Molecular diagnosis of atypical bacterial pneumonias from the community. Paraguay (2014-2017)
DOI:
https://doi.org/10.32480/rscp.2018-23-1.139-146Keywords:
Atypical pneumonias, Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, PCRAbstract
Objectives: To determine the frequency of atypical bacterial pneumonias caused by Legionella pneumophila, Mycoplasma pneumoniae and Chlamydophila pneumoniae, in children and adults of Paraguay during the period 2014-2017 by molecular techniques.
Materials and methods: We included 148 pleural fluid samples from children and adults diagnosed with community-acquired pneumonia (CAP) during the period 2014 to February 2017. Samples were sent to the Central Public Health Laboratory by the Sentinel Centers and Collaborating Centers of the Meningitis and Pneumonia Surveillance Network.
Results: The general frequency of atypical pneumonias was 1.4% (2/148). Legionella pneumophila was detected in 0.7% (1/148) of the patients with suspected pneumonia and one Mycoplasma pneumoniae case in 0.7% (1/148).
Conclusion: Atypical agents present nonspecific and variable manifestations from one case to another, making them difficult to distinguish from other etiologies. The new approaches to microbiological diagnosis are promising, it is expected that molecular diagnostic tests for these pathogens are important tools in the clinical laboratory.
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References
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26. Garcia-Vidal C, Labori M, Viasus D, Simonetti A, Garcia-Somoza D, Dorca J, et al. Rainfall Is a Risk Factor for Sporadic Cases of Legionella pneumophila Pneumonia. PLoS ONE. 2013;8(4):e61036. Disponible en: https://doi.org/10.1371/journal.pone.0061036
27. Chen ZR, Yan YD, Wang YQ, ZhuH., ShaoX.., Xu J. Epidemiology of community-acquired Mycoplasma pneumoniae respiratory tract infections among hospitalized Chinese children, including relationships with meteorological factors. Hippokratia. 2013;17: 20–26.
28. Cosentini R, Tarsia P, Blasi F, Roma E, Allegra L. Community-acquired pneumonia: role of atypical organisms. Monaldi Arch Chest Dis. 2001;56(6):527-34.
29. Samransamruajkit R, Jitchaiwat S, Wachirapaes W, Deerojanawong J, Sritippayawan S, Prapphal N: Prevalence of Mycoplasma and Chlamydia pneumonia in severe community-acquired pneumonia among hospitalized children in Thailand. Jpn J Infect Dis. 2008;61:36-39.
30. Gadsby NJ, Helgason KO, Dickson EM, Mills JM, Lindsay DS, Edwards GF, Hanson MF, Templeton KE, ESCMID Study Group for Molecular Diagnostics, ESCMID Study Group for Legionella Infections, Basel, Molecular diagnosis of Legionella infections—clinical utility of front-line screening as part of a pneumonia diagnostic algorithm. J Infect. 2016;72:161–170.
31. Torres A, Lee N, Cilloniz C, Vila J, Van der Eerden M. 2016. Laboratory diagnosis of pneumonia in the molecular age. Eur Respir. 2016;48:1764–1778. doi: 10.1183/13993003.01144-2016.
2. Berebichez-Fridman R, Blachman-Braun R, Azrad-Daniel S, Vázquez-Campuzano R, Vázquez-López R. Atypical pneumonias caused by Legionella pneumophila, Chlamydophila pneumoniae and Mycoplasma pneumonia. Rev Med Hosp Gen Méx. 2015;78(4):188-195.
3. Parra W. Neumonías atípicas. Neumol Pediatr. 2013;(8):74-78.
4. Sepúlveda A, Castet A, Bertrand P. Atypical pneumonia: mycoplasma and chlamydia pneumoniae. Making an accurate diagnosis and deciding when to treat. Neumol Pediatr. 2015;10(3):118-123.
5. Principi N, Esposito S, Blasi F Allegra L. Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in Children with Community-Acquired Lower Respiratory Tract Infections. Clinical Infectious Diseases. 2001;32(9):1281–1289. doi: https://doi.org/10.1086/319981
6. Cunha B. The atypical pneumonias: clinical diagnosis and importance. Clinical Microbiology and Infection. 2006;12:12–24. doi:10.1111/j.1469-0691.2006.01393.x
7. Remington LT, Sligl W. Community-acquired pneumonia. Curr Opin Pulm Med. 2014;20(3) 215–24.
8. Inostroza E, Pinto R. Pneumonia due to atypical agents in children. Revista Médica Clinica Las Condes. 2017;(28):90-96.
9. Marchello C, Dale AP, Thai TN, Han DS, Ebell MH. Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta- Analysis. Annals of Family Medicine. 2016;14(6):552-566. doi:10.1370/afm.1993
10. Phin N, Parry-Ford F, Harrison T, et al. Epidemiology and clinical management of Legionnaires’ disease. Lancet Infect Dis. 2014;14(10):1011–1021.
11. Omori R, Nakata Y, Tessmer HL, Suzuki S, Shibayama K. The determinant of periodicity in Mycoplasma pneumoniae incidence: an insight from mathematical modelling. Sci Rep. 2015;5:14473.
