Thurman Kathleen A, Walter Nicholas D, Schwartz Stephanie B, Mitchell Stephanie L, Dillon Michael T, Baughman Andrew L, Deutscher Meredith, Fulton John P, Tongren Jon E, Hicks Lauri A, Winchell Jonas M
Respiratory Diseases Branch, Office of Workforce and Career Development, Atlanta, Georgia, USA.
Clin Infect Dis. 2009 May 1;48(9):1244-9. doi: 10.1086/597775.
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.
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.
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.
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.
肺炎支原体仍然是社区获得性肺炎（CAP）的重要病因。需要一种更具确定性的方法来可靠检测肺炎支原体，以识别疫情并预防潜在致命的肺外并发症。
我们分析了2起由肺炎支原体引起的CAP疫情。从临床确诊病例、家庭接触者和无症状个体中采集鼻咽和/或口咽拭子标本及血清样本。对所有拭子标本进行肺炎支原体实时聚合酶链反应（PCR）检测，并将其诊断效用与2种市售血清学检测试剂盒进行比较。
对于病例，实时PCR检测阳性率为21%，而免疫球蛋白M和免疫球蛋白G/免疫球蛋白M血清学检测的阳性率分别为81%和54%。对于非病例，实时PCR检测阳性率为1.8%，而免疫球蛋白M和免疫球蛋白G/免疫球蛋白M试剂盒血清学检测阳性率分别为63%和79%。实时PCR的敏感性随着症状出现至样本采集时间间隔的增加而降低，在0 - 21天达到峰值敏感性48%。10 - 18岁人群免疫球蛋白M抗体检测试验的特异性为43%，但19岁人群的敏感性增至82%。
全面的数据分析表明，没有单一可用检测方法能可靠识别由肺炎支原体引起的CAP疫情。事实证明，联合检测方法是识别由肺炎支原体引起的CAP疫情最可靠的方法，尤其是在没有其他可疑呼吸道病原体的情况下。
