atherosclerotic tissue samples and blood samples were collected for the detection of mycoplasma antibodies (IgA) by ELISA from the 97 patients with coronary artery disease (CAD). M. pneumoniae specific IgA, IgG and IgM were measured by using the Anti-M. pneumoniae IgA/IgG/IgM ELISA. Detection of M. pneumoniae targeting the P1 adhesion gene was performed by PCR Acute infection of M. pneumoniae was diagnosed in 43.3% (42) of patients by PCR. The M. pneumoniae specific antibodies were detected in 36.1% (35) of patients. Twenty-five (25.8%) cases had IgG antibodies, 15 (15.5%) cases had IgM antibodies, 3 (3.1%) cases had IgA antibodies, 10 (10.3%) cases had both IgM + IgG antibodies and 1 (1%) case of each had IgM + IgA and IgG + IgA antibodies. None of the cases was positive for all three antibodies. A Pearson correlation coefficient analysis revealed an excellent correlation between the PCR and the serological results (r=0.921, p<0.001). A majority (17, 40.5%) of the M. pneumoniae positive patients are within the 41-50 years of age group, followed by 10 (23.8%) patients in the age group of 61-70 years and 2 (4.8%) patients were >70 years of age. Our study reported an unusually higher prevalence of M. pneumoniae by serological tests (36.1%) and PCR (43.3%). Although the hypothesis of the association of M. pneumoniae and CAD is yet to be proven, the unusually high prevalence of M. pneumoniae in CAD patients indicates an association, if not, in the development of atherosclerosis.

Resumo A doença coronariana (DCC) tem sido associada a significativa morbidade e mortalidade em todo o mundo. Embora ainda sejam controversos, vários estudos têm demonstrado a associação de infecções por M. pneumoniae com aterosclerose. Avaliamos a possível associação de infecções por micoplasma em pacientes com diagnóstico de aterosclerose pelos métodos ELISA e PCR. Amostras de tecido aterosclerótico e amostras de sangue foram coletadas para a detecção de anticorpos contra micoplasma (IgA) por ELISA de 97 pacientes com doença arterial coronariana (DAC). IgA, IgG e IgM específicos para M. pneumoniae foram medidos usando o Anti-M. pneumoniae IgA / IgG / IgM ELISA. A detecção de M. pneumoniae visando o gene de adesão P1 foi realizada por PCR. A infecção aguda por M. pneumoniae foi diagnosticada em 43,3% (42) dos pacientes pela PCR. Os anticorpos específicos para M. pneumoniae foram detectados em 36,1% (35) dos pacientes. Vinte e cinco (25,8%) casos tinham anticorpos IgG, 15 (15,5%) casos tinham anticorpos IgM, 3 (3,1%) casos tinham anticorpos IgA, 10 (10,3%) casos tinham anticorpos IgM + IgG e 1 (1%) caso de cada um tinha anticorpos IgM + IgA e IgG + IgA. Nenhum dos casos foi positivo para os três anticorpos. A análise do coeficiente de correlação de Pearson revelou uma excelente correlação entre o PCR e os resultados sorológicos (r = 0,921, p < 0,001). A maioria (17, 40,5%) dos pacientes positivos para M. pneumoniae está na faixa etária de 41-50 anos, seguida por 10 (23,8%) pacientes na faixa etária de 61-70 anos e 2 (4,8%) pacientes tinham > 70 anos de idade. Nosso estudo relatou uma prevalência incomumente maior de M. pneumoniae por testes sorológicos (36,1%) e PCR (43,3%). Embora a hipótese da associação de M. pneumoniae e DAC ainda não tenha sido comprovada, a prevalência incomumente alta de M. pneumoniae em pacientes com DAC indica uma associação, se não, no desenvolvimento de aterosclerose.

Prevalence and association of mycoplasma infection in the development of coronary artery disease / Prevalência e associação de infecção por micoplasma no desenvolvimento de doença arterial coronariana

Coronary heart disease (CHD) has been associated with significant morbidity and mortality worldwide. Although remain controversial, several studies have demonstrated the association of M. pneumoniae infections with atherosclerosis. We evaluated the possible association of mycoplasma infections in patients diagnosed with atherosclerosis by ELISA and PCR methods. Atherosclerotic tissue samples and blood samples were collected for the detection of mycoplasma antibodies (IgA) by ELISA from the 97 patients with coronary artery disease (CAD). M. pneumoniae specific IgA, IgG and IgM were measured by using the Anti-M. pneumoniae IgA/IgG/IgM ELISA. Detection of M. pneumoniae targeting the P1 adhesion gene was performed by PCR Acute infection of M. pneumoniae was diagnosed in 43.3% (42) of patients by PCR. The M. pneumoniae specific antibodies were detected in 36.1% (35) of patients. Twenty-five (25.8%) cases had IgG antibodies, 15 (15.5%) cases had IgM antibodies, 3 (3.1%) cases had IgA antibodies, 10 (10.3%) cases had both IgM + IgG antibodies and 1 (1%) case of each had IgM + IgA and IgG + IgA antibodies. None of the cases was positive for all three antibodies. A Pearson correlation coefficient analysis revealed an excellent correlation between the PCR and the serological results (r=0.921, p70 years of age. Our study reported an unusually higher prevalence of M. pneumoniae by serological tests (36.1%) and PCR (43.3%). Although the hypothesis of the association of M. pneumoniae and CAD is yet to be proven, the unusually high prevalence of M. pneumoniae in CAD patients indicates an association, if not, in the development of atherosclerosis.

