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Mycoplasma pneumoniae infections, 11 countries in Europe and Israel, 2011 to 2016

Beeton, Michael L, Zhang, Xu-Sheng, Uldum, Søren A, Bébéar, Cécile, Dumke, Roger, Gullsby, Karolina, Ieven, Margareta, Loens, Katherine, Nir-Paz, Ran, Pereyre, Sabine, Spiller, O. Brad and Chalker, Victoria J 2020. Mycoplasma pneumoniae infections, 11 countries in Europe and Israel, 2011 to 2016. Eurosurveillance 25 (2) , pii=1900112. 10.2807/1560-7917.ES.2020.25.2.1900112

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Mycoplasma pneumoniae is a major cause of respiratory infection in humans and macrolide antibiotics, such as azithromycin, are used as the first-line of treatment in many countries. The bacterium is transmitted from person-to-person by respiratory droplets with the incubation period ranging from 4 days to 3 weeks [1]. Because of M. pneumoniae’s intrinsic resistance to many antibiotics, including all cell wall inhibitors, macrolide antibiotics such as azithromycin and clarithromycin are the drug of choice for treatment. In cases of suspected infection in immunocompromised individuals, bactericidal fluoroquinolones may be considered. Tetracyclines are an alternative for treatment of adults with possible macrolide-resistant M. pneumoniae infections. Prudent use of antibiotics has been urged for all cases of M. pneumoniae infection because of worldwide reports of macrolide resistance, which have been reported as ranging from 0.2% in Sweden to more than 90% in China [2-5]. M. pneumoniae infections show seasonal variation. In temperate climates, the number of infections peak during the latter months of the years, with epidemic periods every 4 to 7 years on average [6-8]. The most recent survey in 2012 by Lenglet et al indicated that some countries in the European Union and European Economic Area experienced an increase in M. pneumoniae cases in 2011 whereas others did not, indicating that a universal geographic increase had not occurred [5]. Little is understood about the transmission of M. pneumoniae within populations and several factors have been postulated to account for transmission dynamics, including the immunity level of the population, the bacterial population based on the P1 adhesin type, the age and extent of mixing of children in educational settings. Methodologies for detection of M. pneumoniae include nucleic acid amplification tests (NAAT), serology and culture with varying sensitivities and specificities. There is no international standard material for quality control detection in assays, although external quality control schema exist for some methodologies (NAAT). There are no internationally defined guidelines on the requirements for surveillance of M. pneumoniae, macrolide resistance testing and surveillance, reference system structure, routine testing and bacterial strain discrimination. However, a few countries such as France and the United States (US) have surveillance within specific regions and national surveillance is seen in countries such as Denmark [9] and Japan, the latter of which has maintained an active surveillance system for this pathogen for some time [10]. Overall, laboratory confirmed cases and surveillance data regarding the number of cases and reported cases of macrolide resistance are likely to be underestimated. This is further confounded because an undefined proportion of patients will have mild disease or may be carriers within community settings, without active testing to confirm the infection. Further underestimation is likely to occur from patients receiving empirical treatment in the absence of laboratory-confirmed infection with M. pneumoniae.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: European Centre for Disease Prevention and Control
ISSN: 1560-7917
Date of First Compliant Deposit: 17 January 2020
Date of Acceptance: 15 July 2019
Last Modified: 22 Jan 2020 12:20

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