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.

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.

Clinical significance of different bacterial load of Mycoplasma pneumoniae in patients with Mycoplasma pneumoniae pneumonia

OBJECTIVE: This retrospective study was conducted to investigate the clinical significance of differentMycoplasma pneumoniae bacterial load in patients with M. pneumoniae pneumonia (MP) in children. METHODS: Patients with MP (n=511) were identified at the Children's Hospital Affiliated to Soochow University database during an outbreak of MP between January 2012 and February 2013. RESULTS: Comparing patients with high and low bacterial load those with higher loads were significantly older (p<0.01) and had fever significantly more frequently (p=0.01). Presence of wheezing at presentation was associated with low bacterial load (p=0.03). Baseline positive IgM was present in 93 (56.4%) patients with high bacterial load compared to 46 (27.8%) patients with low bacterial load (p<0.001). Co-infection with viruses was found significantly more frequent among patients with low bacterial load (24.2%) than those with high bacterial load (8.5%) [p<0.001]. Bacterial co-infection was also more frequently detected among patients with low bacterial load (22.4%) than in those with high bacterial load (12.1%) [p=0.01]. CONCLUSION: M. pneumoniae at a high bacterial load could be an etiologic agent of respiratory tract disease, whereas the etiologic role of MP at a low bacterial load remains to be determined. .

Macrolide Resistance of Mycoplasma pneumoniae and Its Detection Rate by Real-Time PCR in Primary and Tertiary Care Hospitals

BACKGROUND: This study aimed to evaluate the prevalence of Mycoplasma pneumoniae in primary and tertiary care hospitals and its macrolide resistance rate. METHODS: Nasopharyngeal swabs were collected from 195 pediatric patients in primary and tertiary care hospitals from October to November 2010. The AccuPower MP real-time PCR kit (Bioneer, Korea) was used for the detection of M. pneumoniae. Direct amplicon sequencing was performed to detect point mutations conferring resistance to macrolides in the 23S rRNA gene. RESULTS: Among the 195 specimens, 17 (8.7%) were M. pneumoniae positive, and 3 of the strains (17.6%) obtained from these 17 specimens displayed the A2063G mutation in 23S rRNA. Three macrolide-resistant M. pneumoniae isolates were isolated from patients hospitalized at the primary care hospital. The positive rates of M. pneumoniae for the primary and tertiary care hospitals were 12.1% (15/124) and 2.8% (2/71), respectively (P=0.033). CONCLUSIONS: The positive rate of M. pneumoniae in the primary care hospital was higher than that in the tertiary care hospital. Simultaneous detection of M. pneumoniae and macrolide-resistant mutation genes in the 23S rRNA by real-time PCR is needed for rapid diagnosis and therapy of M. pneumoniae infections.

Pneumonia adquirida na comunidade e derrame pleural parapneumônico relacionados a Mycoplasma pneumoniae em crianças e adolescentes / Mycoplasma pneumoniae-related community-acquired pneumonia and parapneumonic pleural effusion in children and adolescents

OBJETIVO: Determinar a prevalência e as características da pneumonia adquirida na comunidade (PAC) e derrames pleurais parapneumônicos (DPP) relacionados a Mycoplasma pneumoniae em um grupo de crianças e adolescentes. MÉTODOS: Estudo observacional retrospectivo com 121 pacientes hospitalizados com PAC e DPP em um hospital de referência terciária, entre 2000 e 2008, divididos em seis grupos (G1 a G6) segundo o agente etiológico: M. pneumoniae com ou sem coinfecção, em 44 pacientes; outros agentes que não M. pneumoniae, em 77; M. pneumoniae sem coinfecção, em 34; Streptococcus pneumoniae, em 36; Staphylococcus aureus, em 31; e coinfecção M. pneumoniae/S. pneumoniae, em 9, respectivamente. RESULTADOS: Na comparação entre os grupos, G1 apresentou frequências maiores em gênero feminino, tosse seca, uso prévio de beta-lactâmicos e na duração dos sintomas até a admissão, assim como menor uso de assistência ventilatória e de drenagem torácica que G2, enquanto G3 teve maiores frequências em uso prévio de beta-lactâmicos e tosse seca, maior duração dos sintomas antes da admissão e menor frequência de uso de drenos torácicos que G4 e G5, ao passo que G3 teve média de idade maior e menor frequência de náuseas/vômitos que G4, assim como menor uso de assistência ventilatória que G5. A coinfecção M. pneumoniae/S. pneumoniae aumentou a duração dos sintomas até a admissão. CONCLUSÕES: Nesta amostra, a prevalência de PAC e DPP por M. pneumoniae foi de 12,75%. Embora a doença apresentasse quadros mais leves que aquela por outros organismos, a evolução foi mais prolongada. Nossos dados sugerem a necessidade de uma maior diligência na investigação de M. pneumoniae em crianças e adolescentes com PAC e DPP em nosso meio.

