Antibodies to various mycoplasmas in patients with coronary heart disease

BACKGROUND

Clinical and epidemiologic features of coronary heart disease may not be explained solely by established risk factors. The role of infectious pathogens in the development and rupture of atherosclerotic plaques remains elusive but an association between Chlamydia pneumoniae, Mycoplasma pneumoniae and CHD has been reported previously.

OBJECTIVES

To determine whether there is an association between mycoplasmal infections and CHD.

METHODS

We conducted a prospective cohort analysis of 150 consecutive hospitalized patients with CHD (85 with acute coronary syndrome and 65 admitted for unrelated reasons) and 98 healthy blood donors. Antibody titers for Mycoplasma pneumoniae, M. fermentans, M. hominis and Ureaplasma urealyticum were measured with the agglutination test or specific enzyme-linked immunosorbent assay in all three groups of patients.

RESULTS

Analysis of the antibody titers did not reveal any significant difference in the presence of mycoplasmal antibodies between the patients with ACS, patients with known stable CHD hospitalized for non-CHD reasons, and healthy blood donors.

CONCLUSIONS

Determination of specific antibodies did not reveal a significant association among different types of mycoplasmal infection and CHD.

[Role of Chlamydia pneumoniae and Mycoplasma pneumoniae infections in the course of asthma]

Respiratory infections are one of the major causes of asthma exacerbations. Among numerous pathogens that may lead to exacerbations, particular attention should be paid to atypical bacteria: Chlamydia pneumoniae and Mycoplasma pneumoniae. Despite significant frequency, infections caused by these species are underestimated due to untypical clinical course and lack of easily accessible diagnostic tests. Although acute infection can be easily linked with deterioration of asthma control, the role of respiratory colonisation by Chlamydia pneumoniae or Mycoplasma pneumoniae has not been precisely defined. It is known that serologic signs of both past infection and chronic current infection (IgA) with Chlamydia pneumoniae or Mycoplasma pneumoniae are found more often in asthmatics compared to healthy controls. Besides respiratory colonisation by Chlamydia pneumoniae or Mycoplasma pneumoniae confirmed by culture or molecular tests is also more common in asthmatics. This is particularly relevant in cases of uncontrolled asthma that followed symptoms of respiratory infection. This may lead to the conclusion that atypical infections can play a role in asthma induction in previously healthy individuals as well as deteriorations in the course of the disease. Studies mentioned above have led to the new therapeutic possibility - eradication of Chlamydia pneumoniae. In some of the studies on eradication with macrolides promising results have been gained in terms of asthma control, but in most of the cases improvement was only temporary.

A practical approach to the prevention of miscarriage. Part 4--role of infection

PURPOSE

To evaluate the role of infection as a cause of pregnancy loss.

METHODS

Studies concerning the risk factor of certain microorganisms for first trimester miscarriage and premature rupture of membranes are reviewed. The microorganisms especially considered were ureaplasma/mycoplasma, the potpourri of organisms causing bacterial vaginosis and chlamydia trachomatis.

RESULTS

The consensus is that all these microorganisms can on occasion lead to first trimester spontaneous abortion and second trimester loss especially related to premature rupture of membranes.

CONCLUSIONS

Reactivation during pregnancy is possible so the best strategies involve giving a course of appropriate antibiotics prior to pregnancy but giving antibiotics at least intermittently during the first trimester. Similar antibiotic therapy could be considered for unexplained recurrent miscarriage where negative cultures exist.

[Influence of TORCH-infections on the spermatogenesis of men]

