1
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Sheiko GE, Belova AN, Rakhmanova EM, Boyko AN. [Combination of post-infectious optic neuritis and Guillain-Barré syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:106-110. [PMID: 37796076 DOI: 10.17116/jnevro2023123091106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The coexistence of optic neuritis and Guillain-Barré syndrome is a rare combination of neurological diseases. The trigger of an autoimmune inflammatory process is often a respiratory mycoplasma infection. Ignorance of such combination can lead to diagnostic and therapy mistakes. This article describes the case of a rare combination of overlapping optic neuritis and Guillain-Barré syndrome, associated with Mycoplasma pneumoniae and provides the short literature review. Further studies are required to identify common pathogenetic mechanisms of combined inflammatory lesions of the optic nerves and peripheral nervous system.
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Affiliation(s)
- G E Sheiko
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E M Rakhmanova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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2
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Co-occurrence of polyneuritis crainials and visual impairment: a case report and literature review. Neurol Sci 2022; 44:1563-1574. [PMID: 36585596 PMCID: PMC9803404 DOI: 10.1007/s10072-022-06580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Polyneuritis cranialis (PNC) with the disease characteristics of Guillain-Barré syndrome (GBS) in addition to both ocular and bulbar weakness in the absence of limb paralysis or ataxia is defined as an unusual variant of GBS. As evidence of central nervous system (CNS) involvement, visual impairment is an unusual finding complicating with GBS spectrum disorders and has never been reported in patients with PNC. METHODS We describe a very rare case who clinically presented with progressive multiple cranial nerve palsy and visual impairment. Furthermore, a literature search of concurrent GBS and optic neuritis (ON) as well as PNC attributed to GBS was conducted. RESULTS A diagnosis of PNC was considered due to the typical clinical characteristics as well as the presence of cerebrospinal fluid cytoalbumin dissociation and serum antibodies against gangliosides. The clinical manifestations and the bilateral optic nerve involvement in brain magnetic resonance imaging further suggested possible optic neuritis (ON). The patient received treatment with intravenous immunoglobulin followed by short-term use of corticosteroids and finally achieved a full recovery. Thirty-two previously reported cases (17 women, mean age 40) of concurrent GBS and ON and 20 cases of PNC (5 women, mean age 40) were analyzed. We further provided a comprehensive discussion on the potential etiologies, clinical features, therapeutic strategies, and prognosis. CONCLUSIONS This rare case with the co-occurrence of PNC and visual impairment and the related literature review may help clinicians advance the understanding of GBS spectrum disorders and make appropriate diagnoses and treatment decisions for the rare variants and CNS complications of GBS.
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Been Sayeed SJ, Moniruzzaman M, Mahmud R, Rashid MB, Chandra Das S. Acute Hemorrhagic Leucoencephalitis (AHLE): A Rare CNS Presentation of Mycoplasma pneumoniae. Cureus 2022; 14:e30921. [DOI: 10.7759/cureus.30921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
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4
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Andersen EW, Ryan MM, Leventer RJ. Guillain-Barré syndrome with optic neuritis. J Paediatr Child Health 2022; 58:887-890. [PMID: 34331483 DOI: 10.1111/jpc.15656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Erik W Andersen
- Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Monique M Ryan
- Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Neuroscience, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard J Leventer
- Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Neuroscience, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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5
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Danni multipli dei nervi cranici. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)46000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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Li W, Ding X, Zhao R, Xiong D, Xie Z, Xu J, Tan M, Li C, Yang C. The role of targeted regulation of COX11 by miR-10a-3p in the development and progression of paediatric mycoplasma pneumoniae pneumonia. J Thorac Dis 2021; 13:5409-5418. [PMID: 34659807 PMCID: PMC8482332 DOI: 10.21037/jtd-21-710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Abstract
Background MiR-10a-3p is associated with the pathogenesis of many immune inflammatory diseases including Mycoplasma pneumoniae pneumonia (MPP), and cytochrome coxidase assembly homologue 11 (COX11) is one of its direct target proteins. This study investigates the function and mechanism of miR-10a-3p targeting with COX11 in the development and progression of paediatric MPP. Methods Ninty-seven paediatric MPP patients and 100 age- and sex-matched healthy children were enrolled. Clinical and laboratory indicators of paediatric MPP patients were collected. The mRNA levels of the COX11 gene and miR-10a-3p were detected by qRT-PCR. THP-1 mononuclear macrophages were stimulated using MPP lipid-associated membrane proteins (Mp-LAMPs). The relative expression level of miR-10a-3p was detected after 12, 24, and 48 h. THP-1 cells were transfected to overexpress or inhibit the expression of miR-10a-3p, miR-10a-3p, COX11 mRNA, NF-κB signalling pathway-related proteins, and C-reactive protein (CRP) were detected after 48 h by Western blot. Results The relative expression level of miR-10a-3p in the MPP group was 2.38±0.52, compared with 1.76±0.38 in control group (t=4.584, P<0.001) whileCOX11 in MPP group was 3.70±1.12, compared to 5.78±1.84 in control group (t=4.876, P<0.001). Pearson correlation analysis showed that miR-10a-3p and COX11 in MPP group presented a negative correlation (r=-0.679, P<0.001). By searching in the prediction website of TargetScan database, it was found that miR-10a-3p and Cox11 genes had targeted regulatory binding sites, and the targeting relationship between miR-10a-3p and Cox11 genes was confirmed by dual luciferase reporting assay in 293T cells. Among paediatric MPP patients, miR-10a-3p expression had a positive correlation with the white blood cells count, erythrocyte sedimentation rate (ESR), and CRP expression, while COX11 mRNA expression had a positive correlation with ESR and CRP. After LAMP stimulation, the miR-10a-3p expression level in THP-1 cells significantly increased (P<0.05). After THP-1 cells were transfected with the miR-10a-3p mimic or inhibitor, the relative expression level of miR-10a-3p significantly increased or decreased, respectively. COX11 expression in the mimic group significantly decreased, whereas COX11 in the inhibitor group significantly increased (both P<0.05). In addition, after transfection, IκBα expression significantly decreased and that of p-IKKα/β, p-p65, and CRP significantly increased in the mimic group, and the opposite was true in the inhibitor group. Conclusions In paediatric MPP, increased miR-10a-3p downregulated COX11, activating NF-κB signalling pathway to promote disease development and progression.
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Affiliation(s)
- Wenhong Li
- Department of Paediatrics, The First Affiliated Hospital of the Qiqihar Medical University, Qiqihar, China
| | - Xin Ding
- Department of Paediatrics, The First Affiliated Hospital of the Qiqihar Medical University, Qiqihar, China
| | - Rui Zhao
- Department of Medical Records, The First Affiliated Hospital of the Qiqihar Medical University, Qiqihar, China
| | - Donghui Xiong
- Department of Personnel, The First Affiliated Hospital of the Qiqihar Medical University, Qiqihar, China
| | - Zhiping Xie
- Department of Epidemiology and Health Statistics Public Health School of Qiqihar Medical University, Qiqihar, China
| | - Jing Xu
- Department of Paediatrics, The First Affiliated Hospital of the Qiqihar Medical University, Qiqihar, China
| | - Meiling Tan
- Department of Paediatrics, The First Affiliated Hospital of the Qiqihar Medical University, Qiqihar, China
| | - Chunyu Li
- Department of Paediatrics, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Chunfu Yang
- Department of Paediatrics, The First Affiliated Hospital of the Qiqihar Medical University, Qiqihar, China
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7
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Loesch-Biffar AM, Junker A, Linn J, Thon N, Heck S, Ottomeyer C, Straube A, Pfister HW. Case Report: Minimal Neurological Deficit of Two Adult Patients With Weston-Hurst Syndrome Due to Early Craniectomy: Case Series and Review of Literature on Craniectomy. Front Neurol 2021; 12:673611. [PMID: 34531810 PMCID: PMC8438150 DOI: 10.3389/fneur.2021.673611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: We describe two new cases of acute hemorrhagic leucoencephalitis (AHLE), who survived with minimal sequelae due to early measures against increased intracranial pressure, particularly craniotomy. The recently published literature review on treatment and outcome of AHLE was further examined for the effect of craniotomy. Methods: We present two cases from our institution. The outcome of 44 cases from the literature was defined either as good (no deficit, minimal deficit/no daily help) or poor outcome (severe deficit/disabled, death). Patients with purely infratentorial lesions (n = 9) were excluded. Fisher's exact test was applied. Results: Two cases are presented: A 43-year-old woman with rapidly progressive aphasia and right hemiparesis due to a huge left frontal white matter lesion with rim contrast enhancement. Pathology was consistent with AHLE. The second case was a 56-year-old woman with rapidly progressive aphasia and right hemiparesis. Cranial MRI showed a huge left temporo-occipital white matter lesion with typical morphology for AHLE. Both patients received craniotomy within the first 24 h and consequent immunosuppressive-immunomodulatory treatment and survived with minimal deficits. Out of 35 supratentorial reported AHLE cases, seven patients received decompressive craniotomy. Comparing all supratentorial cases, patients who received craniotomy were more likely to have a good outcome (71 vs. 29%). Conclusion: Due to early control of the intracranial pressure, particularly due to early craniotomy; diagnosis per biopsy; and immediate start of immunosuppressive-immunomodulatory therapies (cortisone pulse, plasma exchanges), both patients survived with minimal sequelae. Craniotomy plays an important role and should be considered early on in patients with probable AHLE.
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Affiliation(s)
- Anna Mira Loesch-Biffar
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Junker
- Institute of Neuropathology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jennifer Linn
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Suzette Heck
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Caroline Ottomeyer
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Hans Walter Pfister
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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8
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Grzonka P, Scholz MC, De Marchis GM, Tisljar K, Rüegg S, Marsch S, Fladt J, Sutter R. Acute Hemorrhagic Leukoencephalitis: A Case and Systematic Review of the Literature. Front Neurol 2020; 11:899. [PMID: 32973663 PMCID: PMC7468463 DOI: 10.3389/fneur.2020.00899] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To present a patient with acute hemorrhagic leukoencephalitis (AHLE) and a systematic review of the literature analyzing diagnostic procedures, treatment, and outcomes of AHLE. Methods: PubMed and Cochrane databases were screened. Papers published since 01/01/2000 describing adult patients are reported according to the PRISMA-guidelines. Results: A 59-year old male with rapidly developing coma and cerebral biopsy changes compatible with AHLE is presented followed by 43 case reports from the literature including males in 67% and a mean age of 38 years. Mortality was 47%. Infectious pathogens were reported in 35%, preexisting autoimmune diseases were identified in 12%. Neuroimaging revealed uni- or bihemispheric lesions in 65% and isolated lesions of the cerebellum, pons, medulla oblongata or the spinal cord without concomitant hemispheric involvement in 16%. Analysis of the cerebrospinal fluid showed an increased protein level in 87%, elevated white blood cells in 65%, and erythrocytes in 39%. Histology (reported in 58%) supported the diagnosis of AHLE in all cases. Glucocorticoids were used most commonly (97%), followed by plasmapheresis (26%), and intravenous immunoglobulins (12%), without a clear temporal relationship between treatment and the patients' clinical course. Conclusions: Although mortality was lower than previously reported, AHLE remains a life-threatening neurologic emergency with high mortality. Diagnosis is challenging as the level of evidence regarding the diagnostic yield of clinical, neuroimaging and laboratory characteristics remains low. Hence, clinicians are urged to heighten their awareness and to prompt cerebral biopsies in the context of rapidly progressive neurologic decline of unknown origin with the concurrence of the compiled characteristics. Future studies need to focus on treatment characteristics and their effects on course and outcome.
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Affiliation(s)
- Pascale Grzonka
- Intensive Care Units, University Hospital Basel, Basel, Switzerland
| | - Marleen C Scholz
- Intensive Care Units, University Hospital Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Kai Tisljar
- Intensive Care Units, University Hospital Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Intensive Care Units, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Joachim Fladt
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Units, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
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9
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Takeuchi Y, Inatomi Y, Nakajima M, Yonehara T. [Guillain-Barré syndrome with refractory optic neuropathy]. Rinsho Shinkeigaku 2019; 59:652-658. [PMID: 31564705 DOI: 10.5692/clinicalneurol.cn-001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 60-year-old woman with a 3-day history of ataxic gait, blurred vision, and upper extremity paresthesia was admitted to our hospital. She presented with severe visual disturbances (finger counting), ophthalmoplegia, neck weakness, and sensory ataxia. Serum anti-GQ1b antibody, anti-GM3 antibody, and anti-GD3 antibody were strongly positive, which might contribute to the pathogenesis. Since we suspected Guillain-Barré syndrome (GBS), intravenous immunoglobulin therapy (IVIg) and high-dose steroid therapy were administered; however, improvements in her visual acuity were minimal. Additional IVIg and high-dose steroid therapy resulted in limited visual acuity improvements. Therapeutic strategies for patients with GBS and refractory optic neuropathy remain controversial.
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Affiliation(s)
- Yosuke Takeuchi
- Department of Neurology, Saiseikai Kumamoto Hospital
- Department of Neurology, National Hospital Organization Kumamotominami National Hospital
| | | | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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10
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Kowalski T, Fuzzard D, Williams I, Darby J, Mack HG. Bilateral Syphilitic Optic Neuropathy with Secondary Autoimmune Optic Neuropathy and Poor Visual Outcome. Case Rep Ophthalmol 2019; 10:81-88. [PMID: 31043959 PMCID: PMC6477499 DOI: 10.1159/000496142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Abstract
We describe the case of a 65-year-old man who suffered progressive visual loss despite appropriate treatment of ocular syphilis. Our patient initially presented with a unilateral 6th nerve palsy and associated double vision, which self-resolved over 6 months. His ophthalmic examination was otherwise normal. 12 months after the initial complaint, he represented with dyschromatopsia, reduced visual acuity, tonic pupils, and optic nerve atrophy. He tested positive for syphilis and was admitted for treatment of neurosyphilis with high-dose benzylpenicillin. Despite treatment, at a 4-month review his visual acuity remained poor and progression of optic nerve atrophy was noted alongside the development of bilateral central scotomas. Further testing was congruent with a diagnosis of autoimmune optic retinopathy. We propose this to be secondary to his syphilitic infection. Syphilis is known as the "great mimicker," and despite being quite treatable, this case highlights ongoing complexity in the diagnosis and management of syphilis, unfortunately with a poor visual outcome.
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Affiliation(s)
- Tanya Kowalski
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Dujon Fuzzard
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Isla Williams
- Monash University, Alfred Hospital, Prahran, Melbourne, Victoria, Australia.,St Vincent's Hospital, Fitzroy, Victoria, Australia
| | | | - Heather Gwen Mack
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
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Mosquera Gorostidi A, Iridoy Zulet M, Azcona Ganuza G, Gembero Esarte E, Yoldi Petri M, Aguilera Albesa S. Pseudotumour cerebri in children: aetiology, clinical features, and progression. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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12
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Mosquera Gorostidi A, Iridoy Zulet M, Azcona Ganuza G, Gembero Esarte E, Yoldi Petri M, Aguilera Albesa S. Seudotumor cerebri en niños: etiología, características clínicas y evolución. Neurologia 2019; 34:89-97. [DOI: 10.1016/j.nrl.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/08/2016] [Accepted: 11/12/2016] [Indexed: 11/30/2022] Open
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13
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Matsunaga M, Kodama Y, Maruyama S, Miyazono A, Seki S, Tanabe T, Yoshimura M, Nishi J, Kawano Y. Guillain-Barré syndrome and optic neuritis after Mycoplasma pneumoniae infection. Brain Dev 2018; 40:439-442. [PMID: 29429558 DOI: 10.1016/j.braindev.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 01/09/2018] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
We report the case of a 12-year-old girl who developed Guillain-Barré syndrome (GBS) and optic neuritis (ON) following Mycoplasma pneumoniae infection. Her symptoms, including bilateral vision impairment and tingling in her hands and right foot, were resolved after methylprednisolone pulse therapy. Serum anti-galactocerebroside (Gal-C) IgM antibodies were detected in our patient. This is the first report of a child with GBS and ON associated with M. pneumoniae infection.
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Affiliation(s)
- Manaka Matsunaga
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuichi Kodama
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Shinsuke Maruyama
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akinori Miyazono
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shunji Seki
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takayuki Tanabe
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Michiyoshi Yoshimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Junichiro Nishi
- Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshifumi Kawano
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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15
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Baheerathan A, Ross Russell A, Bremner F, Farmer SF. A Rare Case of Bilateral Optic Neuritis and Guillain-Barré Syndrome Post Mycoplasma pneumoniae Infection. Neuroophthalmology 2017; 41:41-47. [PMID: 28228838 DOI: 10.1080/01658107.2016.1237975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022] Open
Abstract
Neurological complications are the most commonly encountered extra-pulmonary manifestation of infection with Mycoplasma pneumoniae (M. pneumoniae). Here the authors report the case of a 39-year-old woman who was admitted with acute-onset bilateral visual loss coinciding with ascending numbness. Clinical examination, neurological imaging, and nerve conduction studies revealed a syndrome of bilateral optic neuritis and Guillain-Barré syndrome (GBS). Serological testing confirmed recent exposure to M. pneumoniae. The patient did not experience any clinical benefit with pulsed intravenous methylprednisolone but demonstrated marked clinical and radiological improvement following 5 days of plasma exchange. This report will explore the diagnostic and therapeutic approach to patients with neuro-ophthalmological and neurological complications of M. pneumoniae infection in addition to discussing previously encountered cases.
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Affiliation(s)
- Aravindhan Baheerathan
- Department of Neurology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
| | - Amy Ross Russell
- Department of Neurology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
| | - Fion Bremner
- Department of Neuro-ophthalmology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
| | - Simon F Farmer
- Department of Neurology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
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16
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Chiang WY, Huang HM. Bilateral monosymptomatic optic neuritis following Mycoplasma pneumoniae infection: a case report and literature review. Indian J Ophthalmol 2016; 62:724-7. [PMID: 25005204 PMCID: PMC4131329 DOI: 10.4103/0301-4738.136236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Herein, we report the clinical findings, treatment choice, and clinical course of a rare case of Mycoplasma pneumoniae (M. pneumoniae) infection with the sole manifestation of optic neuritis (ON). To the best of our knowledge, this is the first case presenting monosymptomatic visual loss without papillitis, neurological symptoms, and abnormal findings on brain imaging. Related articles about ON after M. pneumoniae infection were reviewed to summarize the clinical presentation, possible mechanisms, clinical survey, treatment, and prognosis of this condition. We propose that a Mycoplasma profile is necessary in children who present with ON, especially when this condition is accompanied by prodromal symptoms of the respiratory tract infection.
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Affiliation(s)
| | - Hsiu-Mei Huang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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17
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Mao Z, Hu X. Clinical characteristics and outcomes of patients with Guillain–Barré and acquired CNS demyelinating overlap syndrome: a cohort study based on a literature review. Neurol Res 2014; 36:1106-13. [DOI: 10.1179/1743132814y.0000000400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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18
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19
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Berghoff W. Chronic Lyme Disease and Co-infections: Differential Diagnosis. Open Neurol J 2012; 6:158-78. [PMID: 23400696 PMCID: PMC3565243 DOI: 10.2174/1874205x01206010158] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 12/22/2022] Open
Abstract
In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th, i.e. approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with Borrelia burgdorferi by tick bite resulting in multiple infections but a fraction of co-infections occur independently of tick bite. Clinically relevant co-infections are caused by Bartonella species, Yersinia enterocolitica, Chlamydophila pneumoniae, Chlamydia trachomatis, and Mycoplasma pneumoniae. In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in patients not infected by Borrelia burgdorferi can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by Bartonella henselae, Yersinia enterocolitica, and Mycoplasma pneumoniae. Chlamydia trachomatis primarily causes polyarthritis. Chlamydophila pneumoniae not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by Yersinia enterocolitica. For the remaining infections predominantly tetracyclines and macrolides are used. Quinolones are for alternative treatment, particularly gemifloxacin. For Bartonella henselae, Chlamydia trachomatis, and Chlamydophila pneumoniae the combination with rifampicin is recommended. Erythromycin is the drug of choice for Campylobacter jejuni.
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Blindness, Weakness, and Tingling. Surv Ophthalmol 2012; 57:565-72. [DOI: 10.1016/j.survophthal.2011.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 09/29/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
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Mycoplasmal cerebral vasculopathy in a lymphoma patient: presumptive evidence of Mycoplasma pneumoniae microvascular endothelial cell invasion in a brain biopsy. J Neurol Sci 2011; 309:18-25. [PMID: 21840544 DOI: 10.1016/j.jns.2011.07.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 07/21/2011] [Accepted: 07/22/2011] [Indexed: 11/22/2022]
Abstract
A 73-year-old man had episodic encephalopathy, ataxia and neuropathy. Symptoms largely resolved but adenopathy later lead to the diagnosis of a low-grade follicular lymphoma. The neurological symptoms soon recurred with new pontine calcifications identified by computed tomography. Brain biopsy revealed microvascular endothelial cell nuclear changes. Electron microscopy identified small polymorphic bacteria without a cell wall and with terminal and attachment organelles within endothelial cells and clustered in some microvascular lumina. Immunostaining was positive for Mycoplasma pneumoniae and convalescent serum enzyme immunoassay was positive for M. pneumoniae IgG. The patient again recovered and he was neurologically stable 33 months after the initial episode. The ultrastructural findings of the bacterial cells are distinctive of some mycoplasmal species when compared to other small bacteria. Mycoplasma-like organisms are reported in four autopsied patients who had chronic encephalopathy, movement disorders, and some of the same light- and electron-microscopic findings in the brain as our patient. Direct neuroinvasion by Mycoplasma species has been suggested, while anatomic observations in our patient and in the four autopsy cases show microvascular invasion but not parenchymal invasion. Most mycoplasmal encephalitis may be immune-mediated. The frequency of neurovascular invasion is not known. It may be rare and it may persist.
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22
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Encéphalite à Mycoplasma pneumoniae chez une patiente adulte. Rev Neurol (Paris) 2011; 167:640-4. [DOI: 10.1016/j.neurol.2011.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 01/18/2011] [Accepted: 02/02/2011] [Indexed: 11/19/2022]
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23
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Lai CC, Chang YS, Li ML, Chang CM, Huang FC, Tseng SH. Acute anterior uveitis and optic neuritis as ocular complications of influenza A infection in an 11-year-old boy. J Pediatr Ophthalmol Strabismus 2011; 48 Online:e30-3. [PMID: 21732577 DOI: 10.3928/01913913-20110628-03] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 03/24/2011] [Indexed: 11/20/2022]
Abstract
The authors describe an 11-year-old boy developing bilateral acute anterior uveitis, papillitis in one eye, and neuroretinitis in the other eye after an upper respiratory tract infection of influenza A virus, possibly H1N1. Steroid pulse therapy resolved these conditions. The authors recommend alertness for visual blurring and ocular inflammation after influenza A infection.
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Affiliation(s)
- Chun-Chieh Lai
- Department of Ophthalmology, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd., Tainan, Taiwan
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24
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Güngör L, Güngör I, Oztürk HE, Onar MK. Visual evoked potentials in guillain-barré syndrome. J Clin Neurol 2011; 7:34-9. [PMID: 21519525 PMCID: PMC3079158 DOI: 10.3988/jcn.2011.7.1.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/17/2010] [Accepted: 08/17/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy with various clinical features. Optic neuritis occurs in rare cases. In this study we determined the incidence and patterns of visual evoked potential (VEP) abnormality in GBS in association with ophthalmologic findings. METHODS Thirty-two patients with a diagnosis of GBS were included in the study. The correlation between pathologic VEPs and categories of neurologic deficit and electrophysiological findings were examined statistically. RESULTS The patients ranged in age from 19 to 77 years. Five cases (16%) had abnormal VEPs. All five of these patients exhibited increased P100 latency differences between the two eyes. Other abnormalities were prolonged p100 latency, increased interocular amplitude difference, and distorted p100 configuration. Pathologic signs on ophthalmologic examination were observed in 80% of patients with abnormal VEPs. VEP abnormality was never present in pure axonal forms. There was no significant correlation between pathologic VEP and cerebrospinal fluid protein level or categories of neurologic deficits. CONCLUSIONS Involvement of the optic pathways is not a frequent finding in GBS. When present it is always asymmetric and generally accompanied with pathologic findings on ophthalmologic examination. VEPs may be abnormal in different clinical variants of GBS, and especially in demyelinating forms.
