MYCOPLASMA PNEUMONIAE

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Mycoplasma pneumoniae

SYNONYM OR CROSS REFERENCE: Eaton agent, walking pneumonia, primary atypical pneumonia, pleural atypical pneumonia ^{(1, 2)}.

CHARACTERISTICS: M. pneumoniae is a respiratory tract Gram-negative spindle shaped pleomorphic bacterium, which belongs to the Mycoplasmataceae family, in the Mollicutes class ^{(1, 3)}. It measures 1-2 μm long by 0.1-0.2 μm wide ⁽⁴⁾. M. pneumoniae is motile, using gliding motility instead of pili or flagella ^{(5, 6)}. This bacterium lacks the cell wall and its three-layered membrane, leading M. pneumoniae to have a parasitic, intracellular, and saprophytic existence ⁽⁷⁾. M. pneumoniae colonies are 100 μm in diameter and a stereomicroscope is necessary to be able to observe them. M. pneumoniae is considered an atypical pathogen which metabolizes glucose.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: M. pneumoniae is the cause of many upper respiratory tract infections (50% of cases), including primary atypical pneumonia and tracheobrontitis ⁽²⁾. Those infections may be followed or preceded by complication in 25% of patients. The majority of infected patients are asymptomatic. The disease gradually develops, with a disease onset of days to almost one month, and clinical manifestations include sore throat, hoarseness, fever, cough (may be purulent), headaches, coryza, earache, myalgias, chills, and general malaise ⁽²⁾. There may also be dyspnea and, in some cases, the cough may take on a pertussis-like character. Some children may develop inflammation of the throat, cervical adenopathy, conjunctivitis, and myringitis. Progression to pneumonia is rare for children under five years of age, but common for those between 5 and 15 years old. Adults usually develop mild disease or are asymptomatic; however, infection can be severe in the elderly or immunocompromised. Individuals with co-morbid conditions, such as functional asplenia, sickle cells disease, and other immunosuppressive states are at greater risk to develop more fulminant pneumonia and joint infection ⁽²⁾. Complications may occur before, during, or after respiratory symptoms, and may also occur without any respiratory syndrome ⁽²⁾. The most common complications involve the central nervous system, and may include encephalitis (the most common), coma, optic neuritis, diplopia, acute disseminated encephalomyelitis, mental confusion, cerebellar syndrome and polyradiculitis, cranial nerve palsy, aseptic meningitis and meningoencephalitis, and acute psychosis. Complications affecting the motor system include brachial plexus neuropathy, ataxia, chorioathetosis, and ascending paralysis (Guillain-Barré syndrome). Erythematous macropapular and vesicular rashes (25%), nonspecific myalgia, arthralgias and polyarthropathies (14%), cardiac, gastrointestinal, renal complications, and ears symptoms may also occur.

EPIDEMIOLOGY: M. pneumoniae occurs worldwide, but there are more cases in temperate climates ^{(2, 8)}. There is a slight gender difference in certain age groups. Elderly individuals and infants are less susceptible to pneumonia. Outbreaks tend to occur in late summer and early fall, and there are cyclic epidemics every 3-5 years in civilian and military populations ^{(1, 8)}.

HOST RANGE: Humans are the only known host for M. pneumoniae ⁽²⁾.

INFECTIOUS DOSE: Less than 100 CFU ⁽⁸⁾.

MODE OF TRANSMISSION: M. pneumoniae is principally transmitted by large droplet from person-to-person and may be transmitted by fomites to those in close contact with an infected person. As a result, secondary cases among close contacts are frequent, but since the shedding period is long, contamination may take weeks ⁽²⁾.

INCUBATION PERIOD: 4 to over 23 days ⁽²⁾.

COMMUNICABILITY: Transmission rates are high and M. pneumoniae will be shed in upper respiratory infections for 2 to 8 days before onset of symptoms, and as long as 14 weeks after infection ^{(1, 8)}.

SECTION III - DISSEMINATION

RESERVOIR: Humans.

ZOONOSIS: None.

VECTORS: None.

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: M. pneumoniae is susceptible to most common antibiotics except nalidixic acid, cephalosporins, penicillins, and rifampicin ⁽⁵⁾.

SUSCEPTIBILITY TO DISINFECTANTS: Phenolic disinfectants, 1% sodium hypochlorite, 70% ethanol, formaldehyde, glutaraldehyde, iodophore, and peracedic acid are effective against M. pneumoniae ⁽⁹⁾.

PHYSICAL INACTIVATION: M. pneumoniae is inactivated by UV, microwave, gamma radiation, moist heat (121°C for at least 20 min) and dry heat (165-170°C for 2 h) ^(10-13).

SURVIVAL OUTSIDE HOST: If protected from evaporation, M. pneumoniae can survive for one hour in liquid specimen and can survive for at least 4 hours in air ^{(3, 14)}. Airborne survival time is generally higher when relative humidity (RH) is lower. 50% of the sample survives for 4h at 10% RH, 35% at 25% RH, 20% at 90 % RH and less than 10% at 60 and 80% RH.

SECTION V - FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Diagnosis typically done through the complement fixation test, and culture with immunofluorescent antibody (IFA) test and PCR can also confirm negative results ⁽¹⁵⁾. Serologic tests can also be used, however, results varies according to the presence of HIV.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Administer appropriate drug therapy ⁽⁵⁾.

IMMUNIZATION: Different vaccine strains have been used, but none have been successful at protecting against infection ⁽¹⁶⁾.

PROPHYLAXIS: None.

SECTION VI - LABORATORY HAZARD

LABORATORY-ACQUIRED INFECTIONS: 97 hospital personnel have been infected and 2 lab workers have developed pneumonia as a result of infection during an outbreak in 1989 ⁽¹⁷⁾.

SOURCES/SPECIMENS: M. pneumoniae may be found in any type of clinical specimen, but more commonly on specimen from the respiratory tract ⁽²⁾.

PRIMARY HAZARDS: Laboratory workers should pay attention to parenteral inoculation, droplets exposure on mucous membrane, infectious aerosol and ingestion ⁽²⁾.

SPECIAL HAZARDS: None.

SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 ⁽¹⁸⁾.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk to splashes ⁽¹⁹⁾.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited ⁽¹⁹⁾. Additional precautions should be considered with work involving animals and large scale activities.

SECTION VIII - HANDLING AND STORAGE

SPILLS: Allow aerosols to settle. Wearing protective clothing, gently cover spill with paper towels and apply appropriate disinfectant, starting at perimeter and working towards the centre. Allow sufficient contact time before clean up ⁽¹⁹⁾.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled.

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: September 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©

Public Health Agency of Canada, 2011

Canada

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