A doença coronariana (DCC) tem sido associada a significativa morbidade e mortalidade em todo o mundo. Embora ainda sejam controversos, vários estudos têm demonstrado a associação de infecções por M. pneumoniae com aterosclerose. Avaliamos a possível associação de infecções por micoplasma em pacientes com diagnóstico de aterosclerose pelos métodos ELISA e PCR. Amostras de tecido aterosclerótico e amostras de sangue foram coletadas para a detecção de anticorpos contra micoplasma (IgA) por ELISA de 97 pacientes com doença arterial coronariana (DAC). IgA, IgG e IgM específicos para M. pneumoniae foram medidos usando o Anti-M. pneumoniae IgA / IgG / IgM ELISA. A detecção de M. pneumoniae visando o gene de adesão P1 foi realizada por PCR. A infecção aguda por M. pneumoniae foi diagnosticada em 43,3% (42) dos pacientes pela PCR. Os anticorpos específicos para M. pneumoniae foram detectados em 36,1% (35) dos pacientes. Vinte e cinco (25,8%) casos tinham anticorpos IgG, 15 (15,5%) casos tinham anticorpos IgM, 3 (3,1%) casos tinham anticorpos IgA, 10 (10,3%) casos tinham anticorpos IgM + IgG e 1 (1%) caso de cada um tinha anticorpos IgM + IgA e IgG + IgA. Nenhum dos casos foi positivo para os três anticorpos. A análise do coeficiente de correlação de Pearson revelou uma excelente correlação entre o PCR e os resultados sorológicos (r = 0,921, p 70 anos de idade. Nosso estudo relatou uma prevalência incomumente maior de M. pneumoniae por testes sorológicos (36,1%) e PCR (43,3%). Embora a hipótese da associação de M. pneumoniae e DAC ainda não tenha sido comprovada, a prevalência incomumente alta de M. pneumoniae em pacientes com DAC indica uma associação, se não, no desenvolvimento de aterosclerose.

Características clínicas de adultos mayores con neumonía adquirida en la comunidad / Clinical characteristics of older adults with community-acquired pneumonia

La neumonía adquirida en la comunidad es una enfermedad infecciosa común que causa una morbilidad y mortalidad sustanciales. Las personas mayores son las más frecuentemente afectadas, y se deben considerar varios aspectos relacionados con el cuidado de esta condición en los ancianos. El patógeno más común en esta patología sigue siendo Streptococcus pneumoniae, seguido de Haemophilus influenzae, Mycoplasma pneumoniae. El objetivo de este estudio fue determinar las características clínicas de adultos mayores con esta patología en el hospital "Alfredo Noboa Montenegro". Para las variables cualitativas fue empleada la frecuencia absoluta y el por ciento. Para la asociación entre variables cualitativas se utilizó la prueba Jicuadrado de independencia. En caso de las tablas de contingencia 2x2 cuando tuvo alguna celda con frecuencia esperada menor que 5 se utilizó el test exacto de Fisher. Más del 54% de los pacientes estudiados fue clasificado como grado II; de ellos el mayor porcentaje (66,7%) correspondió a los hombres. Le siguió en orden de frecuencia el grado III con 25% y alrededor del 83% fue del sexo femenino. No se obtuvo asociación estadística entre el sexo y el grado de los pacientes estudiados por lo que se pude afirmar que ambas variables fueron independientes. En la mayoría de casos los pacientes resultan infra diagnosticados desde los niveles primarios de atención al confundirlos con otro tipo de patologías, lo que provoca un retraso en la identificación y tratamiento del paciente que en el futuro influye en un pronóstico negativo de este(AU)

Community-acquired pneumonia is a common infectious disease that causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. The most common pathogen in this pathology is still Streptococcus pneumoniae, followed by other pathogens such as Haemophilus influenzae, Mycoplasma pneumonia. The objective of this study was to determine the clinical characteristics of older adults with this disease in hospital "Alfredo Noboa Montenegro". For the qualitative variables the absolute frequency and the percent were used. For the association between qualitative variables, the Chi-square independence test was used. In the case of the 2x2 contingency tables, when Fisher had an expected cell shorter than 5, Fisher's exact test was used. More than 54% of the patients studied were classified as grade II; of them, the highest percentage (66.7%) corresponded to men. Next in order of frequency was grade III with 25% and about 83% was female. There was no statistical association between sex and the degree of the patients studied, so we could say that both variables were independent. In the majority of cases, patients are diagnosed from the primary care levels when they are confused with other types of pathologies, which causes a delay in the identification and treatment of the patient that in the future influences a negative prognosis(AU)

The critical function of miR-1323/Il6 axis in children with Mycoplasma pneumoniae pneumonia

Abstract Objective: Mycoplasma pneumoniae pneumonia (MPP) is a common respiratory infection in children. Tumor necrosis factor-cx (TNF-α), interleukin-17 (IL-17), and IL-6 have correlation with Mycoplasma pneumoniae lung infection and MPP pathogenesis. Method: miRNAs participate in the pathogenesis of various diseases by regulating the development and differentiation of the immune cell. Blood was collected and total RNA was isolated. miRNA microarrays were performed to identify differentially expressed miRNAs in MPP patients. The levels of relative miRNAs and mRNAs were evaluated by qRT-PCR. Results: There are 23 differentially expressed miRNAs in MPP children's plasma, 15 miRNAs had enhanced expression and 8 had depressed expression. MPP patients showed lower mir-1323 level in blood samples than healthy controls. MPP patients with pleural effusion had much higher Il6 and Il17a mRNA levels than those without pleural effusion. The expression level of Il6 had a negative correlation with miR-1323 level. In the human THP-1 cell line, the level of miR-1323 was significantly reduced through lipopolysaccharides treatment. In THP-1 cells, overexpression or silencing of miR-1323 significantly reduced or promoted Il6 expression. Conclusion: In conclusion, miR-1323 targets the mRNA of Il6 and inhibits the expression of Il6. The pathogenesis of MPP inhibits the expression of miR-1323 in macrophages, triggers the overexpression of Il6, and enhances inflammation response.

