title: Comparison of laboratory diagnostic procedures for detection of Mycoplasma pneumoniae in community outbreaks.
abstract: BACKGROUND
  Mycoplasma pneumoniae continues to be a significant cause of community-acquired pneumonia (CAP). A more definitive methodology for reliable detection of M. pneumoniae is needed to identify outbreaks and to prevent potentially fatal extrapulmonary complications.
  
  
  METHODS
  We analyzed 2 outbreaks of CAP due to M. pneumoniae. Nasopharyngeal and/or oropharyngeal swab specimens and serum samples were obtained from persons with clinically defined cases, household contacts, and asymptomatic individuals. Real-time polymerase chain reaction (PCR) for M. pneumoniae was performed on all swab specimens, and the diagnostic utility was compared with that of 2 commercially available serologic test kits.
  
  
  RESULTS
  For cases, 21% yielded positive results with real-time PCR, whereas 81% and 54% yielded positive results with the immunoglobulin M and immunoglobulin G/immunoglobulin M serologic tests, respectively. For noncases, 1.8% yielded positive results with real-time PCR, whereas 63% and 79% yielded serologically positive results with the immunoglobulin M and immunoglobulin G/immunoglobulin M kits, respectively. The sensitivity of real-time PCR decreased as the duration between symptom onset and sample collection increased, with a peak sensitivity of 48% at 0-21 days. A specificity of 43% for the immunoglobulin M antibody detection assay was observed for persons aged 10-18 years, but the sensitivity increased to 82% for persons aged 19 years.
  
  
  CONCLUSIONS
  Thorough data analysis indicated that no single available test was reliable for the identification of an outbreak of CAP due to M. pneumoniae. A combination of testing methodologies proved to be the most reliable approach for identification of outbreaks of CAP due to M. pneumoniae, especially in the absence of other suspected respiratory pathogens.
authors.affiliation: Respiratory Diseases Branch, Office of Workforce and Career Development, Atlanta, Georgia, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Thurman
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Walter
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Schwartz
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Michael T
authors.initials: MT
authors.lastname: Dillon
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Baughman
authors.forename: Meredith
authors.initials: M
authors.lastname: Deutscher
authors.forename: John P
authors.initials: JP
authors.lastname: Fulton
authors.forename: Jon E
authors.initials: JE
authors.lastname: Tongren
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Winchell