OBJECTIVE: To determine the prevalence and the characteristics of Mycoplasma pneumoniae-related community-acquired pneumonia (CAP) and parapneumonic pleural effusion (PPE) in children and adolescents. METHODS: This was a retrospective observational study involving 121 patients with CAP/PPE hospitalized in a tertiary referral hospital between 2000 and 2008, divided into six groups according to the etiologic agent (G1 to G6, respectively): M. pneumoniae with or without co-infection, in 44 patients (group 1); etiologic agents other than M. pneumoniae, in 77 (group 2); M. pneumoniae without co-infection, in 34 (group 3); Streptococcus pneumoniae, in 36 (group 4); Staphylococcus aureus, in 31 (group 5); and M. pneumoniae/S. pneumoniae co-infection, in 9 (group 6). RESULTS: In comparison with group 2, group 1 showed higher frequencies of females, dry cough, and previous use of beta-lactam antibiotics; longer duration of symptoms prior to admission; and lower frequencies of use of mechanical ventilation and chest tube drainage. In comparison with groups 4 and 5, group 3 showed higher frequencies of previous use of beta-lactam antibiotics and dry cough; longer duration of symptoms prior to admission; a lower frequency of use of chest tube drainage; a higher mean age and a lower frequency of nausea/vomiting (versus group 4 only); and a lower frequency of use of mechanical ventilation (versus group 5 only). M. pneumoniae/S. pneumoniae co-infection increased the duration of symptoms prior to admission. CONCLUSIONS: In this sample, the prevalence of M. pneumoniae-related CAP/PPE was 12.75%. Although the disease was milder than that caused by other microorganisms, its course was longer. Our data suggest that M. pneumoniae-related CAP and PPE in children and adolescents should be more thoroughly investigated in Brazil.

Mycoplasma Pneumoniae: evaluación de la pobración hospitalaria / Mycoplasma Pneumoniae: evaluation in the hospital population

Mycoplasma pneumoniae es un patógeno común del tracto respiratorio, en niños y adultos. Causa entre un 10 y un 30% de las neumonías atípicas de la comunidad. La edad clásicamente descripta de primoinfección es entre 5 y 9 años. Las manifestaciones extrapulmonares son menos frecuentes. Las técnicas de laboratorio apropiadas para el diagnóstico son los ensayos serológicos, que detectan anticuerpos específicos y la reacción en cadena de la polimerasa (PCR) que detecta directamente el material genético de la bacteria. Objetivo: Determinar la edad promedio de la primoinfección, la entidad clínica más frecuente que motiva el análisis y el porcentaje de pacientes con manifestaciones pulmonares y extrapulmonares. Materiales y métodos: Se efectuó el análisis de 180 pacientes, de 7 meses a 15 años, que consultaron en este hospital, y que tuvieron un resultado positivo para anticuerpos IgM anti M. pneumoniae. Se clasificaron en 4 grupos: de 7 meses a 2 años (A), >2 a 5 años (B), >5 a 10 años (C), >10 a 15 años (D). Las IgM se detectaron en suero por inmunofluorescencia indirecta, luego de un pre-tratamiento con absorbente para eliminar IgG y factor reumatoideo. Resultados: La edad promedio de los pacientes fue de 8,7 años. Un 9% correspondió al al grupo A, 23% al grupo B, 31% al grupo C y 37% al grupo D. Las manifestaciones respiratorias representaron el 39,4% de todos los casos, 40% correspondieron a manifestaciones extrapulmonares, y 20,6% a pacientes con síndrome febril prolongado. Conclusiones: M. pneumoniae es considerado un patógeno de niños en edad escolar, pero en nuestro estudio un 32% correspondió a niños menores a 5 años. A pesar de ser un patógeno típicamente respiratorio, observamos un alto porcentaje de manifestaciones extrapulmonares que motivaron la consulta (40%) y de pacientes con síndrome febril prolongado (20,6%) como único síntoma asociado a la primoinfección por M. pneumoniae (AU)