Seroprevalencia de anticuerpos anti-Mycoplasma pneumoniae en niños menores de 12 años / Seroprevalence of anti-Mycoplasma pneumoniae antibodies in otherwise healthy children

Resumen: Introducción: La infección por Mycoplasma pneumoniae (Mypn) podría estar ocurriendo a edades más tempranas, debido a fenómenos sociales como concurrencia a centros de cuidado diurno en forma más frecuente y precoz. Objetivo: estimar la prevalencia de anticuerpos anti-Mypn en niños de 0-12 años, y explorar si la edad, asistencia a centro de cuidados diurnos/escuela, hacinamiento o convivencia con niños incrementan el riesgo de seropositividad. Pacientes y Método: Estudio transversal incluyendo niños de 0-12 años de edad que requirieron extracciones de sangre para control, por lo demás sanos. En todos los casos se consignaron las variables mencionadas y se determinó IgG anti-Mypn mediante enzimoinmunoanálisis. Se evaluó la asociación entre predictores y seropositividad en un modelo de regresión logística. Resultados: Se incluyeron 232 pacientes (edad promedio 56,4 ± 40,0 meses). El 56,9% concurría a centro de cuidado diurno/escuela, 63,8% convivían con menores de 12 años y 15,9% presentaban hacinamiento. El 14,6% presentaba anticuerpos anti-Mypn. Los niños seroposi- tivos no mostraron diferencias significativas con aquellos seronegativos en relación a edad (63,1 ± 40,7 vs. 55,4 ± 41,3 meses), escolaridad (64,7% vs 55,5%), hacinamiento (14,7% vs 14,9%), ni con vivencia con menores (64,7% vs 63,6%). La edad tampoco se mostró como predictor independiente de seropositividad en el modelo multivariado. Conclusión: La prevalencia de anticuerpos anti-Mypn fue 14,6%. La edad no fue predictor de seropositividad.

Abstract: Introduction: Mycoplasma pneumoniae (Mypn) infection could be occurring at an earlier age due to social pheno mena such as attending daycare centers more frequently and earlier than decades ago. Objective: to estimate the prevalence of anti-Mypn antibodies in children aged 0-12 years, and to explore whether age, attendance to daycare center/school, overcrowding or the presence of children aged below 12 years in the households increase the risk of seropositivity. Patients and Method: Cross-sectional stu dy including healthy children aged 0-12 years which required blood draws for routine laboratory tests. In all cases, the aforementioned variables were recorded and anti-Mypn IgG was determined by enzyme immunoassay. The association between predictors and seropositivity was assessed in a logistic regression model. Results: We included 232 patients (average age 56.4 ± 40.0 months). 56.9% attended a daycare center/school, 63.8% co-habited with children under 12 years old, and 15.9% lived in overcrowded households. The prevalence of anti-Mypn antibodies was 14.6%. There were no significant differences between seropositive and seronegative children regarding age (63.1 ± 40.7 vs. 55.4 ± 41.3 months), school/day-care attendance (64.7% vs. 55.5%), overcrowding (14.7% vs. 14.9%), or co-habiting with children (64.7% vs. 63.6%). Age was not an independent predictor of seropositivity in the multivariate model. Conclusion: The prevalence of anti-Mypn antibodies in children was 14.6% and age was not a predictor of seropositivity.

Neumonía y miositis aguda benigna de la infancia por Mycoplasma pneumoniae asociado a encefalitis: reporte de caso / Pneumonia and benign acute myositis of childhood due to Mycoplasma pneu-moniae associated with encephalitis: a case report

Una de las principales causas de neumonía en niños entre 5 y 15 años es el Mycoplasma pneumoniae, una bacteria que causa manifestaciones clínicas atípicas como la miositis y encefalitis. Reportamos un caso de una niña de cinco años que presentó limitación funcional en extremidades inferiores precedida por una infección respiratoria superior. Posteriormente, se complicó con neumonía y encefalitis. Se administraron antibióticos y antivirales debido al deterioro clínico del paciente. La serología de inmunoglobulinas para Mycoplasma pneumoniae fue positiva; mientras que los demás estudios virales fueron negativos. El curso clínico fue favorable con disminución progresiva de la dificultad respiratoria, trastorno del sensorio y mejoría en la limitación funcional en las extremidades inferiores a los 15 días de tratamiento.

One of the leading causes of pneumonia in children between 5 to 15 years is Mycoplasma pneumoniae, a bacterium that causes atypical clinical manifestations such as myositis and encephalitis. We report a 5-year-old girl who presented functional limitations of the lower extremities preceded by an upper respiratory infection. Later on, she developed pneumonia and encephalitis. Antibiotics and antivirals were administered due to the clinical deterioration of the patient. IgM serology for Mycoplasma pneumoniae was positive, while the other viral studies were negative. The clinical course was favorable with a progressive decrease in respiratory distress, sensorial disorder, and improvement in the functional limitations of the lower limbs after 15 days of treatment.

