Volume 30, Number 5—May 2024
Research Letter
Novel Variant and Known Mutation in 23S rRNA Gene of Mycoplasma pneumoniae, Northern Vietnam, 2023
Dinh-Dung Nguyen1, Nhan Thi Ho1, Lynn G. Dover, Anh Hang Mai Vo, Ha Thi Thanh Ly, Phuong Mai Doan, Hang Thi Nguyen, Nguyen Thi Thao Luu, An Nhat Pham, and Huyen Thi Thanh Tran
Table
Summary of patient characteristics in study of novel variant and known mutation in 23S rRNA gene of Mycoplasma pneumoniae, northern Vietnam, 2023*
| Characteristic | No mutation, n = 7 | 23S rRNA gene mutation, n = 6 | Total, n = 13 |
|---|---|---|---|
| Mutation type | |||
| A2063G | 0 | 4 (66.7) | 4 (30.8) |
| C2353T |
0 |
2 (33.3) |
2 (15.4) |
| PCR panel of 7 respiratory bacteria | 7 (100.0) | 6 (100.0) | 13 (100.0) |
| Positive with Mycoplasma pneumonia | 7 (100.0) | 6 (100.0) | 13 (100.0) |
| Positive with Hemophilus influenzae | 2 (28.6) | 2 (33.3) | 4 (30.8) |
| Positive with Streptococcus pneumoniae | 4 (57.1) | 3 (50.0) | 7 (53.8) |
| Positive with other bacteria |
0 |
0 |
0 |
| Nasopharyngeal culture | |||
| Negative | 3 (42.9) | 2 (33.3) | 5 (38.5) |
| Positive | 2 (28.6) | 0 | 2 (15.4) |
| Not done |
2 (28.6) |
4 (66.7) |
6 (46.2) |
| Culture result | |||
| H. influenzae | 1 (50.0) | 0 | 1 (50.0) |
| S. pyogenes |
1 (50.0) |
0 |
1 (50.0) |
| Co-detection of other bacteria by PCR panel | 4 (57.1) | 4 (66.7) | 8 (61.5) |
| Co-detection of other bacteria by PCR panel or culture |
5 (71.4) |
4 (66.7) |
9 (69.2) |
| Mycoplasma IgM test done | 2 (28.6) | 2 (33.3) | 4 (30.8) |
| Positive result |
1 (50.0) |
2 (100.0) |
3 (75.0) |
| Influenza antigen rapid test done | 1 (14.3) | 2 (33.3) | 3 (23.1) |
| Positive result |
0 |
0 |
0 |
| Patient sex | |||
| M | 4 (57.1) | 2 (33.3) | 6 (46.2) |
| F |
3 (42.9) |
4 (66.7) |
7 (53.8) |
| Patient age, y (max median, min median) |
4.000 (1, 7) |
5 (2, 13) |
4 (1, 13) |
| Hospitalized |
5 (71.4) |
3 (50.0) |
8 (61.5) |
| Day of illness at hospital visit and nasopharyngeal sample aspiration, median (min, max) |
5 (4, 7) |
4 (3, 5) |
5 (3, 7) |
| Days with fever at hospital visit (min median, max median) |
5 (2, 5) |
4 (3, 5) |
4 (2, 5) |
| Cough | 7 (100.0) | 6 (100.0) | 13 (100.0) |
| Shortness of breath | 0 | 1 (16.7) | 1 (7.7) |
| Wheezing | 0 | 1 (16.7) | 1 (7.7) |
| Chest pain | 1 (14.3) | 0 | 1 (7.7) |
| Pulmonary rale | 4 (57.1) | 4 (66.7) | 8 (61.5) |
| Lung lesion on chest radiograph |
7 (100.0) |
6 (100.0) |
13 (100.0) |
| Oxygen supplement | 0 | 1 (16.7) | 1 (7.7) |
| Treatment before hospital visit |
2 (28.6) |
4 (66.7) |
6 (46.2) |
| Antibiotic treatment before hospital visit | |||
| Amoxicillin and clavulanic acid | 1 (14.3) | 1 (16.7) | 2 (15.4) |
| Azithromycin | 1 (14.3) | 0 | 1 (7.7) |
| Clarithromycin |
0 |
1 (16.7) |
1 (7.7) |
| Antibiotic treatment duration before hospital visit, d (min median, max median) |
3.5 (3,4) |
4 (3,6) |
4 (3,6) |
| Macrolide initiated at the beginning of hospital treatment | 6 (85.7) | 6 (100.0) | 12 (92.3) |
| Azithromycin | 4 (57.1) | 5 (83.3) | 9 (69.2) |
| Clarithromycin |
2 (28.6) |
1 (16.7) |
3 (23.1) |
| Other antibiotic in combination at the beginning of hospital treatment | |||
| Amoxicillin/clavulanic acid | 4 (57.1) | 4 (66.7) | 8 (61.5) |
| Cefdinir | 0 | 1 (16.7) | 1 (7.7) |
| Ceftriaxone |
2 (28.6) |
1 (16.7) |
3 (23.1) |
| Switch to clarithromycin | 0 | 2 (66.7) | 2 (33.3) |
| After 5 d | 0 | 1 (50.0) | 1 (50.0) |
| After 6 d |
0 |
1 (50.0) |
1 (50.0) |
| Other initial antibiotic | |||
| Amoxicillin/clavulanic acid |
1 (14.3) |
0 |
1 (7.7) |
| Macrolide used after other initial antibiotic | 1 (14.3) | 0 | 1 (7.7) |
| Azithromycin (1 d after other initial antibiotic) |
1 (14.3) |
0 |
1 (7.7) |
| Clinical response to initial antibiotic treatment |
5 (71.4) |
3 (50) |
8 (61.5) |
| Clinical evaluation after how many days of initial macrolide treatment median (min, max) |
2.5 (2, 3) |
3 (3, 3) |
3 (2, 3) |
| Clinical nonresponse to initial antibiotic treatment | |||
| Persistent fever | 2 (28.6) | 1 (16.7) | 3 (23.1) |
| Persistent or worse chest radiograph | 0 | 2 (28.6) | 2 (15.4) |
| Persistent respiratory distress | 0 | 1 (16.7) | 1 (7.7) |
| New respiratory distress |
2 (28.6) |
0 |
2 (15.4) |
| Alternative antibiotic | |||
| Clarithromycin | 0 | 2 (33.3) | 2 (15.4) |
| Levofloxacin |
2 (28.6) |
1 (16.7) |
3 (23.1) |
| Response to alternative antibiotics |
2 (28.6) |
3 (50.0) |
5 (38.5) |
| Treatment result | |||
| Discharged with no complication | 5 (71.4) | 3 (50.0) | 8 (61.5) |
| Recovered with outpatient treatment |
2 (28.6) |
3 (50.0) |
5 (38.5) |
| *Data are no. (%) unless otherwise indicated. |
1These authors contributed equally to this article.
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