The purpose of the given study was to reveal causal relations between infection of the urino-genital tract by intracellular parasites, the so-called TORCH-infections, and the decrease of spermatogenesis. For observation 182 men of reproductive age (from 22 to 38 years) with oligozoospermia and aspermia, without any complaints or clinical symptoms indicating existence of infections of urino-genital tracts, were selected. Out of those, 131 revealed oligozoospermia, i.e. the quantity of spermatozoons was no higher than 20 mln in 1 ml of ejaculate, and 51 revealed - aspermia. For examination of some TORCH infections, medical doctors in charge directed 44 oligozoospermia patients and 15 aspermia patients, who respectively constituted group I and group II. Examinations were carried out for Chlamydia trachomatis--(Ch.t), Herpes simplex virus--(HSV), Ureaplasma urealiticum--(U.u.), Cytomegalovirus--(CMV), and Mycoplasma hominis--(M.h.). In the group with oligozoospermia, cases of infections by Chlamydias (41.5%) and Herpes virus (51.3%) were frequent, but Ureaplasma (56,5%) was more frequent than any infections. Cytomegalovirus occurred in the least number of cases. Making any conclusions on the frequency of infections by M.h. is difficult due to the low number of examinations. Similar picture was observed in Group II as well. Following successful treatment of infections in Group I, 8 patients with Ch.t. and 8 patients with U.u. showed an improved spermogram after several months. Treatment of other infections did not yield tangible results. In Group II spermatogenesis remained without any changes.

Anti-NMDA receptor encephalitis: report of ten cases and comparison with viral encephalitis

The California Encephalitis Project (CEP), established in 1998 to explore encephalitic etiologies, has identified patients with N-methyl-D-aspartate receptor (NMDAR) antibodies, the likely etiology of their encephalitis. This study compares the presentation of such patients to those with viral encephalitis, so that infectious disease clinicians may identify individuals with this treatable disorder. Patients were physician-referred, and standardized forms were used to gather demographic, clinical, and laboratory data. Features of anti-NMDAR+ patients were compared with the viral encephalitides of enteroviral (EV), rabies, and herpes simplex-1 (HSV-1) origins. Sixteen cases with confirmed viral etiologies were all negative on NMDAR antibody testing. Ten anti-NMDAR+ patients were profiled with a median age of 18.5 years (range 11-31 years). None were Caucasian. They had a characteristic progression with prominent psychiatric symptoms, autonomic instability, significant neurologic abnormalities, and seizures. Two had a teratoma, and, of the remaining eight, four had serologic evidence of acute Mycoplasma infection. The clinical and imaging features of anti-NMDAR+ patients served to differentiate this autoimmune disorder from HSV-1, EV, and rabies. Unlike classic paraneoplastic encephalitis, anti-NMDAR encephalitis affects younger patients and is often treatable. The association of NMDAR antibodies in patients with possible Mycoplasma pneumoniae infection warrants further study.

Persistent exposure to Mycoplasma induces malignant transformation of human prostate cells

Recent epidemiologic, genetic, and molecular studies suggest infection and inflammation initiate certain cancers, including those of the prostate. The American Cancer Society, estimates that approximately 20% of all worldwide cancers are caused by infection. Mycoplasma, a genus of bacteria that lack a cell wall, are among the few prokaryotes that can grow in close relationship with mammalian cells, often without any apparent pathology, for extended periods of time. In this study, the capacity of Mycoplasma genitalium, a prevalent sexually transmitted infection, and Mycoplasma hyorhinis, a mycoplasma found at unusually high frequency among patients with AIDS, to induce a malignant phenotype in benign human prostate cells (BPH-1) was evaluated using a series of in vitro and in vivo assays. After 19 weeks of culture, infected BPH-1 cells achieved anchorage-independent growth and increased migration and invasion. Malignant transformation of infected BPH-1 cells was confirmed by the formation of xenograft tumors in athymic mice. Associated with these changes was an increase in karyotypic entropy, evident by the accumulation of chromosomal aberrations and polysomy. This is the first report describing the capacity of M. genitalium or M. hyorhinis infection to lead to the malignant transformation of benign human epithelial cells and may serve as a model to further study the relationship between prostatitis and prostatic carcinogenesis.

Incidence of anti-zona pellucida and anti-sperm antibodies among infertile Jordanian women and its relation to mycoplasmas

Anti-zona-pellucida autoantibodies (AZP-Ab) and anti-sperm isoantibodies (ASA) were assessed in the cervical secretions from 73 infertile Jordanian women and 41 fertile control women using latex agglutination. Significantly more women with infertility had AZP-Ab and ASA (16.4% and 8.2% respectively) compared with fertile women (9.4% and 0%), with no relation to the etiology of infertility. Using polymerase chain reaction Mycoplasma hominis and Ureaplasma urealyticum were detected in cervical secretions of 19.2% and 13.7% of infertile women, and the presence of mycoplasma was significantly correlated with the presence of AZP-Ab and ASA.