Mycoplasma pneumoniae is a common pathogen of the human respiratory tract of in children and young adults. It causes 10 to 30% of community-acquired atypical pneumonia. Primary infection classically is considered to occur during the first 5 or 9 years of life. Extrapulmonary symptoms are less frequent. Appropriate diagnostic techniques are serological assays for the detection of specific antibodies, and polymerase chain reaction (PCR) for the direct detection of DNA. Aims: To determine: the median age of primary infection, the most frequent clinical entity that motivated the analysis, and the percentage of patients with respiratory or extrapulmonary manifestations. Materials y Methods: Analysis of 180 patients of the hospital, from 7 months to 15 years with positive result for IgM anti M. pneumoniae was performed. They were classified in 4 groups: 7 months to 2 years (A),> 2 to 5 years (B),> 5 to 10 years (C),> 10 to 15 years (D). IgM were detected by indirect inmunofluorescent assay in serum specimens, pre-treated with absorbent to eliminate IgG and rheumatoid factor. Results: Patients median age was 8,7 years; 9% corresponding to group A, 23% to group B, 31% to group C and 37% to group D. Respiratory manifestations represented 39,4 % of all cases, 40% with extrapulmonary symptoms and prolonged febrile syndrome accounted for 20,6 % as the only symptom associated with primary infection by M. pneumoniae. Conclusions: M. pneumoniae is generally considered to be a pathogen of school-aged children, but in our study 32% of cases corresponded to less than 5 year-old children. Although this agent is typically described as a respiratory pathogen, we observed a high percentage of extrapulmonary manifestations that motivated the analysis (40 %) and prolonged febrile syndrome (20,6 %) as the only symptom associated with primary infection by M. pneumoniae (AU)

Infección por Mycoplasma pneumoniae / Mycoplasma pneumoniae infection

La infección por Mycoplasma de infecciones respiratorias agudas en niños, siendo responsable de hasta 40 por ciento de las neumonías adquiridas en la comunidad (NAC). El grupo de mayor riesgo son los escolares, sin embargo también lo constituyen los menores de 5 años. Si bien las manifestaciones clínicas son inespecíficas, los síntomas más frecuentes son fiebre, tos, compromiso del estado general y cefalea. El diagnóstico se puede establecer determinando niveles de IgM en fase aguda, aunque recientemente se ha sugerido el rol de la reacción de polimerasa en cadena para efectos clínicos, permitiendo aumentar la sensibilidad diagnóstica. Las alteraciones de laboratorio son inespecíficas y no permiten distinguir la infección por M. pneumoniae de la producida por otros microorganismos. Los hallazgos radiológicos pueden sugerir el diagnóstico, destacando la presencia de infiltrados pulmonares focales, de predominio intersticial. El cuadro clínico tiende a ser benigno y autolimitado, aunque en ocasiones puede producir neumonía fulminante o manifestaciones extrapulmonares con compromiso neurológico, dermatológico, hematológico, cardiaco, renal yosteoarticular. El tratamiento antibiótico ha demostrado que disminuye la morbilidad asociada a NAC, acorta la duración de síntomas y disminuye la frecuencia de episodios de sibilancias recurrentes; sin embargo no ha demostrado disminuir el riesgo de contagio o transmisión a otras personas.

Prevalence and clinical features of mycoplasma pneumoniae in Thai children.

OBJECTIVE: To determine the prevalence and clinical features of mycoplasma pneumoniae in Thai children with community acquired pneumonia (CAP). MATERIAL AND METHOD: Diagnosis of current infection was based on > or = 4 fold rise in antibody sera or persistently high antibody titers together with the presence of mycoplasma DNA in respiratory secretion. The clinical features were compared between children who tested positive for M pneumoniae, and those whose results were negative. RESULTS: Current infection due to M. pneumoniae was diagnosed in 36 (15%) of 245 children with paired sera. The sensitivity and specificity of polymerase chain reaction (PCR) in diagnosing current infection in the present study were 78% and 98% respectively. The mean age of children with mycoplasma pneumoniae was higher than CAP with unspecified etiology. The presenting manifestations and initial laboratory finding were insufficient to predict mycoplasma pneumoniae precisely, the presence of chest pain and lobar consolidation on chest X-ray, however, were significant findings in children with mycoplasma pneumoniae. CONCLUSION: The present study confirms that M. pneumoniae plays a significant role in CAP in children of all ages. Children with this infection should be identified in order to administer the appropriate antibiotic treatment.

Seroprevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in Stable Asthma and Chronic Obstructive Pulmonary Disease

Mycoplasma pneumoniae and Chlamydia pneumoniae have been suggested to take part in the acute exacerbation of bronchial asthma and chronic obstructive pulmonary disease (COPD). Several studies have questioned whether they may play pathogenic roles in connection with bronchial asthma and COPD. This study was designed to evaluate the seroprevalences of M. pneumoniae and C. pneumoniae in stable asthma and COPD patients, and to compare with control patients. The medical records of one hundred forty patients who underwent M. pneumoniae and C. pneumoniae serology were retrospectively reviewed. Seroprevalences of M. pneumoniae and C. pneumoniae in the asthma group (11.1% and 8.3%, respectively) were higher than in the control group (4.4% and 2.2%, respectively) without statistical significance. The seroprevalence of M. pneumoniae in the COPD group (16.9%) was significantly higher than in the control group, and the seroprevalence of C. pneumoniae in the COPD group (3.4%) was higher than in the control group without statistical significance. This study raises important questions about the relation of M. pneumoniae and C. pneumoniae infection with stable asthma or COPD.

Mycoplasma pneumoniae infection in Yemen: incidence, presentation and antibiotic susceptibility

To determine the incidence, clinical presentation and antibiotic susceptibility of Mycoplasma pneumoniae at the main hospitals in Sana'a, we studied 405 patients clinically and radiographically diagnosed with lower respiratory tract infections aged 10-60 years. M. pneumoniae was identified by 3 different methods: culture, antigen detection and IgM serology. Antibiotic susceptibility testing was performed for confirmed isolates by macro-broth dilution technique. There were 125 patients [30.9%] with current infection, mostly among younger age groups, with bronchopneumonia the most common underlying clinical condition. All tested isolates were susceptible to all antibiotics in the in vitro antibiogram, with erythromycin the most active. The results indicate the need for different approaches in the diagnosis of M. pneumoniae infection in Yemen

Aspects actuels des pneumopathies aigues bactériennes mortelles dans le service de pneumophtisiologie du centre hospitalier et universitaire, CHU, de Treichville

Les pneumopathies aigues bactériennes sont des affections fréquentes. Elles représentent la deuxième cause d'hospitalisation .après la tuberculose. Ce sont également des affections graves car leur évolution est émaillée de COMPLICATIONSs mortelles. A partir d'une étude rétrospective conduite au CHU de Treichville dans le service de P.P.H sur la période de Janvier 1997 à décembre 1999, nous avons étudié le profil épidémiologique, clinique, paraclinique, thérapeutique des patients décédés de pneumopathies aigues supposées bactériennes. Pendant la période de l'étude, 68 cas de pneumopathies aigues supposées bactériennes ont été analysés sur 1045 cas de pneumopathies hospitalisées. Nous avons abouti aux conclusions suivantes : - Le taux de mortalité est de 14,4 pour cent; - Le maximum de décès s'observe dans la population jeune (20 à 40 ans); - La toux, la dyspnée représentent les principaux motifs de consultation, le délai entre le début des signes et la consultation est supérieure à 15 jours; - L'examen clinique retrouve un syndrome de condensation pulmonaire; - Les lésions radiologiques sont dominées par l'atteinte alvéolaire. Elles sont le plus souvent étendues; - Le pneumocoque apparaŒt comme le principal agent pathogène incriminé; - La quasi-totalité des patients présentaient des signes de gravité. Au terme de notre étude, nous attirons l'attention des praticiens sur l'intérˆt de la prise en charge précoce des pneumopathies aigues afin d'en réduire la mortalité

Neumonía por Mycoplasma pneumoniae en niños Latinoamericanos / Pneumonia by mycoplasma penumoniae in Latin American children

Según publicaciones de 1989 a 1999, la prevalencia de neumonía por M.pneumoniae en niños latinoamericanos fluctúa entre 0.99 por ciento y 30 por ciento. El cuadro clínico y radiológico es similar al descrito en la literatura. Es importante su asociación con episodio de crisis asmática.

Neumonía por mycoplasma: cuatro años de estudio / Mycoplasma pneumonia: four years study

