Infections caused by Mycoplasma pneumoniae

Statistical analysis of Stevens-Johnson syndrome caused by Mycoplasma pneumonia infection in Japan

BACKGROUND

Stevens-Johnson syndrome (SJS) associated with Mycoplasma pneumoniae (M. pneumoniae) infection is mainly observed in children. In adults, drugs are a major cause of SJS, but some adult patients with SJS are infected with M. pneumoniae. We analyzed patients with SJS associated with M. pneumoniae infection to elucidate the differences between drug-induced SJS and M. pneumoniae-associated SJS and also to study differences between M. pneumoniae-associated SJS in children and adults.

METHODS

This is a retrospective review of Japanese patients who have been reported as M. pneumoniae-associated SJS in medical Journals published from 1981 to 2009, compared with data of Japanese patients with drug-induced SJS reported from 2000 to 2009.

RESULTS

Thirty-eight cases of M. pneumoniae-associated SJS and 78 cases of drug-induced SJS were analyzed in this study. Ocular lesions were observed more frequently in M. pneumoniae-associated SJS than in drug-induced SJS (p < 0.01), and adult patients showed a higher ratio of sequelae in their eyes than did patients under 20 years of age (p < 0.01). Sixty-six percent of adult patients with M. pneumoniae-associated SJS developed fever/respiratory symptoms and mucocutaneous lesions on the same day. In contrast, most of the patients under 20 years of age developed fever/respiratory symptoms before mucocutaneous involvement. This means that these adult patients were infected and immunized previously and developed allergic reactions to M. pneumoniae soon after the later infection.

CONCLUSIONS

In order to prevent ocular sequelae in adult patients when M. pneumoniae infection is suspected, more intensive treatment may be needed in adult patients than in younger patients.

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 and its role as a human pathogen

Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur.

Mycoplasmas in plaque and saliva of children and their relationship to gingivitis

Gingivitis is common in children but its etiology is not well understood. Results of earlier studies have suggested that mycoplasmas may have a role in the disease. In this study two plaque samples and one stimulated saliva sample were taken from each of a group of sixty (60) 5 to 9 year-old children and cultured selectively for mycoplasmas. Subjects had been selected on the basis of gingival status buccal to the most posterior tooth in an upper quadrant, 20 each having scores 0, 1, or 2 at this site using the Löe and Silness index. Plaque samples were taken from the adjacent tooth surface and from a second posterior site where the adjacent gingiva was free of signs of inflammation. Mycoplasmas were cultured from 54 saliva samples and from 57 plaque samples. Isolation frequency and numbers of mycoplasmas in relation to total anaerobic counts were consistently related to gingivitis scores in both plaque and saliva samples, with higher frequencies and proportions with increasing levels of gingival inflammation at the selected site. In plaque samples this finding held good for both comparisons between groups of subjects and for those between test and control sites within subjects. Findings would appear to confirm the suggestions of earlier studies that mycoplasmas in the oral cavity are associated with gingivitis in children.

Pulmonary involvement in Mycoplasma pneumoniae infection in families

The transmission rate and the clinical and pulmonary manifestations of serologically proven mycoplasma infections were reviewed in 34 patients from 11 families consisting of 30 children and adolescents aged 1 to 18 years, and four parents aged 30 to 41 years (total number of family members = 59:37 children, 22 adults). Twenty-seven of the 37 children had pulmonary involvement (73%). The total infection rate was 58%, and the infection rate in children 81%. The roentgenologic findings in children with pneumonia showed no pathognomonic features. The most common X-ray finding was bronchopneumonia (48%). Pulmonary infiltrates occurred in six children (20%) under four years of age. Three of the children (10%) had severe clinical and/or radiological manifestations. These findings depict a pattern of mycoplasma infection that is different from previous reports, i.e. high pulmonary infection rates in families, the occurrence of pneumonic infiltrations in young children and a quite severe clinical and radiological course in some of the patients.