Encefalomielitis aguda diseminada por Mycoplasma pneumoniae en un niño previamente sano / Acute disseminated encephalomyelitis due to Mycoplasma pneumoniae in a previously healthy boy

Se presenta el caso de un niño de 5 años sin antecedentes de enfermedad, que se internó en terapia intensiva por convulsiones tónico-clónicas focalizadas en la cara y en el hemicuerpo derecho, con documentación de temperatura axilar de 37,4°C. Se descartó la presencia de gérmenes comunes y la etiología viral a través de estudios de muestras de líquido cefalorraquídeo (LCR). Se sospechó la presencia de Mycoplasma pneumoniae por comprobarse inmunofluorescencia positiva en suero para anticuerpos de clase IgM. El diagnóstico se confirmó mediante la detección del ADN de dicho patógeno sobre la biopsia cerebral efectuada por el método de la reacción en cadena de la polimerasa (PCR) y una histología compatible con encefalomielitis aguda diseminada. El paciente recibió tratamiento con claritromicina y su evolución fue favorable. Al menos dentro de nuestros conocimientos, este es el primer caso en el que se detectó ADN de M. pneumoniae en una biopsia cerebral por el método de PCR.

We present here the case of a previously healthy 5 year-old boy hospitalized in an intensive care unit due to tonic-clonic seizures focused on the face and right side of the body, and axillary temperature of 37.4 °C. Common bacterial and viral etiology was ruled out through studies of cerebrospinal fluid (CSF) samples. Mycoplasma pneumoniae was suspected by a positive immunofluorescence serum test for IgM class antibodies. Finally, with a brain biopsy, M. pneumoniae was confirmed by polymerase chain reaction (PCR) and acute disseminated encephalomyelitis by pathological anatomy. The patient was treated with clarithromycin and had an uneventful evolution. At least to our knowledge, this is the first case in which M. pneumoniae DNA was detected by PCR in a brain biopsy.

Caracterización del síndrome de Guillain-Barré en pacientes pediátricos / Characterization of the Guillain-Barré syndrome in pediatric patients

El Síndrome de Guillain Barré (SGB) se caracteriza por la manifestación de manera aguda o subaguda de un conjunto de signos y síntomas que demuestran la afectación del sistema nervioso periférico, expresada en parálisis fláccida y arreflexia, que eventualmente pueden complicarse amenazando la vida y/o posteriormente cronificarse si no se instauran tratamientos específicos de manera oportuna. Las causas más importantes del SGB se atribuyen a agentes infecciosos los cuales desencadenan un mecanismo de respuesta autoinmune que afectan tanto la mielina como el axón. La presente investigación caracterizó el SGB en los pacientes ingresados en el Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga entre los años 2010 y 2016(AU)

Guillain Barré Syndrome (GBS) is characterized by acute or subacute manifestation of peripheral nervous system alterations such as flaccid paralysis and arreflexia, which can eventually be life-threatening and/or become chronic if specific treatments are not established in a timely manner. The main causes of GBS are attributed to infectious agents which trigger an autoimmune response that affect both the myelin and the axon. GBS is the most frequent cause of flaccid paralysis in the pediatric population. The present investigation characterized the GBS in patients admitted to the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga in the period 2010 to 2016(AU)

Mycoplasma pneumoniae: manifestaciones neurológicas y controversias diagnósticas. A propósito de un caso / Mycoplasma pneumoniae: neurologic manifestations and diagnostic controversies. A case report

Mycoplasma pneumoniae (Mp) es el agente causal de un 30% de las manifestaciones respiratorias de la población general. La neumonía ocupa el primer lugar dentro de este grupo. Las manifestaciones neurológicas representan las formas más frecuentes de presentación clínica extrapulmonar (40%). Las encefalitis y meningoencefalitis son las formas más habituales de sintomatología neurológica asociada a infección por Mp. La presentación de más de una variante clínica en un mismo paciente asociada a primoinfección por Mp es posible. El diagnóstico serológico plantea, habitualmente, controversias en su interpretación. A partir del caso de una niña de 7 años con inyección conjuntival, adenopatía cervical, rash descamativo y fotofobia con "pseudoedema de papila bilateral", que desarrolla durante su evolución parálisis facial periférica y meningitis aséptica, se analizarán las controversias que se plantean en relación con la interpretación diagnóstica asociada al compromiso neurológico por Mp.

Mycoplasma pneumoniae (Mp) is responsible for 30% of the respiratory manifestations of the general population. Pneumonia occupies the first place within this group. Among the extra-respiratory forms (40%), the neurological ones are the most frequent. Meningoencephalitis and aseptic meningitis are the most common. The presentation of more than one clinical variant in the same patient associated with primoinfection by Mp is possible. In relation to the serological diagnosis, controversies in interpretation sometimes occur. This is a 7-year-old girl with conjunctival injection, cervical adenopathy, photophobia with bilateral papilla pseudoedema, and scaly rash that develops peripheral facial paralysis and aseptic meningitis. We will discuss diagnostic controversies.

Prevalencia de la infección por Mycoplasma pneumoniae en pacientes pediátricos con exacerbación aguda del asma / Prevalence of Mycoplasma pneumoniae infection in pediatric patients with acute asthma exacerbation

Introducción. El Mycoplasma pneumoniae puede estar implicado en la exacerbación refractaria del asma, Objetivo. Establecer la prevalencia de la infección por Mycoplasma pneumoniae en pacientes con exacerbación aguda del asma. Material y método. Se realizó un estudio prospectivo, transversal, observacional, caso-control, en pacientes mayores de 2 años y menores de 12. Se determinaron anticuerpos inmunoglobulina M (IgM) para M. pneumoniae por serología por técnica de ensayo por inmunoabsorción ligado a enzima (enzyme-linked immunosorbent assay; ELISA en sus siglas en inglés), utilizando el kit NovaLisa® NovaTec. Se consideró prueba positiva a valores > 11 NTU (NovaTec unidades). El análisis estadístico fue análisis de la varianza (analysis of variance; ANOVA, por sus siglas en inglés) y chi cuadrado con un nivel de significancia de p < 0,05. Resultados. Se estudiaron 180 niños, 130 correspondieron al grupo de niños asmáticos y 50, al grupo control. La IgM específica fue positiva en 60 pacientes, que correspondió al 46,15% de niños asmáticos (p < 0,001). La gravedad de la exacerbación estuvo relacionada directamente con los niveles de IgM (p < 0,001). La tasa de hospitalización fue de 75%, asociada de forma significativa con los niveles de IgM específica (p < 0,001). Conclusión. Nuestros datos sugieren que en los niños con asma aguda, tienen alta prevalencia (46%) de infección por Mycoplasma pneumoniae y estrecha relación entre la exacerbación aguda grave del asma y la infección por Mycoplasma pneumoniae. Estos resultados podrían tener implicaciones terapéuticas orientadas hacia la utilización de antibióticos específicos contra este microorganismo atípico.

Introduction. Mycoplasma pneumoniae may be involved in refractory asthma exacerbation. Objective. To determine the prevalence of Mycoplasma pneumoniae infection in patients with acute asthma exacerbation. Material and method. A prospective, crosssectional, observational, case-control study was carried out in patients older than 2 years old and younger than 12. Immunoglobulin M (IgM) antibodies were serologically determined for M. pneumoniae, using the NovaLisa® NovaTec kit for enzyme-linked immunosorbent assay (ELISA). Test results ≥ 11 NTU (NovaTec units) were regarded as positive. The statistical analysis was performed by means of the analysis of variance (ANOVA) and the χ² test, with a significance level of p < 0.05. Results. One hundred and eighty children were studied, of which 130 had asthma and 50 comprised the control group. Specific IgM was positive for 60 patients, that is 46.15% of the asthmatic children (p < 0.001). The severity of the exacerbation was directly related to IgM levels (p < 0.001). Hospitalization rate was 75%, and it was significantly associated to specific IgM levels (p < 0.001). Conclusion. Our data suggest that children with acute asthma show a high prevalence (46%) of Mycoplasma pneumoniae infection and that there is a close relation between severe acute asthma exacerbation and the presence of Mycoplasma pneumoniae infection. These findings might result in therapeutic implications centered in the use of specific antibiotics to fight this atypical organism.

A study of community-acquired Mycoplasma pneumoniae in Yantai, China / Estudio de Mycoplasma pneumoniae adquirido en la comunidad en Yantai, China

Abstract Introduction: Community-acquired pneumonia (CAP) is a global disease responsible for a large number of deaths, with significant economic impact. As diagnostic tools have increased in sensitivity, understanding of the etiology of CAP has begun to change. Mycoplasma pneumoniae is one of the major pathogens causing CAP. Macrolides and related antibiotics are first-line treatments for M. pneumoniae. Macrolide resistance has been spreading for 15 years and now occurs in worldwide. We undertook the first study on macrolide resistance of M. pneumoniae in Yantai. This may be helpful to determine the appropriate therapy for CAP in this population. Objective: To investigate the rate and mechanism of macrolide resistance in Yantai. Methods: Pharyngeal swab samples were collected from adult CAP patients. Samples were assayed by polymerase chain reaction (PCR) and cultivated to test for M. pneumoniae. Nested PCR was used to specifically amplify M. pneumoniae 23S rRNA gene fragments containing mutations, and amplicons were analyzed by CE-SSCP for macrolide resistance mutations. Results were confirmed by sequencing. Twenty-seven strains of M. pneumoniae were isolated and the activities of nine antibiotics against M. pneumoniae were tested in vitro. Results: Out of 128 samples tested, 27 were positive for M. pneumoniae. Mycoplasma 100% macrolides resistance to Mycoplasma pneumoniae. The mechanism of macrolides resistance was A2063G point mutation in the sequence directly binding to macrolides in the 23S rRNA V domain in vitro. The mean pyretolytic time for the fluoroquinolone group was 4.7 ±2.9 d, which was significantly shorter than 8.2 ±4.1 d for the azithromycin group. Conclusions: Macrolides are not the first-line treatment for M. pneumoniae respiratory tract infections in Yantai.

Resumen Introducción: Neumonía adquirida por en la comunidad (NAC) es una enfermedad responsable por un gran número de muertes y un impacto económico importante. Debido a que el diagnostico incrementó la sensibilidad, se cambió la etiología de la NAC. Adicionalmente, Mycoplasma pneumoniae es uno de los patógenos que causan la NAC. Los macrólidos y antibióticos relacionados son la primera línea de tratamiento para M. pneumoniae. La resistencia a macrólidos se aumentó en los últimos 15 años y ahora se encuentra distribuido en todo el mundo. Nosotros realizamos el primer estudio de resitencia a M. pneumoniae a los macrólidos en Yantai. Esto podría ser útil para determinar una terapia apropiada para NAC en esta población. Objetivo: Investigar la tasa y el mecanismo para la resitencia a los macrólidos en Yantai. Métodos: Se colectaron muestras faringeas usando un hisopo. Las muestras se analizaron mediante la reacción en cadena de la polimerasa (PCR) y por cultivo para M. pneumoniae. Se uso una PCR anidad para amplificar fragmentos del gen 23S rRNA especifico con las mutaciones para M. pneumoniae. Se analizaron amplicomes por CE-SSCP para determinar la resitencia a los macrólidos. Estos resultados se confirmaron por secuenciación. Se aislaron 27 cepas de M. pneumoniae y se probaron nueve antibióticos in vitro. Resultados: De 128 muestras, 27 fueron positivas para M. pneumoniae. Se determinó una resistencia a macrólidos por Mycoplasma del 100%. Los mecanismos de esta resitencia fue una mutacion punctual A2063G en la secuencia que se une directamente a los macrólidos en el dominio 23S rRNA V in vitro. El tiempo piotolítico medio para el grupo de fluoroquinolonas fue 4.7 ±2.9 d, que fue significativamente más corto que para el grupo de azitromicina: 8.2 ±4.1 d. Conclusiones: Los macrólidos no son la primera linea de tratamiento para las infecciones del tracto respiratorio contra M. pneumoniae respiratory tract infections en Yantai.

