Mycoplasma pneumoniae-an emerging extra-pulmonary pathogen

Severe Mycoplasma pneumoniae infection requiring extracorporeal membrane oxygenation with concomitant ischemic stroke in a child

Mycoplasma pneumoniae is one of the most common agents causing respiratory disease in children. The most common extra-pulmonary manifestations of M. pneumoniae include central nervous system involvement, with stroke being an uncommon but devastating consequence. We present a 13-year-old girl with severe respiratory disease requiring extracorporeal membrane oxygenation, who developed ischemic stroke associated with clinical and serologic evidence of M. pneumoniae. A case of M. pneumoniae causing this degree of respiratory failure associated with stroke has not been previously reported. Prompt recognition of severe mycoplasmal infection may allow for earlier treatment and concomitant evaluation of neurologic injury.

Investigation of Mycoplasma pneumoniae infection in pediatric population from 12,025 cases with respiratory infection

Although Mycoplasma pneumoniae (MP) is a major pathogen of primary atypical pneumonia in children, the clinical and laboratory characteristics of MP infection in large pediatric population are less reported. Here, we retrospectively analyzed 12,025 hospitalized children with respiratory infection by using serology and polymerase chain reaction (PCR) methods simultaneously. The results showed that 2433 (20.23%) children had MP infection, which mainly occurred in November to April. The presence of sore throat and pharyngitis was peculiar to MP infection. The positive percentage of MP-DNA was higher than that of MP-IgM in children aged <1 (P < 0.0001) and 1-3 years (P < 0.0001). Moreover, the positive rate of P1 gene, the key adhesion gene for MP infection, was higher in children with MP infection than in those with other pathogens (P < 0.0001). Our work provides the clinical information of children MP infection and highlights the superiority of PCR and potential usage of P1 as a diagnosis target for MP infection.

Mycoplasma pneumoniae infection presenting as bullous papular purpuric gloves and socks syndrome: novel association and review of the literature

Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited, often febrile illness with symmetric edema and erythema of the hands and feet; papular, petechial, and purpuric acral dermatosis; and mucosal lesions in children and young adults. Most of the cases of PPGSS have been reported to be caused by parvovirus B19 and other viruses. This study describes a case resulting from Mycoplasma pneumoniae infection in an adolescent male and reviews the literature.

Mycoplasma pneumoniae infection associated with urticarial vasculitis mimicking adult-onset Still's disease

Mycoplasma pneumoniae is well known to be a frequent cause of atypical pneumonia worldwide. However, it may also present with a wide variety of clinical features, including cutaneous symptoms, which are not widely recognised. Urticarial vasculitis occurring with M. pneumoniae has been described to occur in only one other case report. This amalgamation of non-specific clinical symptoms and signs can lead to a diagnostic dilemma. We describe a case of M. pneumoniae infection presenting with extrapulmonary manifestations and urticarial vasculitis, which was misdiagnosed as adult-onset Still's disease (AOSD). Had immunosuppressive therapy been commenced for AOSD in the presence of undiagnosed infection, this may have resulted in potentially serious consequences. This case highlights the need to remain vigilant about diagnosing M. pneumoniae as its serological diagnosis may take weeks and it has many extrapulmonary manifestations, which can masquerade as other conditions.

Mycoplasma pneumonia: Clinical features and management

Mycoplasma pneumonia is a common respiratory pathogen that produces diseases of varied severity ranging from mild upper respiratory tract infection to severe atypical pneumonia. Apart from respiratory tract infections, this organism is also responsible for producing a wide spectrum of non-pulmonary manifestations including neurological, hepatic, cardiac diseases, hemolytic anemia, polyarthritis and erythema multiforme. This review focuses on molecular taxonomy, biological characteristics, epidemiology, clinical presentation, radiology and various laboratory tools in diagnosis, differential diagnosis, treatment and prevention of mycoplasma pneumonia.