Mycoplasma pneumoniae infections in children

Details are given of all serologically confirmed Mycoplasma pneumoniae infections in children referred to Bristol hospitals during an epidemic lasting 18 months. 44 children, many below school age, had lower respiratory infections. The majority had cough and malaise which had failed to respond to antibiotics given before referral. Chest x-rays showed no pathognomonic features: segmental or patchy consolidation was common; 3 cases of lobar consolidation. Cold agglutinins were raised in 9 out of 12 cases. In the majority of cases the total leucocyte count was normal and the absolute neutrophil count raised. Mean duration of symptoms was 4.2 weeks (range 1-16). Treatment with erythromycin or tetracycline appeared to have little effect in most cases. Seven nonrespiratory manifestations were seen in 6 children. These were meningitis (2 cases), Stevens-Johnson syndrome (4 cases, 1 case complicated by toxic epidermal necrolysis), and acute haemolytic anaemia (1 case).

Polyradiculoneuritis and Mycoplasma pneumoniae infection

A patient with severe Mycoplasma pneumonia developed polyradiculoneuritis and respiratory failure. The acute phase of the illness was complicated by a myocarditis, and recovery of neurological function was slow. Residual left hemidiaphragmatic paralysis was present 1 year after onset of the illness.

Complete heart block in a young child presumably due to mycoplasma pneumoniae myocarditis

The case is described of an 18 months old boy with sudden onset complete heart block, heralded by Stokes-Adams attacks. General signs of viral illness preceded and accompanied the syndrome; this, along with angiographic evidence of poorly contracting left ventricle, led to the diagnosis of non bacterial myocarditis. Serologic tests disclosed a significant rise in antibodies against mycoplasma pneumoniae (1/16 to 1/128). The His-bundle electrogram showed a block above the His-bundle, but fairly widespread damage to the conduction system is suspected. The complete heart block proved to be permanent and a fixed rate pacemaker had to be implanted.

The radiographic patterns of acute mycoplasma pneumonitis

Twenty-two cases of serologically proven pulmonary mycoplasma infection have been reviewed. All showed abnormality on plain chest radiographs. A definitive diagnosis could not be made on initial or individual films. However, studies of sequential films enabled diagnostic patterns to be distinguished.

Severe mycoplasma pneumonia

A patient who developed who developed a protracted illness following severe mycoplasma pneumonia is described. The acute phase of the infection was complicated by myocarditis and haemolytic anaemia. The respiratory symptoms abated and lung function tests improved with the administration of systemic and inhaled corticosteroids.

Pericarditis during infection with Mycoplasma pneumoniae

A 37-year-old woman was found to have pericarditis during the course of a Mycoplasma pneumoniae infection which also produced primary atypical pneumonia. Intrafamily spread of the infection was observed, with varying clinical manifestations. The case is described because there appears to be little information on mycoplasma pericarditis.

Myocarditis and severe bilateral bronchopneumonia caused by Mycoplasma pneumoniae

A man with severe bilateral bronchopneumonia and a right lobar consolidation caused by Mycoplasma pneumoniae, had a concurrent myocarditis. The possible aetiology of the patchy pulmonary opacities is discussed. A literature review of cases of myocarditis associated with M.pneumoniae is presented.

Mycoplasma pneumoniae infections and exanthems

A review of the medical literature and two case reports of M. pneumoniae infections with exanthems are presented. Erythematous maculopapular and vesicular exanthems were most common. The duration of rash was more than seven days in the majority of instances, and most patients had associated pneumonia. A striking difference in prevalence and clinical symptomatology by sex was noted; 16 of 20 patients analyzed were males, and they frequently dad severe mucocutaneous syndromes. In contrast, severe conjunctivitis, generalized ulcerative stomatitis, and vesicular or bullous exanthems were not seen in females. Clinicians should suspect infection with M. pneumoniae in patients with exanthem and pneumonia, although other etiologic possibilities should also be considered.

The protean manifestations of Mycoplasma pneumoniae infection in adults

Mycoplasma pneumoniae is a well recognized respiratory pathogen in children and young adults. In addition, M. pneumoniae infections may also involve other organ systems. Reviewed here are the various clinical syndromes in adults caused by this infectious agent, with emphasis on those which have recently been seen at The New York Hospital. Two previously unreported manifestations of M. pneumoniae infection, cranial nerve mononeuropathy and hepatitis, are described, and the laboratory methods for diagnosis are discussed.

Oral mycoplasmas in Sjögren's syndrome

Mycoplasmas were sought in the salivary secretions and minor salivary gland tissue of 26 patients with Sjögren's syndrome or the allied sicca complex. A mycoplasma (M. orale type 1) was recovered from the stimulated parotid saliva of only one case. Possible mechanisms of mycoplasmal cell damage in this and allied disorders are considered and some future lines of investigation are suggested.