Mycoplasma pneumoniae Pericarditis and Cardiac Tamponade in a 7-Year-Old Girl with Cystic Fibrosis

Association between Cystic Fibrosis and Pericardial Calcification Detected at Chest CT in Adults

Background Although pericardial calcification has been observed on chest CT scans in patients with cystic fibrosis (CF), its prevalence and characteristics have not been elucidated. Purpose To determine the prevalence and characteristics of pericardial calcification, and identify clinical variables associated with it, in adult patients with CF and to compare this prevalence with that in individuals without CF. Materials and Methods This was a retrospective, single-center case-control study including consecutive patients with CF who underwent chest CT between January 2021 and December 2022. Control group 1 included individuals without CF matched for age and sex. Control group 2 included individuals with previous Mycobacterium tuberculosis infection and no concomitant diagnosis of CF matched for sex. Control group 3 included patients with primary ciliary dyskinesia. Qualitative and quantitative evaluations of pericardial calcification were performed. The χ2 test and Fisher exact test were used for comparisons of categorical variables; the Kruskal-Wallis test and Mann-Whitney U test were used for comparisons of continuous variables. Results Of the 348 adult patients with CF (mean age, 35 years ± 13 [SD]; 193 [55%] male patients), 62 (18%) had pericardial calcification at CT. The prevalence of pericardial calcification was 1% (four of 348) in control group 1, 2% (two of 100) in control group 2, and 4% (one of 24) in control group 3 (P < .001). Pericardial calcification developed de novo in 66% (41 of 62) and progressed in 21% (13 of 62) of patients with CF. The distribution of pericardial calcification in patients with CF was most frequently multifocal (58%; 36 of 62). The median calcium score of pericardial calcification was 65 (IQR, 28-375). In patients with CF, older age, lower forced expiratory volume in 1 second, higher vitamin D level, and a higher prevalence of Burkholderia cenocepacia ET12 infection were associated with pericardial calcification. Conclusion Pericardial calcification was more prevalent in adult patients with CF than in individuals without CF and progressed over time in some patients. © RSNA, 2025 Supplemental material is available for this article.

Chlamydia pneumoniae and Mycoplasma pneumoniae in children with cystic fibrosis: impact on bacterial respiratory microbiota diversity

Objectives: The contribution of intracellular and fastidious bacteria in Cystic fibrosis (CF) pulmonary exacerbations, and progressive lung function decline remains unknown. This project aimed to explore their impact on bacterial microbiota diversity over time in CF children. Methods: Sixty-one children enrolled in the MUCOVIB multicentre prospective cohort provided 746 samples, mostly nasopharyngeal swabs, throat swabs and sputa which were analysed using culture, specific real-time qPCRs and 16S rRNA amplicon metagenomics. Results:  Chlamydia pneumoniae (n = 3) and Mycoplasma pneumoniae (n = 1) were prospectively documented in 6.6% of CF children. Microbiota alpha-diversity in children with a documented C. pneumoniae was highly variable, similarly to children infected with Staphylococcus aureus or Pseudomonas aeruginosa. The transition from routine follow-up visits to pulmonary exacerbation (n = 17) yielded variable changes in diversity indexes with some extreme loss of diversity. Conclusions: The high rate of C. pneumoniae detection supports the need for regular screenings in CF patients. A minor impact of C. pneumoniae on the microbial community structure was documented. Although detected in a single patient, M. pneumoniae should also be considered as a possible aetiology of lung infection in CF subjects.

Mycoplasma pneumoniae Presenting With Pericardial Tamponade

Mycoplasma pneumoniae (MP) is a common cause of community acquired pneumonia in school aged children but rarely causes pericardial and pleural effusions in a previously healthy host. We report an adolescent presenting with pericardial effusion with tamponade and pleural effusions most likely caused by MP infection. Definitive diagnosis of pericardial effusion is a challenge even when pericardial fluid or tissue is available. Serology is the mainstay of diagnosis. IgM is a reliable indicator of recent MP infection, but rising titers are needed which could delay diagnosis. Pericardial effusion with tamponade is a rare presentation of MP infection. As appropriate treatment significantly affects the outcome, investigating for MP should be part of the routine workup for pericarditis of unknown etiology.

A Peculiar Case of Pneumonia due to Mycoplasma pneumoniae in a Child with Cystic Fibrosis and Sensibilization to Aspergillus fumigatus

Aspergillus fumigatus plays a major role in pulmonary exacerbations in patients with cystic fibrosis. The most common A. fumigatus diseases are those based on immune-mediated response to A. fumigatus antigens; including allergic bronchopulmonary aspergillosis (ABPA). In this condition; the presence of A. fumigatus in the lower respiratory tract triggers an IgE-mediated hypersensitivity response that causes airway inflammation; bronchospasms; and bronchiectasis. This case report describes a ten-year-old male patient suffering from cystic fibrosis (CF) in whom the diagnosis of ABPA occurred in association with pneumonia due to Mycoplasma pneumoniae more than two weeks after hospitalization. This case is a good example of how difficult the identification of ABPA in CF patients can be and highlights that ABPA can occur in association with co-infections due to other pathogens. In order to avoid the risk of a late ABPA diagnosis, it is imperative that the diagnostic criteria guidelines are reviewed and standardized.

Mycoplasma Pneumoniae Pericarditis

Mycoplasma pneumoniae is an atypical bacterium that is frequently implicated in respiratory infections, but uncommonly identified as a cause of pericarditis. We report 2 cases of pericarditis attributed to M. pneumoniae that were characterized by prolonged respiratory prodromes, pericardial, and pleural effusions, elevated inflammatory markers, and relapsing clinical courses. In conclusion, our experience suggests that M. pneumoniae should be considered as a potential cause in cases of pericarditis associated with upper respiratory symptoms, pneumonia, pleural effusions, arthralgia, and/or a recurrent/refractory clinical course. The availability of effective antibiotic treatment makes this an important diagnosis to make.

Non-typeable Haemophilus influenzae purulent pericarditis in a child with cystic fibrosis

Early airway colonization and infection with Haemophilus influenzae in children with cystic fibrosis (CF) is common. Although the pathogenicity of non-typeable H. influenzae (NTHi) in patients with CF is controversial, this organism can cause both upper and lower respiratory tract infections. Extra-pulmonary disease, however, is rare. Purulent pericarditis is a suppurative complication of bacterial infection of the pericardial space that can arise as a result of direct extension from an adjacent infection. We describe a case of purulent pericarditis due to NTHi in a young child with CF that developed as a complication of inadequately treated bronchopneumonia.

Myocarditis and pericarditis in children

Myocarditis and pericarditis are rare but important causes of pediatric chest pain. The diagnostic criteria, clinical course, causes, and treatment of myocarditis is reviewed. There is particular attention to the relationship of myocarditis with dilated cardiomyopathy. Supportive therapy remains the standard of care for pump dysfunction. The identification and treatment of pericarditis with associated large pericardial effusion can be lifesaving. This article reviews the important clinical features that might lead the clinician to diagnose either myocarditis or pericarditis and thus separate the few patients with either of these conditions from the legions of children with noncardiac chest pain.

Usefulness of serum IgG4 in the diagnosis and follow up of autoimmune pancreatitis: A systematic literature review and meta-analysis

High circulating serum immunoglobulin G4 (IgG4) levels have been proposed as a marker of autoimmune pancreatitis (AIP). The aim of the present study was to review the data existing in the English literature on the usefulness of the IgG4 serum levels in the diagnosis and follow up of patients with AIP. A total of 159 patients with AIP and 1099 controls were described in seven selected papers reporting the usefulness of serum IgG4 in diagnosing AIP. In total, 304 controls had pancreatic cancer, 96 had autoimmune diseases, and the remaining 699 had other conditions. The summary receiver-operating characteristic curve analysis was carried out by means of Meta-DiSc open-access software. Serum IgG4 showed good accuracy in distinguishing between AIP and the overall controls, pancreatic cancer and other autoimmune diseases (area under the curve [+/- SE]: 0.920 +/- 0.073, 0.914 +/- 0.191, and 0.949 +/- 0.024, respectively). The studies analyzed showed significantly heterogeneous specificity values in each of the three analyses performed. The analysis of the four studies comparing AIP and pancreatic cancers also showed significantly heterogeneous values of sensitivities and odds ratios. Regarding the usefulness of IgG4 as a marker of efficacy of steroid treatment, a decrease in the serum concentrations of IgG4 was found in the four available studies. The serum IgG4 subclass is a good marker of AIP, and its determination should be included in the diagnostic workup of this disease. However, the heterogeneity of the studies published until now means that more studies are necessary in order to better evaluate the true accuracy of IgG4 in discriminating AIP versus other autoimmune diseases.