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Liu J, Li Y. Thrombosis associated with mycoplasma pneumoniae infection (Review). Exp Ther Med 2021; 22:967. [PMID: 34335909 PMCID: PMC8290426 DOI: 10.3892/etm.2021.10399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Mycoplasma pneumoniae is a common pathogen causing respiratory infections in children and adults. In addition to respiratory diseases, Mycoplasma pneumoniae is also involved in numerous extrapulmonary diseases. Thrombosis is an extrapulmonary manifestation associated with Mycoplasma pneumoniae infection. In recent years, an increasing number of case reports have been published identifying thrombosis secondary to Mycoplasma pneumoniae infection. In the present study, the available relevant literature in English available on PubMed, Medline and Web of Science was consulted. The results of the present study demonstrated that in patients with thrombosis caused by Mycoplasma pneumoniae infection, some of the factors causing thrombosis are transient and some are due to hereditary thrombophilia. Following timely treatment, the majority of patients recovered completely but some patients had a poor prognosis. The present review focuses on the pathogenesis, clinical features, treatment and prognosis of this crucial issue, which contributes toward the understanding of the disease.
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Affiliation(s)
- Jingwei Liu
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yumei Li
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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2
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Sheng CQ, Yang CF, Ao Y, Zhao ZY, Li YM. Mycoplasma pneumoniae pneumonia with pulmonary embolism: A study on pediatric cases in Jilin province of China. Exp Ther Med 2021; 21:201. [PMID: 33574906 PMCID: PMC7818525 DOI: 10.3892/etm.2021.9634] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
Mycoplasma is one of the most common pathogens causing community-acquired pneumonia in pediatric patients. In recent years, the number of refractory or severe cases with drug resistance has been gradually increasing and cases that developed embolism after Mycoplasma pneumoniae (M. pneumoniae) infection have been reported. The present study retrospectively analyzed the clinical features, diagnosis and treatment of M. pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in a series of 7 cases encountered between January 1st, 2016 to August 1st, 2019 at the Department of Pediatric Intensive Care Unit of The First Hospital of Jilin University (Changchun, China). Combined with relevant Chinese and international studies published during the last two decades, a comprehensive analysis was performed. All of the pediatric patients of the present study had fever, cough and dyspnea respiratory symptoms at onset and the disease progressed rapidly. Thereafter, PE was confirmed by a series of examinations. Pulmonary CT indicated patchy inflammations and significantly elevated D-dimer levels, accompanied by positive anticardiolipin antibodies. Furthermore, a filling defect in the pulmonary artery branch was observed on CT pulmonary angiography (CTPA) examination. In 2 cases, the condition was improved with anti-infection and anticoagulation treatment with low-molecular-weight heparin and warfarin, respectively, and the pulmonary embolism disappeared after 3-4 months. A total of 5 cases, who were not responsive to the drug treatment, underwent surgical resection. During the operation, the local tissues were determined to be infarcted and the pathological diagnosis was consistent with pulmonary infarction. Among the 5 cases, 2 died of Acute Respiratory Distress Syndrome at 3-8 days after the operation. The remaining patients underwent 6-12 months of follow-up and respiratory rehabilitation and their quality of life is now good. In conclusion, compared with healthy individuals, pediatric patients with critical MPP have an elevated risk of embolism. It is necessary to be vigilant regarding whether MMP is combined with PE and perform timely CTPA examination. Early detection, early treatment and surgical intervention (if necessary) may significantly reduce the risk of mortality and disability.
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Affiliation(s)
- Chu-Qiao Sheng
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chun-Feng Yang
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yu Ao
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi-Yue Zhao
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yu-Mei Li
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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3
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Becker MA, Cannon J, Certa K. A Case of Mycoplasma Pneumoniae Encephalopathy Presenting as Mania. J Acad Consult Liaison Psychiatry 2020; 62:150-154. [PMID: 33127068 DOI: 10.1016/j.psym.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Madeleine A Becker
- Department of Psychiatry and Human Behavior, Department of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Jennifer Cannon
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA.
| | - Kenneth Certa
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA
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4
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Li T, Yu H, Hou W, Li Z, Han C, Wang L. Evaluation of variation in coagulation among children with Mycoplasma pneumoniae pneumonia: a case-control study. J Int Med Res 2017. [PMID: 28643533 PMCID: PMC5805204 DOI: 10.1177/0300060517709613] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective Acute organ embolism in children with Mycoplasma pneumoniae
pneumonia (MPP) has been reported, but changes in coagulation are unclear.
This study aimed to investigate changes in coagulation in children with
MPP. Methods A total of 185 children with MMP (cases) and 117 healthy children (controls)
were recruited. We measured prothrombin time (PT), activated partial
thromboplastin time (APTT), thrombin time (TT), and plasma fibrinogen (FIB)
and D-dimer levels. Results Plasma FIB (3.39 ± 0.96 g/L vs 2.93 ± 0.6 6g/L, t = 4.50) and D-dimer
(326.45 ± 95.62mg/L vs 263.93 ± 103.32mg/L, t=5.36) in MPP children were
higher than controls and PT (9.54 ± 4.97S vs 11.48 ± 5.96S, t=3.05) and APTT
(31.41 ± 12.01S vs 38.38 ± 11.72S, t=4.95) were shorter
than controls. FIB, D-dimer, PT, and APTT were not different between the
high IgM-titre and low-titre groups. The areas under the receiver operating
characteristic curves in cases and controls for plasma FIB and D-dimer
levels were 0.654 (95% confidence interval [CI], 0.593–0.716,
P = 0.031) and 0.682 (95% CI, 0.619–0.744,
P = 0.032), respectively. Conclusions Children with MPP have a higher risk of blood coagulation and thrombosis.
Controlling these problems should be considered as soon as possible.
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Affiliation(s)
- Tianhua Li
- 1 Department of Paediatrics, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Haiying Yu
- 1 Department of Paediatrics, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Weina Hou
- 2 Department of Radiology, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Zhiyong Li
- 1 Department of Paediatrics, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Chunfang Han
- 1 Department of Paediatrics, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Lihong Wang
- 3 Department of Prenatal Diagnosis, Weifang People's Hospital, Weifang City, Shandong Province, China
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5
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Chahin A, Opal SM. Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations. Infect Dis Clin North Am 2017; 31:111-121. [PMID: 28159171 PMCID: PMC7135102 DOI: 10.1016/j.idc.2016.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Severe legionella pneumonia poses a diagnostic challenge and requires early intervention. Legionnaire's disease can have several presenting signs, symptoms, and laboratory abnormalities that suggest that Legionella pneumophila is the pathogen, but none of these are sufficient to distinguish L pneumophila pneumonia from other respiratory pathogens. L pneumophila is primarily an intracellular pathogen and needs treatment with antibiotics that efficiently enter the intracellular space.
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Affiliation(s)
- Abdullah Chahin
- Critical Care Division, Miriam Hospital, Brown University Alpert School of Medicine, Providence, RI, USA; Infectious Disease Division, Rhode Island Hospital, