Acute Respiratory Infection Due to Mycoplasma Pneumonie: Current Status of Diagnostic Methods
Table 1 Summary of studies of respiratory infections due to Mycoplasma pneumoniae in adults, published since 2003
Reference / Location / Subject age (years) / No of subjects tested / Diagnostic method(s) / No (%) of subjects infected with M. pneumoniae / Comments / Methodological problem a[47] 2003 / Southeast Asia / 16-98 / 98 outpatients, 147 hospitalised patients / Particle agglutination test / 32 (13.1) / 26/98 (26%) in outpatients, 6/147 (4.1%) in hospitalized patients / C
[17] 2003 / Sweden / 10-84 / 177 / CFT / 17 (9.6) / C
[11] 2004 / The Netherlands / 18 / 145 / P1-based PCR, CFT, IgM-IF / 13 (9.0) / 9 definite cases and 4 probable cases
Convalescent phase serum samples 10-14 days after inclusion / …
[36] 2004 / The Netherlands / 1-88 / 159 / P1 gene-based PCR, particle agglutination and ELISA / 19 (11.9) / 7 PCR positive, all also positive in at least 1 serological test,
2-fold titer increase in IgG was defined as positive / D
[29] 2004 / Trinidad and Tobago / >2 / 132 / IgM and IgG EIA on acute phase serum / 88 (66.7) / 36/88 IgM positive / B
[10] 2005 / France / 18 / 3198 / P1-based PCR, Ag-detection by EIA / 109 (3.6) / 114 PCR positive, Ag-detection test had very low sensitivity and results were not mentioned as such. / E
[18] 2005 / Taiwan / 17-99 / 168 / IgM and IgG ELISA / 24 (14.3) / Proportion of positive results by each test not specified / C
[25] 2005 / Chile / 60-96 / 84 / P1-based PCR, 16S rRNA gene-based PCR, IgM and IgG indirect IF / 11 (13.1) / 8 positive by IFI (of which 4 by IFI alone), 7 PCR positive (of which 3 only by PCR), / …
[23]2005 / Canada / 18 / 507 / IgM and IgG ELISA / 76 (15) / Proportion of positive results by each test not specified / C
[31]2005 / Asia / 2 / 1374 / P1-based PCR, and IgM and IgG Particle agglutination test / 167 (12.2) / 129 positive by serology alone, 167 positive by serology plus PCR / …
[32]2005 / The Netherlands / 18 / 107 / PCR / 0 / PCR not described / A
[44] 2005 / The Netherlands / 18 / 105 / P1-based PCR, CFT, and Microparticle agglutination test / 10 / 10 positive by PCR, 5 by conventional methods / …
[4] 2006 / UK / 18 / 80 patients
49 controls / P1-based PCR, 16S rRNA-based PCR / 1 (1.3) / 1 PCR positive patient / …
[14] 2006 / China / 2 / 389 / P1-based PCR and particle agglutination test / 42 (10.8) / 18 positive by serology alone, 42 positive by serology and PCR / …
[41] 2006 / Denmark / 18-96 / 235 patients
113 controls / P1-based PCR and CFT / 14 (5.5) / 13 positive patients, 1 positive control
Proportion of positive results by each test not specified / …
[40] 2006 / Korea / 16 / 202 / P1-based PCR and particle agglutination test / 8 (4.0) / 5 by serology alone, 1 by serology and PCR, 2 by PCR alone / …
[7] 2007 / Chile / 17-101 / 176 / IgM and IgG indirect immunofluorescence / 3 (1.7) / Proportion of positive results by each test not specified / C
[35] 2007 / Thailand / >2 / 755 / PCR, IgM and IgG EIA / 27 (3.6) / 13 positive by seroconversion alone, 12 positive by PCR alone, 2 positive by both PCR and serology / A
[37] 2007 / India / 18 / 100 / Culture, IgM ELISA, cold agglutination test on acute phase serum / 31 (31) / 31 positive by culture, 21 positive by IgM ELISA, 34 positive by cold agglutination test / …
[3] 2008 / Australia / 18 / 885 / IgM EIA and total antibody by particle agglutination / 78 (8.8) / Proportion of positive results by each test not specified / C
[21] 2008 / Belgium / 18 / 147 / Mono and MX real-time NASBA, real-time PCR, culture, IgM and IgG EIA / 19 (12.9) / 8 positive by culture, 15 positive by PCR, 19 positive by real-time MX NASBA, 23 by mono real-time NASBA / …
[46]2008 / The Netherlands / 18 / 201 / PCR, CFT / 8 (4.0) / 7 positive by PCR, 8 positive by serology
PCR not specified / A
[24] 2008 / Chile / 18-94 / 357 / 16S r RNA gene PCR, indirect immunofluorescence / 32 (9.0) / 23 positive by PCR, 13 positive by IgM serology, and 27 by IgG serology / …
[27] 2008 / Japan / 16->80 / NS / Culture, IgM and IgG serology / 210 / 210 IgG M. pneumoniae positive, 38 culture positive / …
[9] 2009 / Egypt / 15-50 / 59 patients
20 controls / PCR, IgM and IgG EIA, culture / 25 (42.4) / 25 patients positive by PCR, 9 patients positive by culture, 29 by IgM serology and 20 positive by significant rise in IgG
2 controls positive by IgM / …
a A: no information provided about the PCR and/or serological assay used; B: single IgG titer used as part of the criteria used to define an acute infection; C: serology used as the only serodiagnostic tool; D: serological titers vary from those recommended for diagnosis of acute infections; E : 1 PCR assay used as the only diagnostic tool; F: (single) IgM titer used as the only serodiagnostic tool in some or all patients
Ag: antigen; CFT: complement fixation test; IFI: indirect immunofluorescence; IgA/G/M: Immunoglobulin A/G/M; MX: multiplex; NASBA: nucleic acid sequence-based amplification;
Table 2. Summary of studies of respiratory infections due to Mycoplasma pneumoniae in pediatric patients, published since 2003.
