Respiratory tract infections during the 2011 Mycoplasma pneumoniae epidemic

Article

Abstract

In 2011, Norway experienced a surge in community acquired Mycoplasma pneumoniae infections. Norway also has one of the highest rates of reported Bordetella pertussis infections, despite high vaccine coverage. We aimed to determine the prevalence of upper respiratory tract pathogens in patients attending primary care physicians for respiratory illness during the 2011 M. pneumoniae epidemic period. A retrospective analysis of data from 26,039 patients that have had nasopharyngeal swabs analysed by nucleic acid amplification testing (NAAT) for M. pneumoniae, C. pneumoniae and B. pertussis was performed. Subsets of samples were tested for additional pathogenic bacteria, including B. parapertussis and B. holmesii, as well as influenza virus. M. pneumoniae, C. pneumoniae and B. pertussis were detected in 2,484 (9.5 %), 261 (1.0 %) and 821 (3.2 %) patients, respectively. Co-infection of M. pneumoniae and B. pertussis was found in 50 (0.19 %) patients, C. pneumoniae and B. pertussis in 4 (0.02 %). Influenza virus was found in 899 (24.5 %) of 3,661 nasopharyngeal swabs. Co-infection of influenza virus and bacterial pathogens was common, although influenza virus co-infection with B. pertussis occurred significantly more often than with C. pneumoniae and M. pneumoniae (20.4 % versus 2.9 % and 9.1 %, respectively; p<0.005). Testing for Bordetella species genes IS1001, IS1002 and recA showed that B. holmesii was most likely misdiagnosed as B. pertussis in 5.8 % of cases. The most prevalent respiratory tract pathogen in the general population in 2011 was M. pneumoniae. B. pertussis was also found frequently as was B. pertussis and influenza virus co-infections.

