title: Epidemiology and Molecular Characteristics of Mycoplasma pneumoniae During an Outbreak of M. pneumoniae-associated Stevens-Johnson Syndrome.
abstract: An increase in Mycoplasma pneumoniae-associated Stevens-Johnson syndrome (SJS) cases at a Colorado pediatric hospital led to an outbreak investigation. We describe the epidemiologic and molecular characteristics of M. pneumoniae among SJS case-patients and surrounding community members during the outbreak.
  
  
  
  M. pneumoniae polymerase chain reaction-positive respiratory specimens from 5 Colorado hospitals and 4 referral laboratories underwent confirmatory polymerase chain reaction testing; positive specimens then underwent multilocus variable-number tandem-repeat analysis (MLVA) and macrolide resistance testing. Three SJS-M. pneumoniae case-patient households were surveyed using a standardized questionnaire, and nasopharyngeal/oropharyngeal swabs were obtained from all consenting/assenting household contacts. International Classification of Diseases, 9th revision codes were used to identify pneumonia cases among Colorado patients 5-21 years of age from January 2009 to March 2014.
  
  
  
  Three different M. pneumoniae MLVA types were identified among the 5 SJS case-patients with confirmed infection; MLVA type 3-X-6-2 was seen more commonly in SJS case-patients (60%) than in 69 non-SJS community specimens (29%). Macrolide resistance was identified in 7% of community specimens but not among SJS case-patients. Of 15 household contacts, 5 (33%) were M. pneumoniae positive; all MLVA types were identical to those of the corresponding SJS case-patient, although the specimen from 1 contact was macrolide resistant. Overall pneumonia cases as well as those caused by M. pneumoniae specifically peaked in October 2013, coinciding with the SJS outbreak.
  
  
  
  The outbreak of M. pneumoniae-associated SJS may have been associated with a community outbreak of M. pneumoniae; clinicians should be aware of the M. pneumoniae-SJS relationship. Household transmission of M. pneumoniae was common within the households investigated.
authors.affiliation: From the *Epidemic Intelligence Service, and †Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; ‡Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and §Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado; ¶Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; ‖Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado; and **Colorado Department of Public Health and Environment, Denver, Colorado.
authors.forename: Louise K Francois
authors.initials: LKF
authors.lastname: Watkins
authors.forename: Daniel
authors.initials: D
authors.lastname: Olson
authors.forename: Maureen H
authors.initials: MH
authors.lastname: Diaz
authors.forename: Xia
authors.initials: X
authors.lastname: Lin
authors.forename: Alicia
authors.initials: A
authors.lastname: Demirjian
authors.forename: Alvaro J
authors.initials: AJ
authors.lastname: Benitez
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Winchell
authors.forename: Christine C
authors.initials: CC
authors.lastname: Robinson
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Bol
authors.forename: Mary P
authors.initials: MP
authors.lastname: Glodé
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Dominguez
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Miller
authors.forename: Preeta K
authors.initials: PK
authors.lastname: Kutty
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D016358:Contact Tracing; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D018942:Macrolides / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D009177:Mycoplasma pneumoniae / Q000187:drug effects / Q000235:genetics*; D011019:Pneumonia, Mycoplasma / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides