Poliomyelitis-like syndrome caused by Mcyoplasma pneumoniae

Surgical Strategies for Brachial Plexus Polio-Like Paralysis

BACKGROUND

Brachial plexus polio-like paralysis is an acute flaccid paralysis of the upper limb following viral infection. Surgical approaches to the paralytic limb have not previously been discussed in the literature. This study is the first to describe the clinical course and propose a surgical strategy for disabilities related to poliomyelitis-like paralysis.

METHODS

Between 1982 and 2004, 17 patients (11 boys and six girls) presented with acute flaccid paralysis of the upper limb. Their clinical course was reviewed retrospectively. Average age at onset of disease was 2 years (range, 4 months to 13 years). All patients had disability in shoulder abduction and/or elbow flexion. Ten patients underwent reconstructive surgery.

RESULTS

Stage V shoulder abduction (>160 degrees) according to Gilbert's classification was regained in five patients who underwent nerve transfer within 1 year of paralysis. One patient treated by nerve transfer after 3 years of paralysis obtained only stage I abduction (<45 degrees). In two patients, multiple local muscle transfers were performed for the shoulder abduction disability, resulting in mild improvement from stage I to stage II abduction (<90 degrees). In four patients, functioning free muscle transplantation for elbow flexion was carried out, and all regained functional M4 muscle strength. Of seven patients in the nonsurgical group, two had complete spontaneous recovery within 1 year, but five had permanent residual limb paralysis at a mean follow-up of 10 years.

CONCLUSIONS

Surgical strategies, including nerve transfer for shoulder abduction deficit within 1 year after attack and functioning free muscle transplantation for the elbow flexion deficit in the late period, should be considered for this disease. Late reconstruction, either by nerve transfer or by using local multiple muscle transfer for shoulder abduction, is ineffective.

Mycoplasma pneumoniae-associated myelitis: a comprehensive review

Myelitis is one of the most severe central nervous system complications seen in association with Mycoplasma pneumoniae infections and both acute transverse myelitis (ATM) as well as acute disseminated encephalomyelitis (ADEM) have been observed. We reviewed all available literature on cases of Mycoplasma spp. associated ATM as well as ADEM with dominant spinal cord pathology and classified those cases according to the strength of evidence implicating M. pneumoniae as the cause. A wide range of data on diagnosis, epidemiology, immunopathogenesis, clinical picture, laboratory diagnosis, neuroimaging and treatment for this rare entity is presented. The use of highly sensitive and specific molecular diagnostic techniques may assist in clearly elucidating the role of M. pneumoniae in ATM/ADEM syndromes in the near future. Immunomodulating therapies may have a role in treating such cases.

Central nervous system manifestations of Mycoplasma pneumoniae infections

Mycoplasma pneumoniae infection is associated with several manifestations from the central nervous system (CNS) such as encephalitis, aseptic meningitis, acute transverse myelitis, stroke, and polyradiculopathy. In the current paper epidemiologic, clinical, laboratory and treatment data on these manifestations are reviewed. The M. pneumoniae induced immune dysregulation and its contributing role in the pathogenesis of neurological insult is discussed. The recent introduction in clinical practice of newer molecular diagnostic techniques has helped in establishing a firmer association between M. pneumoniae infection and CNS disease especially encephalitis. Clinicians should be aware of the potential association between M. pneumoniae infection and several CNS manifestations. The role of various anti-microbial or immunomodulating therapies in treating such manifestations should be further explored.

Mycoplasma pneumoniae and central nervous system complications: a review

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. Little is known about the extrapulmonary manifestations of this organism. Numerous central nervous system (CNS) manifestations have been described with M. pneumoniae. CNS involvement is probably the most common site of involvement in addition to the respiratory system. Up to 7% of patients hospitalized with M. pneumoniae may have CNS symptoms. Common CNS presentations include encephalitis, aseptic meningitis, polyradiculitis, cerebellar ataxia, and myelitis. The mechanism behind these CNS manifestations remains unclear. Direct invasion, neurotoxin production, or an immune-mediated mechanism has been proposed. Newer diagnostic techniques for the direct detection of the antigen and the microorganism are proving useful for the detection of extrapulmonary disease. This review comprehensively reviews the CNS complications that have been reported with M. pneumoniae.

Hopkins syndrome associated with Mycoplasma infection

A 3-year-old boy who presented with flaccid weakness of the right lower limb 1 week after treatment for an acute attack of asthma is described. Sensation was normal. Electromyography suggested anterior horn cell damage and persisting weakness. These features suggested a diagnosis of Hopkins syndrome. Complement fixation test titer and agglutination test titer to Mycoplasma pneumoniae were significantly increased, suggesting a previously unreported association with this syndrome. We review possible infectious agents detected in previous reports.

Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection

A 12-year-old girl with serologically-proved Mycoplasma pneumoniae infection developed right-sided hemiparalysis 10 days after the onset of the disease. Cerebral infarction was documented by cranial computed tomography; cerebral angiography revealed left carotid artery occlusion. Cerebrospinal fluid examination was normal. Cerebral infarction is a rare central nervous system complication of M. pneumoniae infection; however, occlusion of the internal carotid artery near the bifurcation has never been demonstrated; therefore, this patient with central nervous system complication of M. pneumoniae infection is unique.

Postinfectious encephalomyelitis with localized basal ganglia involvement

The diagnosis of postinfectious encephalomyelitis with symmetric lesions in the basal ganglia was confirmed by magnetic resonance imaging in 2 patients. A 7-year-old patient experienced severe dystonia and hyperreflexia; magnetic resonance imaging demonstrated bilateral lesions in the putamina and basis pontes. The other patient, a 2-year-old female, manifested hypotonia, facial grimacing, and athetosis. Symmetric lesions in the globus pallidus and substantia nigra were demonstrated by imaging studies. The nature and monophasic course of illness in these 2 patients, as well as the symmetric involvement of specific regions of the basal ganglia, may result from an immune-mediated postinfectious demyelinating process.

Mycoplasma pneumoniae protein involved in the antibody response in human infection

Antigen from purified Mycoplasma pneumoniae organisms treated with Tween-80-ether was used in a solid phase enzyme immunoassay and compared with the conventional lipid containing complement fixation antigen for measuring antibodies in sera from patients with aseptic or bacterial meningitis or with apparent M pneumoniae infection. In immunoblotting of the enzyme immunoassay antigen, enzyme immunoassay positive sera detected a polypeptide at Mr = 180.000-200.000, while enzyme immunoassay negative sera whether positive or negative in the complement fixation test did not. These results indicate that the enzyme immunoassay antigen containing the high molecular weight polypeptide can be used to measure M pneumoniae antibodies more specifically than the conventional lipid containing complement fixation antigen.