title: Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome.
abstract: BACKGROUND
  Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado.
  
  
  METHODS
  Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection.
  
  
  RESULTS
  During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 7.5, confidence interval [CI] 1.6–35.1), preceding respiratory symptoms (OR 30.0, CI 3.3–269.4) [corrected] an erythrocyte sedimentation rate ≥35 mg/dL (OR 22.8, CI 2.1-244.9), and ≤3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23).
  
  
  CONCLUSIONS
  We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.
authors.affiliation: Department of Pediatrics, Daniel.Olson@childrenscolorado.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Olson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Louise K Francois
authors.initials: LK
authors.lastname: Watkins
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Alicia
authors.initials: A
authors.lastname: Demirjian
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Xia
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Christine C
authors.initials: CC
authors.lastname: Robinson
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Kristin
authors.initials: K
authors.lastname: Pretty
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Alvaro J
authors.initials: AJ
authors.lastname: Benitez
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Winchell
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Maureen H
authors.initials: MH
authors.lastname: Diaz
authors.affiliation: Colorado Department of Public Health and Environment, Denver, Colorado;
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Miller
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Foo
authors.affiliation: University of Colorado School of Public Health.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Mason
authors.affiliation: New York State Department of Health, Albany, New York.
authors.forename: Ursula L
authors.initials: UL
authors.lastname: Lauper
authors.affiliation: Department of Pediatrics.
authors.forename: Oren
authors.initials: O
authors.lastname: Kupfer
authors.affiliation: Department of Ophthalmology.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kennedy
authors.affiliation: Department of Pediatrics.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Glodé
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Preeta K
authors.initials: PK
authors.lastname: Kutty
authors.affiliation: Department of Pediatrics.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Dominguez
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D011019:Pneumonia, Mycoplasma / Q000150:complications* / Q000453:epidemiology*; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult