Clinical characteristics of infections caused by Mycoplasma pneumoniae P1 genotypes in children

  • Jasna Rodman Berlot
  • Uroš Krivec
  • Marina Praprotnik
  • Tatjana Mrvič
  • Rok Kogoj
  • Darja Keše
Original Article


Mycoplasma pneumoniae (M. pneumoniae) isolates can be classified into two major genetic groups, P1 type 1 (MP1) and P1 type 2 (MP2), based on the DNA sequence of the P1 adhesion protein gene. The aim of our study was to determine if M. pneumoniae P1 genotype is associated with disease manifestation and severity of acute M. pneumoniae infection. We compared epidemiological and clinical data of children infected with either MP1 or MP2. In addition, we separately analysed data of patients presenting with individual manifestations of M. pneumoniae infection. Data of 356 patients infected with MP1 were compared with those of 126 patients infected with MP2. MP2-infected children presented with higher median baseline C-reactive protein levels and were admitted to the hospital more often. The distribution of P1 genotype varied among groups of patients with different manifestations of M. pneumoniae infection. MP2 was more common than MP1 among patients with neurological and cardiovascular manifestations, whereas MP1 was more prevalent in other manifestations. The results from our large cohort indicate that the two P1 subtypes may have different pathogenic potential and that infections with MP2 strains could be more virulent than those with MP1 strains.