Exantema Mucocutáneo inducido por Mycoplasma Pneumoniae / Mucocutaneous exanthema induced by Mycoplasma pneumoniae

La infección por Mycoplasma pneumoniae (MP) puede presentar un exantema mucocutáneo grave. Esta entidad, denominada Exantema mucocutáneo inducido por Mycoplasma pneumoniae (EMIM), se caracteriza por presentar una epidemiología, fisiopatología, manifestaciones clínicas, y evolución que la diferencian del síndrome de Stevens Johnson, de la necrólisis epidérmica tóxica, y del exantema multiforme. Se presenta el caso de un niño de 5 años de edad con mucositis oral y genital graves asociadas a infección respiratoria aguda baja con rescate de MP en aspirado nasofaríngeo. Se diagnostica EMIM. Los autores del presente artículo realizan una revisión de la bilbiografía y exponen conceptos y definiciones actualizados que permiten catalogar este cuadro como una entidad independiente

Mycoplasma pneumoniae (MP) infection can present with a severe mucocutaneous exanthema. This entity, called mucocutaneous exanthema induced by Mycoplasma pneumoniae (EMIM), is characterized by an epidemiology, pathophysiology, clinical manifestations, and evolution that differentiate it from Stevens Johnson syndrome, toxic epidermal necrolysis, and exanthema multiforme. We present the case of a 5-year-old boy with severe oral and genital mucositis associated with low acute respiratory infection with MP rescue in nasopharyngeal aspirate. EMIM is diagnosed. The authors of this article conduct a review of the bibliography and present concepts and updated definitions that allow cataloging this disease as an independent entity

Acute Respiratory Infection by Chlamydophila pneumoniae and Mycoplasma pneumoniae in a Population of Older Adults in Colombia / Infección respiratoria aguda por Chlamydophila pneumoniae y Mycoplasma pneumoniae en una población de adultos mayores en Colombia

Introduction: Acute Respiratory Infection (ARI) is a heterogeneous group of viral and bacterial respiratory pathologies including Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) that are not routinely identified; these infections in the older adults have mortality rates 3 to 5 times higher than that recorded in other age groups. Methods: this study was conducted prospectively to determine the proportion of atypical bacterial pathogens in older adults with ARI in Bogotá. Microbiological diagnosis was determined by real-time PCR (qPCR) in samples of respiratory origin and serology for antibodies IgG, IgA and IgM to MP and CP. Results: A total of 71 patients were enrolled from 2012 to 2013. Upper respiratory infections were diagnosed in the 69% of patients and lower respiratory infections in 31%. MP was identified in 9.8% and CP in 8.5%. Conclusions: these findings indicated that CP and MP must be viewed as a significant etiological agent of ARI in older adults in Bogotá.

Introducción: La infección respiratoria aguda (IRA) es un grupo heterogéneo de patologías respiratorias de etiología viral y bacteriana que incluye Chlamydophila pneumoniae (CP) y Mycoplasma pneumoniae (MP), que no son identificados de manera rutinaria, y en el adulto mayor presentan tasas de mortalidad 3-5 veces mayores que las registradas en otros grupos etarios. Metodología: Estudio prospectivo para determinar la proporción de patógenos bacterianos atípicos en los adultos mayores con IRA, en Bogotá. El diagnóstico microbiológico se determinó mediante PCR en tiempo real (qPCR) en muestras de origen respiratorio y serología para anticuerpos IgG, IgA e IgM frente a MP y CP. Resultados: Un total de 71 pacientes fueron incluidos entre 2012 y 2013. Las infecciones respiratorias superiores fueron diagnosticadas en el 69 % de los pacientes y las infecciones del tracto respiratorio inferior en un 31 %. MP fue identificado en el 9,8 % y el 8,5 % en CP. Conclusiones: Estos resultados indican que CP y MP son agentes etiológicos importantes de infecciones respiratorias agudas en los adultos mayores en Bogotá.

Optimización de un método de PCR en tiempo real para el diagnóstico de infecciones por Mycoplasma pneumoniae / Optimization of a real-time PCR method for the diagnosis of Mycoplasma pneumoniae infections

A Mycoplasma pneumoniae se lo ha descrito como causante de diversas patologías, pero la más frecuente es la neumonía de la comunidad, en la que puede asociarse a otros patógenos. Afecta pincipalmente a niños de edad escolar y adultos jóvenes, aunque en las últimas décadas es frecuente hallarlo también en niños menores de 5 años. El daño celular ocurre sobre el epitelio de bronquios y bronquiolos por acumulación de peróxido de hidrógeno y radicales superóxido producidos durante su metabolismo celular. Recientemente se ha reportado que en estos eventos patogénicos también participa una citotoxina conocida como CARDS toxin (community-acquired respiratory distress syndrome) que la bacteria expresa como factor de virulencia, ya que induce una importante respuesta inflamatoria celular. Los métodos moleculares son más sensibles y rápidos que los métodos de diagnóstico tradicionales y se consideran de elección. No obstante, para lograr un diagnóstico óptimo, se aconseja la combinación de estos métodos junto con los serológicos. En el presente estudio se optimiza un método de PCR en tiempo real con iniciadores dirigidos a la región del gen que codifica la CARDS toxin. El método demostró ser muy sensible y rápido para el diagnóstico clínico de M. pneumoniae, con una concordancia қ: 0,95 con el método convencional de PCR anidada que emplea como target al gen que codifica para la citoadhesina P1. A su vez es mucho menos laborioso e implica un menor riesgo de contaminación, lo que permite el manejo de un alto número de muestras clínicas (AU)