Acute disseminated encephalomyelitis in an infant with incontinentia pigmenti

We report the case of a female Japanese infant who was diagnosed with incontinentia pigmenti (IP) on the basis of the clinical and pathological findings of characteristic skin lesions and the detection of deletion in the nuclear factor-kappa B essential modulator gene at Xq28. The patient developed repetitive seizures at the age of 7 months when she was diagnosed with acute disseminated encephalomyelitis (ADEM), an inflammatory demyelinating disease of the central nervous system that often occurs after vaccination or infection. The causative infectious agent in this patient seemed to be Mycoplasma pneumoniae because of the increased titer of its serum antibody and the detection of its DNA in the initial cerebrospinal fluid sample. This patient showed significant improvement on receiving immunosuppressive therapy with corticosteroids. This is the second case report presenting an IP patient susceptible to ADEM, and therefore, ADEM should be considered early in the differential diagnosis of acute neurological illness for IP patients.

Intracranial Hypertension in a Boy with Mycoplasma pneumoniae Infection: The First Report

We describe a 7-y-old boy who developed idiopathic intracranial hypertension (IIH) during the convalescent phase of Mycoplasma pneumoniae (M. pneumoniae) infection. Anti-M. pneumoniae antibody and cold hemagglutinin titer were extremely high during his course, and corticosteroid administration was noticeably effective. It supports an immunopathological mechanism for his intracranial hypertension.

Carditis associated with mycoplasma pneumoniae infection

Among 560 patients with serologically confirmed Mycoplasma pneumoniae infection, 25 (4.5%) had carditis (19 perimyocarditis, 6 pericarditis). During the acute phase 9 patients required intensive care. After an average of 16 months follow-up 11 patients with no previous signs of heart disease still had cardiac symptoms or signs. Thus carditis associated with M. pneumoniae infection is a serious disease, having cardiac sequelae more often than has hitherto been supposed. The pathogenesis of the carditis associated with M. pneumoniae infection is discussed, including the possibility that in some cases the elevated titre in the complement fixation test is non-specific. A summary is given of the 33 cases previously presented in the literature.

Mycoplasma pneumoniae infection associated with affection of the central nervous system

A total of 371 patients with acute, febrile, non-bacterial affection of the CNS hospitalized between Nov. 1, 1971, and June 1, 1976, were examined for Mycoplasma (M.) pneumoniae infection. Nineteen of the patients showed evidence of a current M. pneumoniae infection, 32 of a previous infection, and 320 no evidence. In patients with a current infection due to M. pneumoniae, suggestive evidence is presented that this agent might be involved in the pathogenesis of the neurological syndromes. Compared to cases without the infection, these cases and, to a lesser degree, those with a previous M. pneumoniae infection showed an increased frequency of pathological values, found by various laboratory and instrumental parameters, and a slightly higher frequency of neurological sequelae. Respiratory illness was present in only 11 of the 19 patients infected with M. pneumoniae, a classical respiratory tract pathogen. The overall incidence of current M. pneumoniae infections among patients with neurological syndromes was 5%, with a maximum of 10% during the 1972 epidemic. This is a much higher figure than expected from a mere coincidence of the two conditions.

Mycoplasma pneumonia-associated acute hepatitis in an adult patient without lung infection

Mycoplasma pneumonia is a major cause of respiratory infections in school-aged children. Most M. pneumonia infections in adults involve the respiratory tract. Extrapulmonary manifestations of M. pneumonia infection may be found in the skin, cardiovascular, neurologic and hematologic systems. Concomitant liver disease is rare in adults. Here, we report an unusual case of a patient who presented with fever and abdominal pain, but without pulmonary manifestations. The laboratory work-up demonstrated a hepatocellular pattern of acute hepatitis caused by M. pneumonia infection. Symptoms subsided and laboratory parameters improved with antibiotics treatment. Thus, this case can help raise clinicians' awareness of the possibility of M. pneumonia infection, with or without lung involvement, as a part of the evaluation of undetermined hepatitis.