Mycoplasma pneumoniae Genotype Paediatrics Infection 


Compliance with ethical standards

The authors declare that ethical approval was not required. The study was performed only by using remnants of specimens that had initially been collected for diagnostic purposes. All samples from patients included in the study were rendered anonymous. The patients were registered with an encrypted number code. Therefore, individuals could not be matched with their samples and their epidemiological and clinical data. The study was conducted according to the principles expressed in the Declaration of Helsinki, the Oviedo Convention on Human Rights and Biomedicine and the Slovene Code of Medical Deontology. Since no additional samples or data were collected, the study was deemed to be low risk and the need for additional ethical permission from the National Medical Ethics Committee was waived.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Atkinson TP, Waites KB (2014) Mycoplasma pneumoniae infections in childhood. Pediatr Infect Dis J 33(1):92–94. CrossRefPubMedGoogle Scholar
  2. 2.
    Krause DC, Leith DK, Wilson RM, Baseman JB (1982) Identification of Mycoplasma pneumoniae proteins associated with hemadsorption and virulence. Infect Immun 35(3):809–817PubMedPubMedCentralGoogle Scholar
  3. 3.
    Balish MF, Krause DC (2006) Mycoplasmas: a distinct cytoskeleton for wall-less bacteria. J Mol Microbiol Biotechnol 11(3–5):244–255CrossRefPubMedGoogle Scholar
  4. 4.
    Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP (2017) Mycoplasma pneumoniae from the respiratory tract and beyond. Clin Microbiol Rev 30(3):747–809. CrossRefPubMedGoogle Scholar
  5. 5.
    Cousin-Allery A, Charron A, de Barbeyrac B, Fremy G, Skov Jensen J, Renaudin H et al (2000) Molecular typing of Mycoplasma pneumoniae strains by PCR-based methods and pulsed-field gel electrophoresis. Application to French and Danish isolates. Epidemiol Infect 124(1):103–111CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kogoj R, Mrvic T, Praprotnik M, Kese D (2015) Prevalence, genotyping and macrolide resistance of Mycoplasma pneumoniae among isolates of patients with respiratory tract infections, Central Slovenia, 2006 to 2014. Euro Surveill 20(37). doi:
  7. 7.
    Waites KB (2003) New concepts of Mycoplasma pneumoniae infections in children. Pediatr Pulmonol 36(4):267–278CrossRefPubMedGoogle Scholar
  8. 8.
    Narita M (2016) Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae infection on the basis of possible pathogenesis. Front Microbiol 7:23. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sánchez-Vargas FM, Gómez-Duarte OG (2008) Mycoplasma pneumoniae—an emerging extra-pulmonary pathogen. Clin Microbiol Infect 14(2):105–117CrossRefPubMedGoogle Scholar
  10. 10.
    Cizman M, Beovic B, Marolt-Gomiscek M, Seme K (2013) Kako predpisujemo protimikrobna zdravila v bolnišnicah, 2nd edition. LjubljanaGoogle Scholar
  11. 11.
    Kim KW, Sung JJ, Tchah H, Ryoo E, Cho HK, Sun YH et al (2015) Hepatitis associated with Mycoplasma pneumoniae infection in Korean children: a prospective study. Korean J Pediatr 58(6):211–217. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Krause DC, Baseman JB (1983) Inhibition of Mycoplasma pneumoniae hemadsorption and adherence to respiratory epithelium by antibodies to a membrane protein. Infect Immun 39(3):1180–1186PubMedPubMedCentralGoogle Scholar
  13. 13.
    Baseman JB, Cole RM, Krause DC, Leith DK (1982) Molecular basis for cytadsorption of Mycoplasma pneumoniae. J Bacteriol 151(3):1514–1522PubMedPubMedCentralGoogle Scholar
  14. 14.
    Bredt W (1968) Motility and multiplication of Mycoplasma pneumoniae. A phase contrast study. Pathol Microbiol 32(6):321–326Google Scholar
  15. 15.
    Hasselbring BM, Page CA, Sheppard ES, Krause DC (2006) Transposon mutagenesis identifies genes associated with Mycoplasma pneumoniae gliding motility. J Bacteriol 188(17):6335–6345. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Prince OA, Krunkosky TM, Krause DC (2014) In vitro spatial and temporal analysis of Mycoplasma pneumoniae colonization of human airway epithelium. Infect Immun 82(2):579–586. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kornspan JD, Tarshis M, Rottem S (2011) Adhesion and biofilm formation of Mycoplasma pneumoniae on an abiotic surface. Arch Microbiol 193(11):833–836. CrossRefPubMedGoogle Scholar
  18. 18.
    Simmons WL, Daubenspeck JM, Osborne JD, Balish MF, Waites KB, Dybvig K (2013) Type 1 and type 2 strains of Mycoplasma pneumoniae form different biofilms. Microbiology 159(4):737–747. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lluch-Senar M, Cozzuto L, Cano J, Delgado J, Llórens-Rico V, Pereyre S et al (2015) Comparative “-omics” in Mycoplasma pneumoniae clinical isolates reveals key virulence factors. PLoS One 10(9):e0137354CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Techasaensiri C, Tagliabue C, Cagle M, Iranpour P, Katz K, Kannan TR et al (2010) Variation in colonization, ADP-ribosylating and vacuolating cytotoxin, and pulmonary disease severity among Mycoplasma pneumoniae strains. Am J Respir Crit Care Med 182(6):797–804CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Fan L, Li D, Zhang L, Hao C, Sun H, Shao X et al (2017) Pediatric clinical features of Mycoplasma pneumoniae infection are associated with bacterial P1 genotype. Exp Ther Med 14(3):1892–1898CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Zhao F, Lv M, Tao X, Huang H, Zhang B, Zhang Z et al (2012) Antibiotic sensitivity of 40 Mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant isolates from Beijing, China. Antimicrob Agents Chemother 56(2):1108–1109CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Nilsson AC, Björkman P, Welinder-Olsson C, Widell A, Persson K (2010) Clinical severity of Mycoplasma pneumoniae (MP) infection is associated with bacterial load in oropharyngeal secretions but not with MP genotype. BMC Infect Dis 10:39CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Henrickson SE, Manne S, Dolfi DV, Mansfield KD, Parkhouse K, Mistry RD et al (2018) Genomic circuitry underlying immunological response to pediatric acute respiratory infection. Cell Rep 22(2):411–426. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Goulding J, Snelgrove R, Saldana J, Didierlaurent A, Cavanagh M, Gwyer E et al (2007) Respiratory infections: do we ever recover? Proc Am Thorac Soc 4(8):618–625CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Robnik B, Kese D, Rojko T, Horvat-Ledinek A, Praznikar A, Beovic B (2017) Unilateral brachial plexopathy, a rare complication of Mycoplasma pneumoniae infection. J Infect Chemother.
  27. 27.
    Narita M (2010) Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 16(3):162–169. CrossRefPubMedGoogle Scholar
  28. 28.
    Chergui K, Fourme T, Baron AV, Loubieres Y, Voyer C, Jardin F (1998) Mycoplasma pneumoniae and second-degree heart block. Clin Infect Dis 27(6):1534–1535CrossRefPubMedGoogle Scholar
  29. 29.
    Dumke R, Schurwanz N, Jacobs E (2008) Characterisation of subtype and variant-specific antigen regions of the P1 adhesin of Mycoplasma pneumoniae. Int J Med Microbiol 298:483–491. CrossRefPubMedGoogle Scholar
  30. 30.
    Qu J, Yu X, Liu Y, Yin Y, Gu L, Cao B et al (2013) Specific multilocus variable-number tandem-repeat analysis genotypes of Mycoplasma pneumoniae are associated with diseases severity and macrolide susceptibility. PLoS One 8(12):e82174. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Unit for Pulmonary DiseasesUniversity Children’s Hospital, University Medical CentreLjubljanaSlovenia
  2. 2.Department of Infectious DiseasesUniversity Medical CentreLjubljanaSlovenia
  3. 3.Institute of Microbiology and Immunology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia

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