Program Schedule

Epidemiology and Molecular Characteristics of Mycoplasma pneumoniae (Mp) during an Outbreak of Mp-Associated Stevens-Johnson Syndrome, Colorado, 2013

Session: Poster Abstract Session: Clinical Respiratory Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background: In fall 2013, a novel outbreak of 5 cases of Mycoplasma pneumoniae (Mp)-associated Stevens-Johnson syndrome (SJS) among pediatric patients was identified at Hospital A, Colorado. Mp is a leading cause of community acquired pneumonia in children and young adults, but subsequent development of SJS, a severe, immune-mediated mucocutaneous disorder, is rare. We investigated the epidemiology of Mp in the community and the molecular characteristics of Mp strains in SJS and non-SJS patients to understand why this outbreak occurred.

Methods:   We used ICD-9 codes to identify pneumonia cases (etiology unspecified: 482.9, 486; Mp-specific 483.0) among patients aged 5–21 years at Hospital A from 2009–2013. We collected available Mp-positive specimens from 5 Colorado hospitals and 4 referral laboratories. Quantitative PCR was used to confirm Mp. Subtyping by multilocus variable-number tandem-repeat analysis (MLVA) for differences at 4 genomic loci and macrolide resistance testing were performed on confirmed Mp-positive specimens.

Results: Pneumonia cases peaked in October, 2013 coinciding with the period of the SJS outbreak (September–November, 2013; Figure). Mp was confirmed in specimens from 4 SJS patients and 42 non-SJS patients (Table). MLVA subtyping showed three different strains among SJS patients, all of which also occurred among non-SJS patients. Three SJS patients (75%) had 3 of 4 matching loci in their MLVA pattern (3-X-6-2) compared with 11 (26%) non-SJS patients, although this trend did not reach statistical significance. Macrolide resistance was identified in 7% of all strains.

Conclusion: A heavy community burden of Mp disease likely contributed to the increase in Mp-associated SJS cases seen at Hospital A. The trend toward MLVA pattern 3-X-6-2 raises the possibility that strain features may influence the development of SJS, although the small sample sizes limited interpretation. Clinicians should be aware of the relationship between Mp and SJS.

 Table: Results of laboratory testing


SJS patients, n = 4

n (%)

Non-SJS patients, n = 42

n (%)

Collection dates, 2013



Macrolide testing




4 (100)

37 (88)



3 (7)

MLVA type





1 (25)

8 (19)


2 (50)

3 (7)


1 (25)

26 (62)



Louise Francois Watkins, MD, MPH1, Daniel Olson, MD2, Mauren Diaz, PhD, MPH1, Alvaro Benitez, BS1, Jonas M. Winchell, PhD1, Christine C. Robinson, PhD3, Alicia Demirjian, MD, MMSc1, Xia Lin, PhD, MSPH1, Teresa Foo, MD4, Ursula Lauper, MA, MPH5, Melanie Mason, MS6, Samuel R. Dominguez, MD, PhD7, Mary Glode, MD, FIDSA8, Preeta Kutty, MD1 and Lisa Miller, MD, MSPH9, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Pediatric Infectious Diseases, University of Colorado - Denver, Aurora, CO, (3)Children's Hospital Colorado, Denver, CO, (4)University of Colorado General Preventative Medicine and Public Health Residency, Aurora, CO, (5)New York State Department of Health, Albany, NY, (6)University of Colorado Denver, Denver, CO, (7)Department of Infectious Disease, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, (8)Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (9)Colorado Department of Public Health and Environment, Denver, CO


L. Francois Watkins, None

D. Olson, None

M. Diaz, None

A. Benitez, None

J. M. Winchell, None

C. C. Robinson, Biofire Diagnostics Inc.: Scientific Advisor, Consulting fee

A. Demirjian, None

X. Lin, None

T. Foo, None

U. Lauper, None

M. Mason, None

S. R. Dominguez, None

M. Glode, None

P. Kutty, None

L. Miller, None

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