Life-threatening pneumonia caused by macrolide-resistant Mycoplasma pneumoniae.

From the *Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; †Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; and Divisions of ‡Viral Diseases and §Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
The Pediatric Infectious Disease Journal (Impact Factor: 3.14). 09/2011; 31(2):208-9. DOI: 10.1097/INF.0b013e318234597c
Source: PubMed

ABSTRACT Two siblings had pneumonia caused by macrolide-resistant Mycoplasma pneumoniae as determined by polymerase chain reaction and serology. One of them developed adult respiratory distress syndrome and required extracorporeal membrane oxygenation therapy. This report highlights the need for studies to evaluate the optimal treatment in severe cases of macrolide-resistant M. pneumoniae pneumonia.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Macrolide-resistant Mycoplasma pneumoniae (MR-M. pneumoniae) was isolated from clinical specimens in Shenzhen, China from November 2010 to July 2011. A comparative study was conducted to determine whether macrolides are effective in treating patients infected with MR-M. pneumoniae. Of 57 M. pneumoniae strains, 36 harbored point mutations on A2063G in the 23S ribosomal RNA gene. A total of 36 (63%) strains were classified as MR-M. pneumonia and 21 (37%) as macrolide-susceptible M. pneumoniae (MS-M. pneumoniae). The clinical courses of MR-M. pneumoniae-infected patients (MR patients) treated with macrolides were compared with those of MS-M. pneumoniae-infected patients (MS patients). The patient demographics (sex, age), most laboratory findings, and diagnosis did not show significant differences between the two groups. The MR patients had higher mean total febrile days compared with MS patients (6.56 ± 6.17 days vs. 3.57 ± 3.80 days, P = 0.05). The MR patients were more likely to be have levels of high-sensitivity C-reactive protein than MS patients (42% (15/36) vs. 14% (3/21), P = 0.03). Although the febrile period was prolonged in MR patients treated with macrolides, the fever resolved even when the initial prescription was unchanged. Therefore, these results suggest that macrolides are less effective in MR patients than in MS patients. Pediatr Pulmonol. 2013; 9999:XX-XX. © 2013 Wiley Periodicals, Inc.
    Pediatric Pulmonology 07/2013; · 2.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Mycoplasma pneumoniae (Mpn) is a human pathogen that causes acute and chronic respiratory diseases and has been linked to many extrapulmonary diseases. Due to the lack of cell wall, Mpn is resistant to antibiotics targeting cell wall synthesis such as penicillin. During the last 10 years macrolide-resistant Mpn strains have been frequently reported in Asian countries and have been spreading to Europe and the United States. Therefore, new antibiotics are needed. In this study, 30 FDA-approved anticancer or antiviral drugs were screened for inhibitory effects on Mpn growth and selected analogs were further characterized by inhibition of target enzymes and metabolism of radiolabeled substrates. Sixteen drugs showed varying inhibitory effects and seven showed strong inhibition of Mpn growth. The anticancer drug 6-thioguanine had a MIC (minimum inhibitory concentration required to cause 90% of growth inhibition) value of 0.20 mug ml-1, whereas trifluorothymidine, gemcitabine and dipyridamole had MIC values of approximately 2 mug ml-1. In wild type Mpn culture the presence of 6-thioguanine and dipyridamole strongly inhibited the uptake and metabolism of hypoxanthine and guanine while gemcitabine inhibited the uptake and metabolism of all nucleobases and thymidine. Trifluorothymidine and 5-fluorodeoxyuridine, however, stimulated the uptake and incorporation of radiolabeled thymidine and this stimulation was due to induction of thymidine kinase activity. Furthermore, Mpn hypoxanthine guanine phosphoribosyl transferase (HPRT) was cloned, expressed, and characterized. The 6-thioguanine, but not other purine analogs, strongly inhibited HPRT, which may in part explain the observed growth inhibition. Trifluorothymidine and 5-fluorodeoxyuridine were shown to be good substrates and inhibitors for thymidine kinase from human and Mycoplasma sources. We have shown that several anticancer and antiviral nucleoside and nucleobase analogs are potent inhibitors of Mpn growth and that the mechanism of inhibition are most likely due to inhibition of enzymes in the nucleotide biosynthesis pathway and nucleoside transporter. Our results suggest that enzymes in Mycoplasma nucleotide biosynthesis are potential targets for future design of antibiotics against Mycoplasma infection.
    BMC Microbiology 08/2013; 13(1):184. · 2.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) has increased worldwide. The aim of this study was to estimate the proportion of MRMP in a tertiary hospital in Korea, and to find potential laboratory markers that could be used to predict the efficacy of macrolides in children with MRMP pneumonia.
    Korean Journal of Pediatrics 04/2014; 57(4):186-92.