Detection of Mycoplasma pneumoniae in different respiratory specimens

Mycoplasma pneumoniae (M. pneumoniae) is an important community-acquired pneumonia pathogen. Serological test and polymerase chain reaction (PCR) assay are the two main laboratory tests to detect M. pneumoniae now. Little information was compared about the sensitivity and specificity of PCR using different specimens including bronchoalveolar lavage (BAL) and nasopharyngeal aspirate (NPA). The aim of the present study was to evaluate diagnostic values of different specimens by fluorescence quantitative real-time PCR and to find clinical features helpful to diagnose M. pneumoniae pneumonia (MPP). Four hundred and six hospitalized pneumonia children were studied. M. pneumoniae DNA in NPA and BAL samples were detected by fluorescence quantitative real-time PCR. M. pneumoniae-specific IgM was tested by ELISA. MPP were diagnosed based on positive M. pneumoniae-specific IgM in 101 (24.9%) children. The median ages of MPP and non-MPP children were 4.1 and 2.4 years, respectively, with significant difference between them (p < 0.001). Laboratory results including leukocyte count, neutrophil percentage, immunoglobulins, except serum IgM, subgroups of T lymphocyte, and BAL cell count had no significant differences in MPP and non-MPP. BAL macrophage cell percentage was lower in BAL-PCR positive children (p = 0.003), while BAL neutrophil percentage was higher in BAL-PCR positive children (p = 0.007). PCR from NPA and BAL were similar in diagnostic parameters, including sensitivity, specificity, PPV, and NPV (78.6%, 63.4%, 39.8%, and 90.6% for NPA-PCR, respectively; 70.3%, 58.7%, 36.0%, and 85.6% for BAL-PCR, respectively).

CONCLUSIONS

NPA is better than BAL as PCR sample in MPP diagnosis for similar performance in PCR assay, cheap, and less invasive. BAL is useful in defining local inflammatory condition. Age is the only prefigurative factor in MPP.

Pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae in children - comparative analysis of clinical picture

PURPOSE

The aim of the study was comparative analysis of clinical picture and prevalence of pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae in children.

MATERIAL AND METHODS

The study involved 332 children hospitalized in the 3rd Department of Paediatric, Polish Mother's Memorial Hospital - Research Institute, due to pneumonia caused by Mycoplasma pneumoniae - group I or Chlamydophila pneumonia - group II.

RESULTS

Over 2003-2009 period there were 1870 children hospitalized due to pneumonia, of which in 332 (17.8%) the Mycoplasma pneumoniae and/or Chlamydophila pneumoniae etiology was confirmed. Mycoplasma pneumoniae, Chlamydophila pneumoniae, and mixed infection was diagnosed in 198 (10.6%), 102 (5.5%), and 32 (1.7%) children, respectively. The dominant clinical feature in both groups was cough, observed in 186 (93.9%) and 88 (86.3%) children, respectively. Further, reddening of the throat, rhinitis, shortness of breath, fever, enlarged lymph nodes, skin lesions and dyspepsia were also observed. The frequency of specific clinical features in both groups was similar. Statistical relationship (p≤0.05) was observed only in case of skin lesions. In chest x-ray there was no statistical link as for analyzed changes. Interstitial inflammatory changes were most frequently observed.

CONCLUSIONS

Mycoplasma pneumoniae and Chlamydophila pneumoniae are significant etiological factors in pneumonia in children, and as such they should be taken into consideration in differential diagnosis of pneumonia in children. The clinical picture of pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae is hardly specific, with basic labs and chest x-ray of little help in differentiation of infection etiology.

Identification of an N-terminal 27 kDa fragment of Mycoplasma pneumoniae P116 protein as specific immunogen in M. pneumoniae infections

BACKGROUND

Mycoplasma pneumoniae is an important cause of respiratory tract infection and is increasingly being associated with other diseases such as asthma and extra-pulmonary complications. Considerable cross-reactivity is known to exist between the whole cell antigens used in the commercial serological testing assays. Identification of specific antigens is important to eliminate the risk of cross-reactions among different related organisms. Adherence of M. pneumoniae to human epithelial cells is mediated through a well defined apical organelle to which a number of proteins such as P1, P30, P116 and HMW1-3 have been localized, and are being investigated for adhesion, gliding and immunodiagnostic purposes.

METHODS

A 609 bp fragment P116(N-27), corresponding to the N-terminal region of M. pneumoniae P116 gene was cloned and expressed. A C-terminal fragment P1(C-40), of P1 protein of M. pneumoniae was also expressed. Three IgM ELISA assays based on P116(N-27), P1(C-40) and (P116 (N-27) + P1(C-40)) proteins were optimized and a detailed analysis comparing the reactivity of these proteins with a commercial kit was carried out. Comparative statistical analysis of these assays was performed with the SPSS version 15.0.

RESULTS

The expressed P116(N-27) protein was well recognized by the patient sera and was immunogenic in rabbit. P1(C-40) of M. pneumoniae was also immunogenic in rabbit. In comparison to the reference kit, which is reported to be 100% sensitive and 75% specific, ELISA assay based on purified P116(N-27), P1(C-40) and (P116(N-27) + P1(C-40)) proteins showed 90.3%, 87.1% and 96.8% sensitivity and 87.0%, 87.1% and 90.3% specificity respectively. The p value for all the three assays was found to be < 0.001, and there was a good correlation and association between them.

CONCLUSION

This study shows that an N-terminal fragment of P116 protein holds a promise for serodiagnosis of M. pneumoniae infection. The IgM ELISA assays based on the recombinant proteins seem to be suitable for the use in serodiagnosis of acute M. pneumoniae infections. The use of short recombinant fragments of P116 and P1 proteins as specific antigens may eliminate the risk of cross-reactions and help to develop a specific and sensitive immunodiagnostic assay for M. pneumoniae detection.

Mycoplasma pneumonia and its complications

Mycoplasma pneumoniae continues to be the most frequent cause of atypical pneumonia. Fortunately, the antibiotics listed in this article are generally very effective. Major skills are needed to detect M pneumoniae extrapulmonary diseases, which require a special heightened awareness and sensitivity. It is not known whether early therapy prevents dreaded complications.

Pathogenesis of neurologic manifestations of Mycoplasma pneumoniae infection

Mycoplasma pneumoniae has been associated with various neurologic manifestations, but exactly how the organism can cause such a wide variety of diseases is a long-standing mystery. In this respect, although pneumonia has been considered the hallmark of Mycoplasma pneumoniae infection, emerging accumulations of data have revealed that the infection can cause a number of extrapulmonary manifestations even in the absence of pneumonia. The importance of host immune response in the pathomechanism of pneumonia has been established, but the pathomechanisms of extrapulmonary manifestations remain largely unknown. For this review, extrapulmonary manifestations due to M. pneumoniae infection were classified into three categories: a direct type, in which locally induced cytokines must play a role; an indirect type, in which immune modulation such as autoimmunity must play a role; and a vascular occlusion type, in which vasculitis or thrombosis (either or both, and with or without systemic hypercoagulable state) must play a role. This classification was then applied within a literature review for neurologic manifestations. Most neurologic manifestations due to M. pneumoniae infection could be reasonably classified into and explained by one of the three types of pathomechanisms.

Mycoplasma pneumoniae-associated cerebral infarction in a child

The central nervous system's involvement is the most common reported extra-pulmonary manifestations of Mycoplasma pneumoniae infection, and stroke was one of the most special situations. We presented a 4-year-old child who presented with acute stroke on the third day of the onset of Mycoplasma respiratory tract infection. Brain magnetic resonance angiography demonstrated that occlusion of bilateral internal carotid arteries and vertebral arteries above the level of the first cervical vertebrate which is not been reported previously.

C. pneumoniae community-acquired pneumonia (CAP) in mimicking Mycoplasma pneumoniae meningoencephalitis complicated by asthma

Chlamydophila (Chlamydia) pneumoniae is a common, non-zoonotic cause of community-acquired pneumonia (CAP) in ambulatory young adults. C. pneumoniae clinically presents as a mycoplasma-like illness frequently accompanied by laryngitis. C. pneumoniae CAP may also cause nursing home outbreaks in the elderly. Similar to Mycoplasma pneumoniae in immunocompetent hosts, C. pneumoniae CAP usually manifests as a mild/moderately severe CAP. In contrast with Legionnaire's disease, central nervous system involvement is usually not a feature of C. pneumoniae CAP. M. pneumoniae may rarely present with meningoencephalitis accompanied by high cold agglutinin titers. We present the case of a young man who presented with M. pneumoniae-like illness and was hospitalized for severe CAP that was accompanied by a pertussis-like cough and severe headache. Although his chest x-ray showed a right upper lobe infiltrate, a lumbar puncture was performed to rule out meningitis, but his cerebrospinal fluid profile was unremarkable. Titers for non-zoonotic atypical pneumonia pathogens were negative except for a highly elevated C. pneumoniae immunoglobulin-M titer (1:320). Testing for legionella and pertussis was negative. Q fever and adenoviral titers were also negative. Cold agglutinin titers were repeatedly negative. The patient was successfully treated with moxifloxacin but developed permanent asthma after C. pneumoniae CAP. This case is unusual in several aspects. First, C. pneumoniae usually presents as a mild to moderate CAP, but in this case it was severe. Second, hoarseness was absent, which would have suggested C. pneumoniae. Third, wheezing was an important clue to the diagnosis of C. pneumoniae, which is not a clinical finding with other causes of CAP. Fourth, permanent asthma may follow C. pneumoniae, as well as M. pneumoniae CAP. Fifth, severe headache mimicking M. pneumoniae meningoencephalitis may rarely accompany C. pneumoniae CAP.