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Affiliation(s)
- Levent Güngör
- Department of Neurology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
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25
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Masutani S, Takayama R, Tsugawa T, Nikaido K, Doi T, Tsutsumi H. Intracranial Hypertension in a Boy with Mycoplasma pneumoniae Infection: The First Report. ACTA ACUST UNITED AC 2009; 36:700-1. [PMID: 15370662 DOI: 10.1080/00365540410020839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Sari Masutani
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan
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26
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Catalan M, Naccarato M, Grandi FC, Capozzoli F, Koscica N, Pizzolato G. Acute hemorrhagic leukoencephalitis with atypical features. Neurol Sci 2009; 30:55-7. [DOI: 10.1007/s10072-008-0003-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 10/13/2008] [Indexed: 12/01/2022]
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27
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Stamm B, Moschopulos M, Hungerbuehler H, Guarner J, Genrich GL, Zaki SR. Neuroinvasion by Mycoplasma pneumoniae in acute disseminated encephalomyelitis. Emerg Infect Dis 2008; 14:641-3. [PMID: 18394283 PMCID: PMC2570910 DOI: 10.3201/eid1404.061366] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report the autopsy findings for a 45-year-old man with polyradiculoneuropathy and fatal acute disseminated encephalomyelitis after having Mycoplasma pneumoniae pneumonia. M. pneumoniae antigens were demonstrated by immunohistochemical analysis of brain tissue, indicating neuroinvasion as an additional pathogenetic mechanism in central neurologic complications of M. pneumoniae infection.
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28
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Graber DJ, Levy M, Kerr D, Wade WF. Neuromyelitis optica pathogenesis and aquaporin 4. J Neuroinflammation 2008; 5:22. [PMID: 18510734 PMCID: PMC2427020 DOI: 10.1186/1742-2094-5-22] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 05/29/2008] [Indexed: 12/25/2022] Open
Abstract
Neuromyelitis optica (NMO) is a severe, debilitating human disease that predominantly features immunopathology in the optic nerves and the spinal cord. An IgG1 autoantibody (NMO-IgG) that binds aquaporin 4 (AQP4) has been identified in the sera of a significant number of NMO patients, as well as in patients with two related neurologic conditions, bilateral optic neuritis (ON), and longitudinal extensive transverse myelitis (LETM), that are generally considered to lie within the NMO spectrum of diseases. NMO-IgG is not the only autoantibody found in NMO patient sera, but the correlation of pathology in central nervous system (CNS) with tissues that normally express high levels of AQP4 suggests NMO-IgG might be pathogenic. If this is the case, it is important to identify and understand the mechanism(s) whereby an immune response is induced against AQP4. This review focuses on open questions about the "events" that need to be understood to determine if AQP4 and NMO-IgG are involved in the pathogenesis of NMO. These questions include: 1) How might AQP4-specific T and B cells be primed by either CNS AQP4 or peripheral pools of AQP4? 2) Do the different AQP4-expressing tissues and perhaps the membrane structural organization of AQP4 influence NMO-IgG binding efficacy and thus pathogenesis? 3) Does prior infection, genetic predisposition, or underlying immune dysregulation contribute to a confluence of events which lead to NMO in select individuals? A small animal model of NMO is essential to demonstrate whether AQP4 is indeed the incipient autoantigen capable of inducing NMO-IgG formation and NMO. If the NMO model is consistent with the human disease, it can be used to examine how changes in AQP4 expression and blood-brain barrier (BBB) integrity, both of which can be regulated by CNS inflammation, contribute to inductive events for anti-AQP4-specific immune response. In this review, we identify reagents and experimental questions that need to be developed and addressed to enhance our understanding of the pathogenesis of NMO. Finally, dysregulation of tolerance associated with autoimmune disease appears to have a role in NMO. Animal models would allow manipulation of hormone levels, B cell growth factors, and other elements known to increase the penetrance of autoimmune disease. Thus an AQP4 animal model would provide a means to manipulate events which are now associated with NMO and thus demonstrate what set of events or multiplicity of events can push the anti-AQP4 response to be pathogenic.
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Affiliation(s)
- David J Graber
- Department of Pathology, Dartmouth Medical School, Lebanon, New Hampshire, USA.
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29
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Abstract
Optic neuritis (ON) is an inflammatory disease whose etiology remains obscure. We report a case of ON attributable to Mycoplasma pneumoniae (MP). A 26-year-old man presented a sudden onset bilateral loss of visual acuity, without any history of pulmonary or ear-nose-throat infection. Diagnosis of optic neuritis was made on the basis of visual field loss, though optic disks and visual evoked potentials were normal. Color vision could not be assessed due to a congenital dyschromatopsia. The neurological examination was normal. On magnetic resonance imaging, there was no enhancement or enlargement of optic nerves, but a demyelinating lesion of the cervical spinal cord. Lumbar puncture revealed lymphocytic meningitis with 60 white blood cells, all of them being lymphocytes. Oligoclonal bands were presents in the CSF. With no evidence of any other infection or auto-immune disease, the diagnosis of Mycoplasma pneumoniae infection was established due to the presence of Mycoplasma pneumoniae specific IgM antibodies. Outcome was quite favorable within three months without treatment. Neurological symptoms--encephalitis, meningitis, polyradiculitis, or more rarely ON or cerebella ataxia--are the main extra pulmonary manifestations of Mycoplasma pneumoniae infection. Search for anti-Mycoplasma pneumoniae IgM antibodies should be performed routinely when On is diagnosed.