12. Klement EDF. Talkington O, Wasserzug R, Kayouf N, Davidovitch R, Dumke Y, Bar-Zeev R, Merav J, Boxman WL, Thacker D, Wolf T, Lazarovich Y, Shemer-Avni D, Glikman E, Jacobs I, Grotto C, Block, Nir-Paz R. Identification of risk factors for infection in an outbreak of Mycoplasma pneumoniae respiratory tract disease. Clin. Infect. Dis. 2006;43:1239-1245.
13. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin. Microbiol. Rev. 2004;17:697-728.
14. Zhan P, Suo LJ, Qian Q, et al. Chlamydia pneumoniae infection and lung cancer risk: a meta-analysis. Eur J Cancer. 2011;47(5):742–747.
15. Ngeow YF, Suwanjutha S, Chantarojanasriri T, Wang F, Saniel M, Alejandria M, Hsueh PR, Ping-Ing PR, Park SC, Sohn J, Aziah AM, Liu Y, Seto WH, Ngan CC, Hadiarto M, Hood A, Cheong YM. An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. Int. J. Infect. Dis. 2005;9:144-153.
16. Thurman KA, Warner AK, Cowart KC, Benitez AJ, Winchell JM. Detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella spp. in clinical specimens using a single-tube multiplex real-time PCR assay. Diagn Microbiol Infect Dis 2011;70:1–9.
17. Allegra L, Blasi F. Problems and perspectives in the treatment of respiratory infections caused by atypical pathogens. Pulm Pharmacol Ther. 2001;14:21–27.
18. Thibodeau KP, Viera AJ. Atypical pathogens and challenges in community-acquired pneumonia. Am Fam Physician. 2004;69(7):1699-706.
19. Bartlett JG. Is activity against "atypical" pathogens necessary in the treatment protocols for community-acquired pneumonia? Issues with combination therapy. Clin Infect Dis. 2008;47(3):232-6. doi: 10.1086/591409.
20. Templeton KE, Scheltinga SA, van den Eeden WC, Graffelman AW, van den Broek PJ, Claas EC. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis 2005;41:345–351.
21. Räty R, Rönkkö E, Kleemola M. Sample type is crucial to the diagnosis of Mycoplasma pneumoniae pneumonia by PCR. J Med Microbiol. 2005;54:287–291.
22. Chang H, Chan L, Shao P, Lee P, Chen J, Lee C. Lu C. Huang Li. Comparison of real-time polymerase chain reaction and serological test for the confirmation of Mycoplasma penumoniae infection in children with clinical diagnosis of atypical pneumonia. J Microbiol, Immunol Infect. 2014;47:137-144.
23. Strålin K, Korsgaard J, Olcén P. Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage. European Respiratory Journal. 2006;28:568-575. DOI: 10.1183/09031936.06.00006106
24. Plnar A, Bozdemir N, Kocagöz T, Alaçam R. Rapid detection of bacterial atypical pneumonia agents by multiplex PCR. Cent Eur J Publ Health2004;12(1):3-5.
25. Miranda J. Atypical microorganisms in children with community - Acquired pneumonia: EsSalud Grau Emergency Hospital - Period 2008. Acta méd. Peruana. 2012;29(1):17-22.
26. Garcia-Vidal C, Labori M, Viasus D, Simonetti A, Garcia-Somoza D, Dorca J, et al. Rainfall Is a Risk Factor for Sporadic Cases of Legionella pneumophila Pneumonia. PLoS ONE. 2013;8(4):e61036. Disponible en: https://doi.org/10.1371/journal.pone.0061036
27. Chen ZR, Yan YD, Wang YQ, ZhuH., ShaoX.., Xu J. Epidemiology of community-acquired Mycoplasma pneumoniae respiratory tract infections among hospitalized Chinese children, including relationships with meteorological factors. Hippokratia. 2013;17: 20–26.
28. Cosentini R, Tarsia P, Blasi F, Roma E, Allegra L. Community-acquired pneumonia: role of atypical organisms. Monaldi Arch Chest Dis. 2001;56(6):527-34.
29. Samransamruajkit R, Jitchaiwat S, Wachirapaes W, Deerojanawong J, Sritippayawan S, Prapphal N: Prevalence of Mycoplasma and Chlamydia pneumonia in severe community-acquired pneumonia among hospitalized children in Thailand. Jpn J Infect Dis. 2008;61:36-39.
30. Gadsby NJ, Helgason KO, Dickson EM, Mills JM, Lindsay DS, Edwards GF, Hanson MF, Templeton KE, ESCMID Study Group for Molecular Diagnostics, ESCMID Study Group for Legionella Infections, Basel, Molecular diagnosis of Legionella infections—clinical utility of front-line screening as part of a pneumonia diagnostic algorithm. J Infect. 2016;72:161–170.
31. Torres A, Lee N, Cilloniz C, Vila J, Van der Eerden M. 2016. Laboratory diagnosis of pneumonia in the molecular age. Eur Respir. 2016;48:1764–1778. doi: 10.1183/13993003.01144-2016.
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2018-10-13
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1.
Molecular diagnosis of atypical bacterial pneumonias from the community. Paraguay (2014-2017). Rev. Soc. cient. Py. [Internet]. 2018 Oct. 13 [cited 2025 Oct. 7];23(1):139-46. Available from: http://sociedadcientifica.org.py/ojs/index.php/rscpy/article/view/41
