title: An outbreak of Mycoplasma pneumoniae caused by a macrolide-resistant isolate in a nursery school in China.
abstract: Eighteen out of 45 children were reported to have a respiratory illness during an outbreak at a temporary dormitory in a nursery school in China in 2011. To study the outbreak and to determine the risk factors for infection, an epidemiological investigation was performed. A standardized questionnaire was completed for a total of 45 children with the help of their guardians and parents. In addition, acute- and convalescent-phase serum samples and throat swabs from the children were taken for laboratory diagnosis. The diagnosis of a Mycoplasma-like illness was based on the following clinical criteria. The criteria were onset of illness after 31 May 2011, characterized by a cough, fever(>37.5 °C), or at least 3 of the following symptoms: fever, sore throat, cough or expectoration, and runny or stuffy nose. PCR-restriction fragment length polymorphism (PCR-RFLP), determination of MICs, and sequencing were performed to determine the genotype, antibiotic resistance, and sequence polymorphisms of the isolated strains, respectively. The paired sera revealed that 15 patients were infected with Mycoplasma pneumoniae. Epidemiology confirmed that this was a point source outbreak, characterized by a short incubation period, a high secondary attack rate, and a long period of hospitalization. PCR-RFLP analysis revealed that the 12 isolated strains of M. pneumoniae shared the same subtype P1 gene, and 23S rRNA sequence analysis showed that these strains harbored two macrolide-resistant gene-related point mutations at position 2063 and 2617. In this outbreak, the major risk factor was the distance between the bed of the first patient and the beds of close contacts (beds less than three meters apart). The strains isolated in this study were found to harbor two point mutations conferring macrolide resistance, indicating the importance of pathogen and drug resistance surveillance systems.
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Shaofu
authors.initials: S
authors.lastname: Qiu
authors.forename: Guang
authors.initials: G
authors.lastname: Yang
authors.forename: Lixue
authors.initials: L
authors.lastname: Song
authors.forename: Wenli
authors.initials: W
authors.lastname: Su
authors.forename: Yuanyong
authors.initials: Y
authors.lastname: Xu
authors.forename: Leili
authors.initials: L
authors.lastname: Jia
authors.forename: Ligui
authors.initials: L
authors.lastname: Wang
authors.forename: Rongzhang
authors.initials: R
authors.lastname: Hao
authors.forename: Chuanfu
authors.initials: C
authors.lastname: Zhang
authors.forename: Jingmei
authors.initials: J
authors.lastname: Liu
authors.forename: Xiuping
authors.initials: X
authors.lastname: Fu
authors.forename: Jinrong
authors.initials: J
authors.lastname: He
authors.forename: Jingshan
authors.initials: J
authors.lastname: Zhang
authors.forename: Zhenjun
authors.initials: Z
authors.lastname: Li
authors.forename: Hongbin
authors.initials: H
authors.lastname: Song
mesh_terms: D000900:Anti-Bacterial Agents; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008826:Microbial Sensitivity Tests; D009177:Mycoplasma pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity*; D011019:Pneumonia, Mycoplasma / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology*; D012150:Polymorphism, Restriction Fragment Length; D012578:Schools, Nursery
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides