Movatterモバイル変換

[0]ホーム
URL:

Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
Thehttps:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

NIH NLM Logo
Log inShow account info
Access keysNCBI HomepageMyNCBI HomepageMain ContentMain Navigation
pubmed logo
Advanced Clipboard
User Guide

Full text links

Public Library of Science full text link Public Library of Science Free PMC article
Full text links

Actions

Share

Comparative Study
.2013;10(5):e1001444.
doi: 10.1371/journal.pmed.1001444. Epub 2013 May 14.

Carriage of Mycoplasma pneumoniae in the upper respiratory tract of symptomatic and asymptomatic children: an observational study

Affiliations
Comparative Study

Carriage of Mycoplasma pneumoniae in the upper respiratory tract of symptomatic and asymptomatic children: an observational study

Emiel B M Spuesens et al. PLoS Med.2013.

Abstract

Background: Mycoplasma pneumoniae is thought to be a common cause of respiratory tract infections (RTIs) in children. The diagnosis of M. pneumoniae RTIs currently relies on serological methods and/or the detection of bacterial DNA in the upper respiratory tract (URT). It is conceivable, however, that these diagnostic methods also yield positive results if M. pneumoniae is carried asymptomatically in the URT. Positive results from these tests may therefore not always be indicative of a symptomatic infection. The existence of asymptomatic carriage of M. pneumoniae has not been established. We hypothesized that asymptomatic carriage in children exists and investigated whether colonization and symptomatic infection could be differentiated by current diagnostic methods.

Methods and findings: This study was conducted at the Erasmus MC-Sophia Children's Hospital and the after-hours General Practitioners Cooperative in Rotterdam, The Netherlands. Asymptomatic children (n = 405) and children with RTI symptoms (n = 321) aged 3 mo to 16 y were enrolled in a cross-sectional study from July 1, 2008, to November 30, 2011. Clinical data, pharyngeal and nasopharyngeal specimens, and serum samples were collected. The primary objective was to differentiate between colonization and symptomatic infection with M. pneumoniae by current diagnostic methods, especially real-time PCR. M. pneumoniae DNA was detected in 21.2% (95% CI 17.2%-25.2%) of the asymptomatic children and in 16.2% (95% CI 12.2%-20.2%) of the symptomatic children (p = 0.11). Neither serology nor quantitative PCR nor culture differentiated asymptomatic carriage from infection. A total of 202 children were tested for the presence of other bacterial and viral pathogens. Two or more pathogens were found in 56% (63/112) of the asymptomatic children and in 55.5% (50/90) of the symptomatic children. Finally, longitudinal sampling showed persistence of M. pneumoniae in the URT for up to 4 mo. Fifteen of the 21 asymptomatic children with M. pneumoniae and 19 of the 22 symptomatic children with M. pneumoniae in this longitudinal follow-up tested negative after 1 mo.

Conclusions: Although our study has limitations, such as a single study site and limited sample size, our data indicate that the presence of M. pneumoniae in the URT is common in asymptomatic children. The current diagnostic tests for M. pneumoniae are unable to differentiate between asymptomatic carriage and symptomatic infection.

