title: Gene and cytokine profile analysis of macrolide-resistant Mycoplasma pneumoniae infection in Fukuoka, Japan.
abstract: BACKGROUND
  Recent epidemiologic data suggest that the prevalence of macrolide resistant Mycoplasma pneumoniae (MR-M. pneumoniae) is increasing rapidly worldwide. This study assessed the present status of M. pneumoniae infection in Japan and clinical end-points to distinguish children with MR-M. pneumoniae.
  
  
  METHODS
  During an outbreak of M. pneumoniae infections in Fukuoka, Japan in 2010-11, a total of 105 children with clinically suspected M. pneumoniae infection were enrolled. M. pneumoniae was analyzed for macrolide resistance in domain V of the 23S rRNA gene. Sixty -five patients with PCR positive for M. pneumoniae were analyzed with regard to clinical symptoms, efficacy of several antimicrobial agents and several laboratory data.
  
  
  RESULTS
  Causative pathogens were detected in 81.0% (85 of 105) and M. pneumoniae was identified 61.9% (65 of 105). The resistance rate of M. pneumoniae was 89.2% (58 of 65) in this general pediatric outpatient setting. Patients infected with MR-M. pneumoniae showed longer times to resolution of fever and required frequent changes of the initially prescribed macrolide to another antimicrobial agent. We observed three different genotypes of M. pneumoniae including the rarely reported A2063T mutation (A2063G: 31 strains, A2063T: 27 strains, no mutation: 7 strains). Drug susceptibility testing showed different antimicrobial susceptibility profiles for each genotype. Serum IFN-gamma, IL-6 and IP-10 levels were higher in patients with MR-genotypes than in those infected with no-mutation strains (p < 0.001).
  
  
  CONCLUSIONS
  Macrolide resistance is more common than previously thought and a small epidemic of rarely reported A2063T mutation was observed in Fukuoka, Japan. Furthermore our results reveal the possibility that levels of certain inflammatory cytokines may be a candidate to predict MR-M.pneumoniae infection.
authors: Matsuda Children's Clinic, Fukuoka, Japan. kentaromatsuda@hotmail.com.
authors: Kentaro
authors: K
authors: Matsuda
authors: Mitsuo
authors: M
authors: Narita
authors: Nobuyuki
authors: N
authors: Sera
authors: Eriko
authors: E
authors: Maeda
authors: Hideaki
authors: H
authors: Yoshitomi
authors: Hitomi
authors: H
authors: Ohya
authors: Yuko
authors: Y
authors: Araki
authors: Tatsuyuki
authors: T
authors: Kakuma
authors: Atsushi
authors: A
authors: Fukuoh
authors: Kenji
authors: K
authors: Matsumoto
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000276:immunology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000276:immunology; D007564:Japan / Q000453:epidemiology; D018942:Macrolides / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D009177:Mycoplasma pneumoniae / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D011019:Pneumonia, Mycoplasma / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology* / Q000382:microbiology; D017354:Point Mutation; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D016207:Cytokines; D015850:Interleukin-6; D018942:Macrolides