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30
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An JY, Yoon B, Kim JS, Song IU, Lee KS, Kim YI. Guillain-Barré syndrome with optic neuritis and a focal lesion in the central white matter following Epstein-Barr virus infection. Intern Med 2008; 47:1539-42. [PMID: 18758131 DOI: 10.2169/internalmedicine.47.1224] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of Guillain-Barré syndrome (GBS) accompanied by optic neuritis and a central white matter lesion subsequent to Epstein-Barr virus (EBV) infection. A 49-year-old man presented with visual disturbance and hemiparesis one week after developing cold-like symptoms. T2- and diffusion-weighted brain MRI showed a high-signal intensity lesion in the left internal capsule. The patient's visual acuity improved during steroid pulse therapy, but his hemiparesis progressed to quadriparesis. Nerve conduction studies showed demyelination predominant in the distal nerve terminals, consistent with GBS. Serological testing suggested EBV reinfection. Our findings indicate that EBV-related central and peripheral demyelination can occur simultaneously and can be successfully treated with a combination of corticosteroids and immunoglobulin.
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Affiliation(s)
- Jae Young An
- Department of Neurology, College of Medicine, The Catholic University of Korea
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31
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Schulze Beerhorst K, Klein B, Oelerich M, Rieke K. Koinzidenz von Guillain-Barré-Syndrom und Myelitis. DER NERVENARZT 2007; 78:445-50. [PMID: 17375275 DOI: 10.1007/s00115-007-2254-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 28-year-old male patient developed Guillain-Barré syndrome after a pulmonary infection with typical CSF findings. Five days after the onset, pyramidal signs and spastic increase of muscle tonus in the legs were found. The MRI showed increased signals in the whole spinal cord which were identified as myelitis after review of clinical and neurophysiologic findings. There was a remarkable difference between the dramatic pathologic signals on MRI and the mild clinical symptoms. Four months after onset the patient had no more complaints and presented basically recovered in the clinical examination. The existence of Guillain-Barré syndrome together with myelitis is very rare. A patient with such a good outcome in spite of an extended myelitis is extraordinary.
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Affiliation(s)
- K Schulze Beerhorst
- Abteilung für Neurologie, St. Marienhospital, Knappenstrasse 19, 59071 Hamm.
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32
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Broaders SA, Hooper WC, Phillips DJ, Talkington DF. Mycoplasma pneumoniae subtype-independent induction of proinflammatory cytokines in THP-1 cells. Microb Pathog 2006; 40:286-92. [PMID: 16678382 DOI: 10.1016/j.micpath.2006.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 02/27/2006] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
Mycoplasma pneumoniae can be divided into two main subtypes depending on the amino acid sequences of the P1 adhesin and the P65 protein, both located in the attachment organelle. Differences between these subtypes in infectivity, virulence and interaction with host cells have not been extensively studied. Using ELISA to measure released protein and real-time PCR to quantify mRNA, we have demonstrated that both M. pneumoniae subtypes significantly increased tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and interleukin-8 (IL-8) at comparable levels in THP-1 cells over a 72 h period of time. However, subtype 2 induced a statistically significant increase (P<0.001) in the release of interleukin-1beta at 24 h post-infection compared to subtype 1. These data provide evidence that the induction of proinflammatory cytokine gene and protein expression by M. pneumoniae is not dependent on the infecting subtype.
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Affiliation(s)
- Samantha A Broaders
- Mail Stop C03, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
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33
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Tsiodras S, Kelesidis T, Kelesidis I, Voumbourakis K, Giamarellou H. Mycoplasma pneumoniae-associated myelitis: a comprehensive review. Eur J Neurol 2006; 13:112-24. [PMID: 16490040 DOI: 10.1111/j.1468-1331.2006.01174.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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MESH Headings
- Diagnosis, Differential
- Encephalomyelitis, Acute Disseminated/diagnosis
- Encephalomyelitis, Acute Disseminated/immunology
- Encephalomyelitis, Acute Disseminated/microbiology
- Encephalomyelitis, Acute Disseminated/therapy
- Humans
- Mycoplasma/pathogenicity
- Myelitis, Transverse/diagnosis
- Myelitis, Transverse/immunology
- Myelitis, Transverse/microbiology
- Myelitis, Transverse/therapy
- Peptides
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/immunology
- Pneumonia, Mycoplasma/microbiology
- Pneumonia, Mycoplasma/therapy
- PubMed/statistics & numerical data
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Affiliation(s)
- S Tsiodras
- Fourth Academic Department of Internal Medicine and Infectious Diseases, Attikon University Hospital, University of Athens Medical School, Athens, Greece.
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34
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Puljiz I, Kuzman I, Dakovic-Rode O, Schönwald N, Mise B. Chlamydia pneumoniae and Mycoplasma pneumoniae pneumonia: comparison of clinical, epidemiological characteristics and laboratory profiles. Epidemiol Infect 2005; 134:548-55. [PMID: 16316495 PMCID: PMC2870427 DOI: 10.1017/s0950268805005522] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2005] [Indexed: 11/07/2022] Open
Abstract
The purpose of our retrospective 3-year study was to analyse and compare clinical and epidemiological characteristics in hospitalized patients older than 6 years with community-acquired pneumonia (CAP) caused by Chlamydia pneumoniae (87 patients) and Mycoplasma pneumoniae (147 patients). C. pneumoniae and M. pneumoniae infection was confirmed by serology. C. pneumoniae patients were older (42.12 vs. 24.64 years), and were less likely to have a cough, rhinitis, and hoarseness (P<0.001). C. pneumoniae patients had higher levels of C-reactive protein (CRP), and aspartate aminotransferase (AST) than M. pneumoniae patients (P<0.001). Pleural effusion was recorded more frequently in patients with M. pneumoniae (8.84 vs. 3.37%). There were no characteristic epidemiological and clinical findings that would distinguish CAP caused by M. pneumoniae from C. pneumoniae. However, some factors are indicative for C. pneumoniae such as older age, lack of cough, rhinitis, hoarseness, and higher value of CRP, and AST.
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Affiliation(s)
- I Puljiz
- University Hospital for Infectious Diseases Dr Fran Mihaljevic, Zagreb, Croatia.
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35
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Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005; 51:343-54. [PMID: 16181677 DOI: 10.1016/j.jinf.2005.07.005] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 07/23/2005] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- S Tsiodras
- 4th Academic Department of Internal Medicine and Infectious Diseases, Attikon University Hospital, University of Athens Medical School, 1 Rimini Street, Xaidari, 12462 Athens, Greece.
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36
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Guleria R, Nisar N, Chawla TC, Biswas NR. Mycoplasma pneumoniae and central nervous system complications: a review. ACTA ACUST UNITED AC 2005; 146:55-63. [PMID: 16099235 DOI: 10.1016/j.lab.2005.04.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 03/28/2005] [Accepted: 04/03/2005] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Randeep Guleria
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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37
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Leonardi S, Pavone P, Rotolo N, La Rosa M. Stroke in two children with Mycoplasma pneumoniae infection. A causal or casual relationship? Pediatr Infect Dis J 2005; 24:843-5. [PMID: 16148858 DOI: 10.1097/01.inf.0000177284.88356.56] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report on 2 children who had a stroke biologically related to Mycoplasma pneumoniae infection. Invasion of the central nervous system and an immune mechanism represent 2 pathogenesis pathways. Prompt macrolide therapy does not prevent stroke, but immediate and aggressive immunosuppressive treatment seems to help recovery.
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38
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Mader I, Wolff M, Nägele T, Niemann G, Grodd W, Küker W. MRI and proton MR spectroscopy in acute disseminated encephalomyelitis. Childs Nerv Syst 2005; 21:566-72. [PMID: 15711984 DOI: 10.1007/s00381-004-1077-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Acute disseminated encephalomyelitis (ADEM) is one of a group of demyelinating disorders of the central nervous system (CNS). It is said to be attributed to an overshooting immunologic response following an infection or vaccination. The clinical course and type of manifestation is heterogeneous. The early application of corticosteroids has been shown to be beneficial to outcome; thus, an early diagnosis is highly desirable. METHODS The potential diagnostic value of advanced MR techniques such as proton MR spectroscopy and diffusion-weighted imaging (DWI) was investigated in two paediatric patients with ADEM, one of whom had a remitting and relapsing clinical course and presented with additional cranial nerve involvement. Proton MR spectroscopy revealed typical signs of acute demyelination, such as increased macromolecules, not found in other forms of non-necrotising pathology. CONCLUSION The addition of proton MR spectroscopy and DWI adds to the diagnostic power of MRI in the setting of post-infectious demyelinating disorders of the CNS or ADEM and may obviate the need for biopsy.
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Affiliation(s)
- I Mader
- Department of Neuroradiology, University of Tübingen Medical School, Germany
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39
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Aydin A, Atasever S, Cakmakci H. Acute disseminated encephalomyelitis presenting with bilateral transient amaurosis. Pediatr Neurol 2005; 32:60-3. [PMID: 15607608 DOI: 10.1016/j.pediatrneurol.2004.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 06/10/2004] [Indexed: 11/24/2022]
Abstract
A 4-year-old male presented with acute disseminated encephalomyelitis with seizures and transient amaurosis after initial symptoms of a flulike febrile infection 1 week earlier. Immunoglobulin M type antibody titers against Mycoplasma pneumoniae were significantly increased in serum and cerebrospinal fluid. The patient improved appreciably on immunosuppressive therapy with immunoglobulin. This patient exemplifies a rare case of acute disseminated encephalomyelitis presenting with bilateral transient amaurosis as a complication of M. pneumoniae infection. Aydin A, Atasever S, Cakmakci H. Acute disseminated encephalomyelitis presenting with bilateral transient amaurosis.
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Affiliation(s)
- Adem Aydin
- Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey
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40
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Müller N, Riedel M, Blendinger C, Oberle K, Jacobs E, Abele-Horn M. Mycoplasma pneumoniae infection and Tourette's syndrome. Psychiatry Res 2004; 129:119-25. [PMID: 15590039 DOI: 10.1016/j.psychres.2004.04.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Accepted: 04/18/2004] [Indexed: 10/26/2022]
Abstract
An association between infection and Tourette's syndrome (TS) has been described repeatedly. A role for streptococcal infection (PANDAS) has been established for several years, but the involvement of other infectious agents such as Borrelia Burgdorferi or Mycoplasma pneumoniae has only been described in single case reports. We examined antibody titers against M. pneumoniae and various types of antibodies by immunoblot in patients and in a sex- and age-matched comparison group. Participants comprised 29 TS patients and 29 controls. Antibody titers against M. pneumoniae were determined by microparticle agglutination (MAG) assay and confirmed by immunoblot. Elevated titers were found in significantly more TS patients than controls (17 vs. 1). Additionally, the number of IgA positive patients was significantly higher in the TS group than in the control group (9 vs. 1). A higher proportion of increased serum titers and especially of IgA antibodies suggests a role for M. pneumoniae in a subgroup of patients with TS and supports the finding of case reports implicating an acute or chronic infection with M. pneumoniae as one etiological agent for tics. An autoimmune reaction, however, has to be taken into account. In predisposed persons, infection with various agents including M. pneumoniae should be considered as at least an aggravating factor in TS.
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Affiliation(s)
- Norbert Müller
- Hospital for Psychiatry and Psychotherapy, Ludwig-Maximilians-University München, Nussbaumstrasse 7, D-80336 München, Germany.
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41
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Yang J, Hooper WC, Phillips DJ, Talkington DF. Cytokines in Mycoplasma pneumoniae infections. Cytokine Growth Factor Rev 2004; 15:157-68. [PMID: 15110799 DOI: 10.1016/j.cytogfr.2004.01.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is one of the smallest free-living bacteria known. Along with other unique characteristics of this genus, it lacks the typical peptidoglycan cell wall of most eubacteria. Best known for causing tracheobronchitis and atypical pneumonia in humans, this pathogen also causes a number of extrapulmonary syndromes such as meningitis/encephalitis and arthritis. Recent studies also suggest that infection may be associated with chronic conditions such as asthma. Although the mechanisms of M. pneumoniae pathogenesis remain to be elucidated, one important component of M. pneumoniae infections is the induction of proinflammatory and other cytokines in both acute and chronic conditions. In this review, we survey the induction of cytokines by M. pneumoniae in different model systems, and we discuss the possible role of induced cytokines in M. pneumoniae pathogenesis.
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Affiliation(s)
- Jun Yang
- Department of Pathology and Pathophysiology, and Proteomics Research Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310031, China
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Daxboeck F, Blacky A, Seidl R, Krause R, Assadian O. Diagnosis, treatment, and prognosis of Mycoplasma pneumoniae childhood encephalitis: systematic review of 58 cases. J Child Neurol 2004; 19:865-71. [PMID: 15658791 DOI: 10.1177/08830738040190110401] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most of the knowledge on Mycoplasma pneumoniae encephalitis in children is based on case reports or small case series. The aim of this study was to assess the important features of the disease by a systematic review of previously published cases. Overall, 58 cases (22 female, 36 male; median age 10 years, range: 2-17 years), derived from 38 reports, were reviewed. Forty-five patients (76%) had flulike or respiratory symptoms prior to the onset of neurologic disease, and 23 patients (40%) presented with pulmonary infiltrates. Cerebrospinal fluid (CSF) pleocytosis (mostly mononuclear cells) and elevated cerebrospinal fluid protein counts were present in 34 (59%) and 21 (36%) patients, respectively. Cranial computed tomography (CT) or magnetic resonance imaging (MRI) abnormalities were seen in 18 (31%) and 17 (29%) patients, respectively, whereby various different presentations were observed. Forty-four patients (76%) received antimicrobial therapy active against mycoplasmas, most frequently erythromycin (n = 29) or minocycline (n = 6). Only in one patient, cure was directly attributed to antimicrobial therapy (with chloramphenicol) by the respective authors. Thirty-three patients (57%) recovered without sequelae, 20 patients (34%) had minor to major sequelae, and 5 patients (9%) died. A high cerebrospinal fluid cell count, cerebrospinal fluid protein elevation, and higher age were associated with an unfavorable outcome.
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Affiliation(s)
- Florian Daxboeck
- Division of Hospital Hygiene, Clinical Institute for Hygiene and Medical Microbiology, University of Vienna, University Hospital Vienna, Vienna, Austria.
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43
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Sparing R, Spitzer C, Häfner H, Zolldann D, Reinges MHT, Krings T, Noth J, Kosinski CM. Fulminante Mycoplasma-pneumoniae-assoziierte Meningoenzephalitis des Erwachsenen. DER NERVENARZT 2004; 75:1016-21. [PMID: 15103415 DOI: 10.1007/s00115-004-1718-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mycoplasma pneumoniae (M. pn.) commonly causes respiratory tract infections in humans. In a certain percentage of cases it may also be associated with various peripheral and central nervous system manifestations. We report a case of a 38-year-old previously healthy man who presented with hemiplegia and somnolence after he had suffered from a febrile respiratory infection 10 days earlier. Clinical features and laboratory investigations supported the diagnosis of an acute M. pneumoniae-associated meningoencephalitis. He was treated by an aggressive antibiotic and immunomodulatory regimen over the course of several weeks in the neurocritical care unit. Decompressive hemicraniectomy was performed due to life-threatening raised intracranial pressure. However, the patient recovered almost completely and presented with a mild neurological deficit after 3 months. Based on this case we give a review of the literature and discuss potential pathomechanisms and diagnostic approaches.
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Affiliation(s)
- Roland Sparing
- Neurologische Klinik, Universitätsklinikum der RWTH Aachen, Aachen.
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Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004; 17:697-728, table of contents. [PMID: 15489344 PMCID: PMC523564 DOI: 10.1128/cmr.17.4.697-728.2004] [Citation(s) in RCA: 843] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Ken B Waites
- Department of Pathology, WP 230, University of Alabama at Birmingham, 619 19th St. South, Birmingham, AL 35249, USA.
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45
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Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, P230 West Pavilion, Birmingham, AL 35233, USA.
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46
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Hawley RJ, Madrid R. Post-infectious central and peripheral nervous system diseases in patient with Devic's disease and Guillain-Barre syndrome. Eur J Neurol 2003; 10:600. [PMID: 12940848 DOI: 10.1046/j.1468-1331.2003.00659.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Bitnun A, Ford-Jones E, Blaser S, Richardson S. Mycoplasma pneumoniae ecephalitis. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2003; 14:96-107. [PMID: 12881797 DOI: 10.1053/spid.2003.127226] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mycoplasma pneumoniae causes between 5 and 10 percent of acute childhood encephalitis in Europe and North America. Encephalitis due to this organism may be caused by direct infection of the brain, immune-mediated brain injury or thromboembolic phenomenon. The prognosis is guarded with 20 to 60 percent suffering neurologic sequelae. The diagnosis of M. pneumoniae encephalitis should be based on strong evidence of M. pneumoniae infection that includes detection of the organism in culture or using molecular detection techniques in addition to serology and exclusion of other potential etiologies. Antibiotic therapy should be considered for all children with suspected M. pneumoniae encephalitis; antibiotics with good central nervous system (CNS) penetration such as ciprofloxacin, doxycycline, chloramphenicol or azithromycin are appropriate under most circumstances. Immune modulating therapies, such as corticosteroids, intravenous immune globulin or plasmapharesis, should be considered in those with immune-mediated syndromes such as acute disseminated encephalomyelitis.
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Affiliation(s)
- Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
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48
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Sotgiu S, Pugliatti M, Rosati G, Deiana GA, Sechi GP. Neurological disorders associated with Mycoplasma pneumoniae infection. Eur J Neurol 2003; 10:165-8. [PMID: 12603292 DOI: 10.1046/j.1468-1331.2003.00535.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neurological syndromes caused by Mycoplasma pneumoniae (MP) infection are occasionally reported in adults, usually in the post-infectious period, and three computed tomography documented cases have recently appeared in this journal. Here we present the cases of three young women with recent respiratory tract infection caused by MP some weeks prior to neurological complication documented by magnetic resonance imaging. Two cases suffered from demyelinating disorders of the central nervous system (CNS). The other case had a middle cerebral artery thrombosis, a rare complication of MP infection. Another potential risk factor for stroke in the latter case was the use of oral contraceptives. Recent infection with MP is discussed as a risk factor for cerebrovascular disorders and CNS demyelinating diseases.
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Affiliation(s)
- S Sotgiu
- Institute of Clinical Neurology, University of Sassari, Sassari, Italy.
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