Watkins Louise K Francois, Olson Daniel, Diaz Maureen H, Lin Xia, Demirjian Alicia, Benitez Alvaro J, Winchell Jonas M, Robinson Christine C, Bol Kirk A, Glodé Mary P, Dominguez Samuel R, Miller Lisa A, Kutty Preeta K
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.
Pediatr Infect Dis J. 2017 Jun;36(6):564-571. doi: 10.1097/INF.0000000000001476.
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.
科罗拉多州一家儿科医院中，肺炎支原体相关的史蒂文斯-约翰逊综合征（SJS）病例增加，因此开展了一次疫情调查。我们描述了此次疫情期间，SJS病例患者及周围社区成员中肺炎支原体的流行病学和分子特征。
来自科罗拉多州5家医院和4家转诊实验室的肺炎支原体聚合酶链反应阳性呼吸道标本接受了聚合酶链反应确证检测；阳性标本随后进行多位点可变数目串联重复分析（MLVA）和大环内酯耐药性检测。使用标准化问卷对3户SJS-肺炎支原体病例患者家庭进行了调查，并从所有同意参与的家庭接触者中采集了鼻咽/口咽拭子。使用国际疾病分类第9版编码，确定2009年1月至2014年3月期间科罗拉多州5至21岁患者中的肺炎病例。
在5例确诊感染的SJS病例患者中，鉴定出3种不同的肺炎支原体MLVA类型；MLVA 3-X-6-2型在SJS病例患者中（60%）比在69份非SJS社区标本中（29%）更常见。在7%的社区标本中鉴定出大环内酯耐药性，但在SJS病例患者中未发现。在15名家庭接触者中，5名（33%）肺炎支原体呈阳性；所有MLVA类型均与相应的SJS病例患者相同，尽管1名接触者的标本对大环内酯耐药。总体肺炎病例以及由肺炎支原体引起的病例在2013年10月达到峰值，与SJS疫情一致。
肺炎支原体相关SJS疫情可能与肺炎支原体社区疫情有关；临床医生应了解肺炎支原体与SJS的关系。在所调查的家庭中，肺炎支原体的家庭传播很常见。