Mycoplasma pneumoniae has been described as the cause of different infections, the most common of which is communityacquired pneumonia, possibly associated with other pathogens. Community-acquired pneumonia mainly affects school-age children and young adults, although over the past decades the disease has also been found in children under 5 years of age. Cell damage occurs on the epithelium of the bronchi and bronchioles due to accumulation of hydrogenous peroxide and superoxide radicals produced during cell metabolism. Recently, it has been reported that in these pathogenic events a cytotoxin known as CARDS toxin (community-acquired respiratory distress syndrome) participates, expressed by the bacteria as a factor of virulence, as it induces an important inflammatory cell response. The molecular methods are more sensitive and faster than the traditional diagnostic methods, and are considered the methods of choice; however, for an optimal diagnosis, a combination of these methods together with serological studies is recommended. In the current study, a real-time PCR method with markers targeted to the region of the gene encoding the CARDS toxin was optimized. The method showed to be very sensitive and fast for the clinical diagnosis of M. pneumoniae, with a қ agreement of 0.95 with the conventional nested PCR method that uses the gene encoding cytoadhesin P1 as a target. Additionally, the new method is much easier with a lower risk of contamination, which allows management of a large number of clinical samples (AU)

The epidemiology and clinical features of Mycoplasma pneumoniae infection in neonates

Abstract Objectives This retrospective study was aimed to explore the epidemiological and clinical profiles of Mycoplasma pneumoniae infection in neonates. Methods From 2011 to 2014, 1322 hospitalized neonates with lower respiratory tract infections were screened for Mycoplasma pneumoniae by detection of Mycoplasma pneumoniae antibodies using Serion ELISA classic Mycoplasma pneumoniae kits. Results Mycoplasma pneumoniae was identified in 89 (6.7%) patients. The age ranged from 1 day to 28 days with a median of 22 days. The male to female ratio was 1.15:1. Mycoplasma pneumoniae infection peaked in spring (from March through May) and winter (from December through February). Compared with non-Mycoplasma pneumoniae infected neonates, those with Mycoplasma pneumoniae infection were older, presented fever more frequently, and had less tachypnea. Conclusions Mycoplasma pneumoniae could be an important etiologic agent for respiratory tract infection in neonates. In neonates Mycoplasma pneumoniae infection was usually associated with older age, presence of fever, and less tachypnea. Mycoplasma pneumoniae infection in neonates tends to be a mild process.

Pustulosis exantemática generalizada aguda asociada a Mycoplasma pneumoniae: reporte de un caso / Acute generalized exanthematous pustulosis associated with Mycoplasma pneumoniae infection: a case report

Acute generalized exanthematous pustulosis is an uncommon skin eruption, characterized by fever and the rapid onset of disseminated, non-follicular, sterile pustules, over an erythematous skin background. It is usually classified as a severe cutaneous adverse drug reaction, whose most relevant triggers are antibiotics and anticonvulsants. However, viral and bacterial infections have also rarely been associated with this dermatosis. We report the case of a patient, who developed lesions of acute generalized exanthematous pustulosis as an extrapulmonary manifestation of Mycoplasma pneumoniae infection.

Neumonía por bacterias atípicas: mycoplasma y Chlamydia pneumoniae ¿qué elementos tenemos para hacer un diagnóstico adecuado y decidir cuándo tratar? / Atypical pneumonia: mycoplasma and chlamydia pneumoniae: making an accurate diagnosis and deciding when to treat

Atypical Pneumonia has been studied for many years. Most clinically relevant atypical organisms involved in pneumonia in children are Mycoplasma pneumoniae and Chlamydia pneumoniae. Although great progress has been reached in new techniques, still there is no good tool, neither standardized nor accurate for a definitive diagnosis. In other hand, antibiotic therapy is under review due to contradictory evidence to support their use. We present a critical view of actual knowledge and propose an algorithm to proceed in clinical ground.

La neumonía por bacterias atípicas es sujeto de estudio desde hace años. Dentro de las bacterias atípicas más frecuentes y clínicamente relevantes en niños se reconocen Mycoplasma pneumoniae y Chlamydia pneumoniae. A pesar del aumento en el conocimiento de estas infecciones y avance en las técnicas diagnósticas, aun no contamos con una herramienta estandarizada y confiable que permita realizar un adecuado diagnóstico. Por otra parte, la necesidad real de efectuar un tratamiento antibiótico sigue siendo tema de discusión. Se presenta a continuación una revisión crítica del conocimiento actual y una propuesta de su enfrentamiento clínico.

Estudo biomolecular de produtos de Chlamydophila pneumoniae, Mycoplasma pneumoniae e Borrelia burgdorferi na etiopatogenia da degeneração mixomatosa da valva mitral / A biomolecular study on Chlamydophila pneumoniae, Mycoplasma pneumoniae and Borrelia burgdorferi products in myxoid mitral valve degeneration etiopathogenesis

Introdução e Objetivo: A doença mixomatosa da valva mitral leva ao comprometimento de sua matriz devido à alteração em sua composição tecidual provocada pelo desequilíbrio na quantidade de ácidos mucopolissacarídeos ou glicosaminoglicanos. Sua etiologia ainda não está totalmente esclarecida, podendo ocorrer em formas familiares com transmissão autossômica dominante de penetrância variável, que pode ser dependente do tempo ou de prováveis fatores ambientais, situações em que a interação de agentes infecciosos necessita de maiores esclarecimentos. O objetivo deste estudo é a análise dos produtos dos patógenos da Chlamydophila pneumoniae, Mycoplasma pneumoniae e Borrelia burgdorferi em segmentos de cúspide retirados da valva mitral com degeneração mixomatosa, comparada ao grupo controle e a relação dos produtos bacterianos com aumento de marcadores inflamatórios (CD20, CD48, CD68) e de metaloproteinase (MMP9) na etiopatogenia da degeneração mixomatosa da valva mitral. Método: Estudo observacional, analítico, tipo caso-controle, que analisou 2 grupos contendo 20 pacientes cada e divididos em grupo 1, composto por fragmentos de tecido valvar mitral com diagnóstico de degeneração mixomatosa extraídos em procedimentos de troca ou plásticas valvares mitrais; e grupo 2, formado por segmentos de valvas mitrais sem valvopatia retirados no serviço de verificação de óbito. Foram realizadas colorações de hematoxilina e eosina e Movat para diagnóstico histológico da degeneração mixomatosa e técnica de imunohistoquímica para detecção de antígenos da Borrelia burgdorferi, Mycoplasma pneumoniae, mediadores inflamatórios (CD20, CD45, CD68) e marcadores de metaloproteinase (MMP9). A presença de antígenos da Chlamydophila pneumonia e foi pesquisada pela técnica de hibridização in situ. A análise quantitativa dos aspectos microscópicos foi realizada com o analisador de imagens Aperio. A pesquisa de elementos bacterianos foi feita através de microscopia eletrônica...

Background: The myxomatous mitral valve disease leads to impairment due to changes in their tissue composition caused by the imbalance in the amount of acid mucopolysaccharides or glycosaminoglycans. Its etiology is not yet fully understood and may occur in familial forms of autosomal dominant trait with variable penetrance that can be time-dependent or probable environmental factors, where the interaction of infectious agents requires further elucidation. The purpose of this study is the analysis of the pathogens products of Chlamydophila pneumoniae, Mycoplasma pneumoniae and Borrelia burgdorferi in removed cusp segments of the mitral valve with myxoid degeneration, compared to the control group and the ratio of bacterial products with increased inflammatory markers (CD20, CD48, CD68) and metalloproteinase (MMP9) in the pathogenesis of myxomatous degeneration of the mitral valve. Method: Observational, analytical, case-control study which analyzed 2 groups of 20 patients each and divided in group 1, consisting of fragments of mitral valve tissue with diagnosis of myxomatous degeneration extracted in replacement procedures or mitral valve repair; group 2, formed by segments of mitral valves without valvolpaty clinial disease removed in the coroner service. Hematoxylin and eosin and Movat stains were done for histological diagnosis of myxoid degeneration and immunohistochemical technique for the detection of Borrelia burgdorferi, Mycoplasma pneumonia antigens, inflammatory mediators (CD20, CD45, CD68) and markers of metalloproteinase (MMP9). The presence of Chlamydophila pneumonia antigens was verified through an in situ hybridization technique. The quantitative analysis of the microscopic aspects was performed with the Aperio image analyzer. The research of bacterial elements was performed by a transmission electron microscopy. Results: In group 1, 14 (70%) patients were male and 6 (30%) were female. The mean age was (51 to 79 years, sd...

Hemólisis, exantema, serositis. Manifestaciones extrapulmonares del Mycoplasma pneumoniae: Reporte de un caso / Hemolysis, serositis and exanthema induced by Mycoplasma pneumoniae infection: Report of one case

Mycoplasma infections have extrapulmonary manifestations that may be associated with respiratory symptoms and may have skin, heart, gastrointestinal, rheumatologic, neurologic, hematologic involvement. Cold agglutinin mediated autoimmune hemolytic anemia is the most common hematological manifestation. We report a 27-year-old woman infected with Mycoplasma pneumoniae, who presented respiratory involvement with pneumonia, exanthema, serositis and acute hemolytic anemia that required transfusion. The key for the diagnosis were the extrapulmonary manifestations associated with respiratory involvement after five days of hospitalization.

Characteristics of hospitalized children infected with macrolide-resistant Mycoplasma pneumoniae

BACKGROUND: The aim of this study was to clarify retrospectively the characteristics of children hospitalized for respiratory tract infection caused by macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae). METHODS: Children who were hospitalized for respiratory tract infection due to M. pneumoniae were enrolled in this study. The diagnosis of M. pneumoniae infection was made on the grounds of polymerase chain reaction results. RESULTS: Thirty-three children were hospitalized due to lower respiratory tract infection with M. pneumoniae. Of the 33 children, 31 (median age five years) were identified as being infected with macrolide-resistant M. pneumoniae (A2063G:30, A2064G:1) by sequence analysis. Of the 31 children infected with macrolide-resistant M. pneumoniae, 21 (68%) had received 14- or 15-membered macrolide antibiotics and four (13%) had received minocycline before hospitalization. During hospitalization, minocycline was administered to 16 (52%) of the 31 children infected with macrolide-resistant M. pneumoniae. Of the 20 children infected with macrolide-resistant M. pneumoniae under eight years of age, six (30%) were treated with minocycline during hospitalization. The difference in total febrile days between children receiving minocycline treatment before hospitalization and children not receiving minocycline treatment was three days. CONCLUSIONS: The majority of hospitalized children with respiratory tract infection due to macrolide-resistant M. pneumoniae infection was of preschool age and had received 14- or 15-membered macrolide antibiotics before hospitalization. Because macrolide-resistant M. pneumoniae is widespread in Japan, the administration of minocycline as a second-line antibiotic in children under eight years of age cannot be withheld when clinical symptoms do not improve with macrolide antibiotics. .