Mycoplasma pneumoniae constituye una de las causas, cada vez mas frecuente, de neumonias en la infancia. Objetivos: estudiar 105 casos de neumonias por Mycoplasma pneumoniae habidos en nuestro hospital en los ultimos cuatro anos. Material y metodos: durante dicho tiempo se diagnosticaron en el Servicio de Urgencias de nuestro hospital, un total de 452 neumonias ambulatorias, 132 de ellas causadas por Mycoplasma pneumonlae, lo que significa un porcentaje de casi 30 por ciento; todas fueron seguidas mediante un protocolo de neumonias, recogiendose datos epidemiológicos, clínicos, analíticos y microbiológicos, analizándose sus resultados según un programa estadístico. Resultados: edad media de presentación de 6.38 anos, 38.6 por ciento menores de cinco arlos. No encontramos ningun predominio de sexos en su distribución, aunque si una mayor distribución de los casos entre los meses de enero y julio con 83 por ciento de los casos. Epidemiológicamente encontramos la aparición de casos familiares similares en 37 por ciento de los casos, por 52 por ciento de casos en donde no se encontraron casos similares en el entorno, se hallaron factores de riesgo en 36 por ciento de los casos (enfermedades del tracto respiratorio inferior). La clinica consistió fundamentalmente en fiebre superior a 38§C, tos seca y buen estado general, acompanandose de sintomatologia catarral en los pacientes mas pequenos. A la exploración ffsica encontramos estertores a la auscultación pulmonar en 75 pacientes y una auscultación normal en 23 casos, cinco pacientes cursaron con derrame pleural de leve a moderado. La afectación faringo-amigdalar estaba presente en 74 casos y 14 pacientes cursaron con afectación dermatológica, sólo cuatro de los pacientes precisaron ingreso hospitalario. El tratamiento consistió en batalactamicos y macrólidos, evolucionando a su total curación al mes de iniciado el estudio 93 por ciento de los casos

Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community acquired pneumonia.

A prospective one year study was performed on 62 children admitted at the All India Institute of Medical Sciences with community acquired pneumonia (CAP) for the prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae. Diagnosis of infection with M. pneumoniae was based on serological tests viz microparticle agglutination test for detection of IgM antibodies and indirect immunofluorescence test for antigen detection from throat swabs (sensitivity 85.7%, specificity 93.3%). The indirect solid-phase enzyme immunoassay for detection of IgG antibodies was used to determine the prevalence of C. pneumoniae (sensitivity 88.8%, specificity 75.8%). Seventeen patients (27.4%) were found to have serological evidence of M. pneumoniae infection whereas only 4 (6.4%) patients were seropositive for C. pneumoniae. Results of this study indicate that M. Pneumoniae plays a significant role in CAP in infants and young children. Thus specialized laboratory testing for these agents should be more widely used thereby affecting empiric antibiotic regimens.

Neumonia por mycoplasma pneumoniae en 107 niños de Medellín

Se revisaron las historias de 107 niños con infección respiratoria aguda (IRA) baja que tenían una IgM positiva para Mycoplasma pneumoniae. La edad más afectada fue la de 2 a 6 años (58 por ciento). El tiempo de evolución antes de la consulta fue de 1 a 180 días, con un promedio de 10.7 días. El motivo de consulta más frecuente fue tos (95.3 por ciento), tos prolongada en el 22.45 por ciento, seguida de fiebre (73.5 por ciento), expectoración y rinitis (32.7 por ciento) respectivamente. Al examen se encontró: Sibilancias (67.3 por ciento), estertores crepitantes (30.8 por ciento) fiebre (37 por ciento), faringitis (15.9 por ciento), otitis (13.1 por ciento) y sinusitis (12 por ciento). El hallazgo radiológico más frecuente fue atrapamiento de aire (21.8 por ciento) derrame pleural abacteriano. La proteína C reactiva fue de < 4 mg por ciento en el 70.8 por ciento. El tratamiento fue a base de macrólidos, principalmente claritromicina (72-6 por ciento), broncodilatadores (40 por ciento) y estos asociados a esteroides en el 25.8 por ciento de los casos

Incidence of mycoplasma pneumoniae in lower respiratory tract infection in infants and children

Two hundred infants and children suffering from lower respiratory tract infection and 53 healthy controls from the paediatrics clinic of El-Minia University hospital were the subjects of this study from Dec. 1992 to Aug. 1993. Mycoplasma pneumoniae was isolated from 20 percent of the patients. It was more prevalent in the age group 4-10 years [30 percent], followed by 10-12 years [11.6 percent] and finally those aging from 1 to 4 years [7.5 percent]. M. pneumoniae was isolated from three [5.6 percent] of the control group. The post-pharyngeal swabs were the ideal method for sampling M., pneumoniae, followed by gastric lavage and lastly the sputum samples. The incorporation of high percentage of bacterial inhibitors in addition to anaerobic incubation in a humid atmosphere at 37 C was essential for the primary isolation of the causative agent. The best medium for isolation of mycoplasma species was the SP4 medium followed by S. Hayflick and finally the biphasic media. The most sensitive and specific test for sero logical identification of M. pneumoniae colonies was the dot ELISA test. Moreover, the ideal method for detection of M. pneumoniae antibodies was the ELISA technique which showed better results than the complement fixation test