PubMed Disclaimer

Conflict of interest statement

At the time of the study, AB was a paid member on the Cepheid Scientific Advisory Board in which he is no longer taking part. After the study, AB joined bioMérieux, a company specializing in infectious disease' diagnostics. ADO is Head of the department of Virology of the Erasmus MC. He is involved in or with many initiatives within the virology field. This involvement ranges from expert advice to various international organisations involved in the area of general human and veterinary health to advising spin-out companies of the Erasmus University Medical Center Rotterdam that are endeavouring to bridge the gap between scientific discovery/knowledge and putting these to practical use in society. For purposes of transparency and to avoid of possible conflicts of interest, Professor Osterhaus discloses all his interests in matters related, directly or indirectly, to his position as head of the Department of Virology of Erasmus MC. Professor Osterhaus has share certificates in Viroclinics Biosciences B.V. AMR received fees for speaking from Abbott. AMR has received grants from the NutsOhra Foundation, The Netherlands, and the Thrasher Fund, USA. All other authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Enrollment flow diagram.
ED, emergency department; GPC, General Practitioners Cooperative.
Figure 2
Figure 2. Monthly enrollments during the course of the study.
The enrollments for the symptomatic group are represented above by a red dotted line. The enrollments for the asymptomatic group are represented below by a blue dotted line. The solid lines represent the absolute number ofM. pneumoniae–positive participants. Enrollment for the asymptomatic group started in January 2009.
Figure 3
Figure 3.M. pneumoniae DNA loads.
(A) Pharyngeal bacterial loads (genomic copy number per milliliter on they-axis) ofM. pneumoniae PCR-positive participants in the asymptomatic group (open squares) and the symptomatic group (filled triangles). (B) Nasopharyngeal bacterial loads (genomic copy number per milliliter on they-axis) ofM. pneumoniae PCR-positive participants in the asymptomatic group and the symptomatic group. The bacterial load distribution was compared using the Mann-Whitney U test. (C) Comparison of the bacterial loads in pharyngeal samples and nasopharyngeal samples for the participants who tested positive forM. pneumoniae in both. Correlation was calculated using the Spearman rank test. (D and E) Distribution of bacterial loads for upper RTIs (URTI) and lower RTIs (LRTI) in the pharyngeal and nasopharyngeal samples. The line in each graph represents the median.
Figure 4
Figure 4.M. pneumoniae DNA loads in the longitudinal study.
This figure shows the bacterial DNA loads in the study participants of the asymptomatic group (A) (open squares) and the symptomatic group (B) (filled triangles) during the follow-up study. Each point represents one visit of one participant and is connected by a line to the point representing the next visit. On they-axis the bacterial DNA load (genomic copy number per milliliter) is shown. On thex-axis the consecutive visits are represented.
Figure 5
Figure 5. Anti–M. pneumoniae serum antibody levels.
(A and B) Serum IgM (A) and IgG (B) antibody levels (in units/milliliter) are compared between the asymptomatic group and the symptomatic group (using the Mann-Whitney U test). (C and D) IgM (C) and IgG (D) antibody levels are plotted against the bacterial DNA load (genomic copy number per milliliter) in all samples. Open squares indicate asymptomatic participants. Filled triangles indicate symptomatic participants. The horizontal lines in A and B represent the median.
Figure 6
Figure 6. Number of detected viral and bacterial pathogens.
The dot plot shows the percentages of participants with 0, 1, 2, 3, or >3 pathogens present in the URT. On thex-axis the percentages are shown, on they-axis the number of pathogens is shown. The filled and open triangles show respectivelyM. pneumoniae (Mpn) PCR-positive symptomatic children (n = 44) andM. pneumoniae PCR-negative symptomatic children (n = 46). The filled and open squares show respectivelyM. pneumoniae PCR-positive asymptomatic children (n = 57) andM. pneumoniae PCR-negative asymptomatic children (n = 52).
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, et al. (2011) The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 53: e25–e76. - PMC - PubMed
    1. Harris M, Clark J, Coote N, Fletcher P, Harnden A, et al. (2011) British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 66 Suppl 2: ii1–ii23. - PubMed
    1. Nilsson AC, Bjorkman P, Persson K (2008) Polymerase chain reaction is superior to serology for the diagnosis of acute Mycoplasma pneumoniae infection and reveals a high rate of persistent infection. BMC Microbiol 8: 93. - PMC - PubMed
    1. Waites KB, Talkington DF (2004) Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 17: 697–728. - PMC - PubMed
    1. Ursi D, Ieven M, Noordhoek GT, Ritzler M, Zandleven H, et al. (2003) An interlaboratory comparison for the detection of Mycoplasma pneumoniae in respiratory samples by the polymerase chain reaction. J Microbiol Methods 53: 289–294. - PubMed

Publication types

MeSH terms

Substances

Related information

Grants and funding

“Stichting Vrienden van het Sophia,” Rotterdam, The Netherlands (www.vriendensophia.nl). AMR was supported for this study by an Erasmus MC Fellowship Award (http://www.erasmusmc.nl/research), a Clinical Fellowship Award of The Netherlands Organisation for Health Research and Development (http://www.zonmw.nl/en/), and a Fellowship Award of the European Society for Paediatric Infectious Diseases (http://www.espid.org/award_content.aspx?Group=Awards&Page=Fellowship). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

LinkOut - more resources

Full text links
Public Library of Science full text link Public Library of Science Free PMC article
Cite
Send To

NCBI Literature Resources

MeSHPMCBookshelfDisclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

[8]ページ先頭
©2009-2025 Movatter.jp