Mycoplasma meningitis in infants with spina bifida

Infants with myelomeningocele are liable to develop bacterial colonisation of the lesion which, in the case of Gram-negative bacteria, often progresses to meningitis because of the infants' immature immune status. The time and origin of the bacterial colonisation usually are uncertain. This study reports seven cases of meningitis caused by Mycoplasma hominis, an organism not previously reported to cause meningitis. The commensal status of Mycoplasma hominis in the vagina of many women, and its isolation from the mother of one patient in this group, suggests that the infant acquired the organism in the birth canal and that infection developed over a period of days. Routine cultures from the sac or wound did not show the presence of organisms until after the child had developed signs and symptoms of meningitis. Commensal organisms from the vagina may lie dormant for several days within the closed myelomeningocele and their more virulent strains may then produce meningitis. It is suggested that neonatal meningitis may be caused by organisms acquired during birth, as well as by those to which the infant is exposed later.

[Child with acute disseminated encephalomyelitis (ADEM) initially presenting with psychiatric symptoms]

We recently evaluated a patient with ADEM after a mycoplasma infection who initially presented with psychiatric symptoms, including hyperkinesis, irritability, and emotional outbursts. Psychiatric symptoms in ADEM are rare and usually suggest some underlying psychiatric or psychogenic disorder. This case illustrates that in children who initially present with psychiatric symptoms, even in the absence of typical neurologic symptoms associated with encephalitis such as disturbance of consciousness or seizures, ADEM should be considered in the differential diagnosis. Recent history of infections or vaccinations should also be considered.

[Diagnostic image (388). A boy with blue ears]

An 8-year-old boy was presented with painful blue ears due to infection with Mycoplasma pneumoniae. The changes disappeared spontaneously.

Thrombocytosis in childhood

Thrombocytosis is a frequent finding in hemograms obtained from hospitalized and ambulatory children due to the widespread use of automated blood cell counters. Pediatricians are commonly puzzled in cases of thrombocytosis to determine the underlying cause and the need for therapy. The purpose of this review is to assist the general pediatrician into dealing with this common hematological finding in every day clinical practice. Fortunately, primary thrombocytosis or essential thrombocythemia, a clonal disease, is exceedingly rare in childhood, but may be associated with thromboembolic and hemorrhagic complications. On the other hand, secondary or reactive thrombocytosis is very common and is due to a variety of conditions, such as acute and chronic infections, iron deficiency, bleeding, hemolytic anemias, collagen vascular diseases, malignancies, drugs and splenectomy. Treatment of reactive thrombocytosis should be directed to the underlying problem alone. Administration of platelet aggregation inhibitors such as aspirin is unwarranted. Consultation is necessary only for the rare child with extreme thrombocytosis who has clinical and/or laboratory criteria consistent with essential thrombocythemia, or in whom a hemorrhagic or thrombotic complication has developed.

Mycoplasma meningitis resulting in increased production of cerebrospinal fluid: case report and review of the literature

PURPOSE

We report a case of increased cerebrospinal fluid (CSF) production in a child with concomitant mycoplasma meningitis.

MATERIALS AND METHODS

This 4-year-old boy presented with a 2-week history of body aches, malaise, and headaches. He developed sudden onset of obtundation, apnea, left eye deviation, and bilateral dilated and unreactive pupils. A ventriculostomy was placed initially for a poor neurologic examination in the setting of likely meningitis. Initial intracranial pressure was high, and CSF production was supraphysiologic for the first few days of empiric, broad-spectrum treatment. Mycoplasma meningitis was diagnosed. The ventriculostomy was weaned after adequate treatment for mycoplasma meningitis.

RESULTS AND CONCLUSIONS

At 4 months follow-up, the child remains shunt-free with only mild cognitive-linguistic impairment. Untreated mycoplasma meningitis may cause raised intracranial pressure (possibly as a result of increased CSF production) and result in a poor neurological examination. In this setting, CSF diversion in the form of an external ventricular drain may be beneficial to preserve neurologic function during treatment with antibiotics.