References

  1. 1.
    Mereckiene J, Cotter S, Weber JT, Nicoll A, D’Ancona F, Lopalco PL et al (2012) Influenza A(H1N1)pdm09 vaccination policies and coverage in Europe. Eur Surveill 17(4):20064Google Scholar
  2. 2.
    Rasmussen JN, Voldstedlund M, Andersen RL, Ellermann-Eriksen S, Jensen TG, Johansen HK et al (2010) Increased incidence of Mycoplasma pneumoniae infections detected by laboratory-based surveillance in Denmark in 2010. Eur Surveill 15(45):19708Google Scholar
  3. 3.
    Chalker V, Stocki T, Mentasti M, Fleming D, Harrison T (2011) Increased incidence of Mycoplasma pneumoniae infection in England and Wales in 2010: multiocus variable number tandem repeat analysis typing and macrolide susceptibility. Eur Surveill 16(19):19865Google Scholar
  4. 4.
    Blystad H, Ånestad G, Vestrheim DF, Madsen S, Rønning K (2012) Increased incidence of Mycoplasma pneumoniae infection in Norway 2011. Eur Surveill 17(5):20074Google Scholar
  5. 5.
    Celentano LP, Massari M, Paramatti D, Salmaso S, Tozzi AE (2005) Resurgence of pertussis in Europe. Pediatr Infect Dis J 24:761–765PubMedCrossRefGoogle Scholar
  6. 6.
    Barret AS, Ryan A, Breslin A, Cullen L, Murray A, Grogan J et al (2010) Pertussis outbreak in northwest Ireland, January–June 2010. Eur Surveill 2:15Google Scholar
  7. 7.
    Jenum P, Skarpaas T, Natås O. Eksterne Kvalitetsvurderinger I Bakteriologi, Mykologi Og parasittologi. Rapport fra strategimøte. Folkehelseinstituttet 2003. doi: http://www.fhi.no/dav/C168BB63B7.pdf. Accessed 27 Dec 2012
  8. 8.
    Moi H, Reinton N, Moghaddam A (2009) Mycoplasma genitalium is associated with symptomatic and asymptomatic non-gonococcal urethritis in men. Sex Transm Infect 85:15–18. doi:10.1136/sti.2008.032730 PubMedCrossRefGoogle Scholar
  9. 9.
    Roorda L, Buitenwerf J, Ossewaarde JM, Van der Zee A (2011) A real-time PCR assay with improved specificity for detection and discrimination of all clinically relevant Bordetella species by the presence and distribution of three Insertion Sequence elements. BMC Res Notes 4:11PubMedCrossRefGoogle Scholar
  10. 10.
    Haug C (2012) What did they know, and when did they know it? Tidsskr Nor Lægeforen 132:505PubMedCrossRefGoogle Scholar
  11. 11.
    Dudman SG, Trøseid M, Jonassen TØ, Steinbakk M (2006) [Whooping cough--an increasing problem in Norway]. Tidsskr Nor Lægeforen 126:305–308PubMedGoogle Scholar
  12. 12.
    Folkehelseinstituttet (2012) Kikhoste (pertussis). Folkehelsinstituttet. doi: http://www.fhi.no/eway/default.aspx?pid=233&trg=MainLeft_6039&MainArea_5661=6039:0:15,5078:1:0:0:::0:0&MainLeft_6039=6041:82766::1:6043:60:::0:0. Accessed 31 Dec 2012
  13. 13.
    Lavine JS, Bjørnstad ON, De Blasio BF, Storsaeter J (2012) Short-lived immunity against pertussis, age-specific routes of transmission, and the utility of a teenage booster vaccine. Vaccine 30:544–551. doi:10.1016/j.vaccine.2011.11.065 PubMedCrossRefGoogle Scholar
  14. 14.
    Bébéar C, Pereyre S, Peuchant O (2011) Mycoplasma pneumoniae: susceptibility and resistance to antibiotics. Future Microbiol 6:423–431PubMedCrossRefGoogle Scholar
  15. 15.
    Pereira MS, Candeias JA (1971) The association of viruses with clinical pertussis. J Hyg 69:299–403PubMedGoogle Scholar
  16. 16.
    Lieberman D, Shvartzman P, Ben-Yaakov M, Lazarovich Z, Hoffman S, Mosckovitz R et al (1998) Etiology of respiratory tract infection in adults in a general practice setting. Eur J Clin Microbiol Infect Dis 17:685–689PubMedCrossRefGoogle Scholar
  17. 17.
    Versteegh FGA, Mooi-Kokenberg EANM, Schellekens JFP, Roord JJ (2006) Bordetella pertussis and mixed infections. Minerva Pediatr 58:131–137PubMedGoogle Scholar
  18. 18.
    Jackson LA, Cherry JD, Wang SP, Grayston JT (2000) Frequency of serological evidence of Bordetella infections and mixed infections with other respiratory pathogens in university students with cough illnesses. Clin Infect Dis 31:3–6PubMedCrossRefGoogle Scholar
  19. 19.
    Ferson MJ, Morgan K, Robertson PW, Hampson AW, Carter I, Rawlinson WD (2004) Concurrent summer influenza and pertussis outbreaks in a nursing home in Sydney, Australia. Infect Control Hosp Epidemiol 25:962–966. doi:10.1086/502327 PubMedCrossRefGoogle Scholar
  20. 20.
    Ayala VI, Teijaro JR, Farber DL, Dorsey SG, Carbonetti NH (2011) Bordetella pertussis infection exacerbates influenza virus infection through pertussis toxin-mediated suppression of innate immunity. PLoS One 6:e19016PubMedCrossRefGoogle Scholar
  21. 21.
    Haaheim H, Vorland L, Gutteberg TJ (2001) Laboratory diagnosis of respiratory diseases: PCR versus serology. Nucleosides Nucleotides Nucleic Acids 20:1255–1258PubMedCrossRefGoogle Scholar
  22. 22.
    Njamkepo E, Bonacorsi S, Debruyne M, Gibaud SA, Guillot S, Guiso N (2011) Significant finding of Bordetella holmesii DNA in nasopharyngeal samples from French patients with suspected pertussis. J Clin Microbiol 49:4347–4348PubMedCrossRefGoogle Scholar
  23. 23.
    Templeton KE, Scheltinga SA, Van der Zee A, Diederen BMW, Van Kruijssen AM, Goossens H et al (2003) Evaluation of real-time PCR for detection of and discrimination between Bordetella pertussis, Bordetella parapertussis, and Bordetella holmesii for clinical diagnosis. J Clin Microbiol 41:4121–4126PubMedCrossRefGoogle Scholar
  24. 24.
    Loens K, Beck T, Ursi D, Pattyn S, Goossens H, Ieven M (2006) Two quality control exercises involving nucleic acid amplification methods for detection of Mycoplasma pneumoniae and Chlamydophila pneumoniae and carried out 2 years apart (in 2002 and 2004). J Clin Microbiol 44:899–908PubMedCrossRefGoogle Scholar
  25. 25.
    Kösters K, Riffelmann M, von König Wirsing CH (2001) Evaluation of a real-time PCR assay for detection of Bordetella pertussis and B. parapertussis in clinical samples. J Med Microbiol 50:436–440PubMedGoogle Scholar
  26. 26.
    WHO (2009) CDC protocol of real time RTPCR for swine influenza A (H1N1). The WHO collaborating centre for CDC at Atlanta. World Health Organization 2009. doi: http://www.who.int/csr/resources/publications/swineflu/CDCrealtimeRTPCRprotocol_20090428.pdf. Accessed 31 Dec 2012
  27. 27.
    Waddington C, Andrews N, Hoschler K, Walker W, Oeser C, Reiner A et al (2010) H1N1 influenza and pandemic flu. A special themed issue of the Health Technology Assessment journal series. Health Technol Assess 14:1–130PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Fürst Medisinsk LaboratoriumOsloNorway

Personalised recommendations