Reference / Location / Subject age (years) / No of subjects tested / Diagnostic method(s) / No (%) of subjects infected with M. pneumoniae / Comments / Methodological problem (s)a[1]2003 / Germany / 1-18 / 50 / P1-based PCR, IgM and IgG serology / 16 (32) / 6 positive by PCR, 14 by serology (mainly IgM) / …
[16] 2003 / Chile / 0-14 / 106 / 16S rRNA gene-based PCR, IgM serology (2 tests) on acutephase serum, culture / 31 (29.2) / 31 positive by IgM, in 28/31 cases serology was confirmed by PCR, 19 positive by culture / …
[12] 2004 / The Netherlands / 0-16 / 168 / P1-based PCR / 4 (2.4) / E
[22] 2004 / Greece / 0.5-14 / 65 / P1-based PCR and IgM serology on acute phase serum / 18 (27.5) / 18 positive by IgM, 9 PCR positive / F
[26]2004 / USA / 0-17 / 154 / IgM and IgG serology / 21 (14) / Proportion of positive results by each test not specified / A
[28] 2004 / Japan / 0-14 / 369 / 16S rRNA gene-based PCR, CFT, culture / 69 (18.7) / 68 positive by PCR, 53 culture positive, 76 serology positive / …
[45] 2004 / Greece / 5-14 / 75 / ATPase-based PCR, IgM and IgG serology / 26 (35) / 11 positive by PCR, 21 positive by serology confirmed by 4-fold rise in IgG titre by CF-test if convalescent seum available / F
[8] 2005 / Finland / 0.3-16 / 101 / CFT and IgM and IgA serology / 27 (27) / 27 patients positive with 2 or more tests, 12 patients positive with only 1 test / …
[20] 2005 / China / 0-5 / 85 patients 185 controls / ATPase-based PCR / 6 (7.1) / All positive results were found in patients / E
[38] 2005 / India / 93 / IgM ELISA on acute phase serum / 22 (24) / All positive by single IgM determination / F
[43]2005 / Germany / 6-16 / 38 patients 42 controls / ATPase-based PCR / 4 (10.5) / All positive results were found in patients / E
[2] 2006 / Japan / 0-13 / 141 / ATPase-based PCR, and CF / 58 (41.1) / 58 PCR positive, 13 single serum positive, 27 paired serum positive / …
[19] 2006 / Finland / 0-16 / 220 / 2 IgM EIAs / 11 (5) / Not clear whether positive in acute, convalescent or both sera / F
[48] 2006 / Japan / 0-6 / 339 / P1-based PCR, passive agglutination, IgM, IgG, and IgA ELISA / 81 (23.9) / 66 PCR positive, 106 PA titers above 1:40, among PCR positive patients, 30/36 had a 4-fold increase in PA titer, 36/81 positive for IgG, 16/81 positive for IgA, and 54/81 positive for IgM / …
[15] 2007 / Korea / 0-16 / 234 / P1-based PCR, microparticle agglutination / 152 (65) / 27 by serology alone, 26 by PCR alone, 99 by both PCR and serology / …
[30] 2007 / Japan / 0-6 / 117 / 16S rRNA PCR, CFT / 17 (14.5) / 14 PCR positive / A
[34] 2007 / Japan / 0-15 / 194 / Culture, CFT, rapid test / 45 (23.2) / 14 culture positive, ImmunoCard positive in 39 paired sera and in 14 acute sera, CFT results not presented
[39] 2007 / Turkey / 5-15 / 284 / PCR, IgM ELISA on acute phase serum / NS / 33/203 PCR positive, 86/284 IgM patients, only in 13 cases positive by both PCR and IgM / F
[5] 2008 / Italy / 0-14 / 886 / P1-based PCR, IgM and IgG serology / 102 (12) / 102/886 PCR positive, 63/102 had positive IgM and/or IgG / …
[33] 2008 / Japan / 0-15 / 73 / 16S rRNA gene based PCR, IgM and IgG serology / 6 (8.2) / 6/6 PCR positive, 5/6 IgG seroconversion/significant rise, 1 additional positive by IgG serology, 2/6 Immunocard assay positive, 12 additional patients positive by Immunocard assay / …
[13] 2008 / Japan / 0-19 / 1700 / RTI-PCRb and serology / 251 (14.8) / Results serology not presented, no info on serological assay used / A
[6] 2009 / China / 0-17 / 176 / Templex Resplex Ic / 26 (14.8) / E
[42] 2009 / China / 0-5 / 475 / MX-PCR / 7 (1.5) / E
a A: no information provided about the PCR and/or serological assay used; B: single IgG titer used as part of the criteria used to define an acute infection; C : EIA used as the only serodiagnostic tool; D: serological titers vary from those recommended for diagnosis of acute infections; E : 1 PCR assay used as the only diagnostic tool; F : (single) IgM titer used as the only serodiagnostic tool in some or all patients
Ag: antigen; CFT: complement fixation test; IFI: indirect immunofluorescence; IgA/G/M: Immunoglobulin A/G/M; MX: multiplex; NASBA: nucleic acid sequence-based amplification;
b RTI-kit, Takara Bio, Kyoto, Japan, c Genaco Biomedical Products, Inc., Huntsville, AL, USA
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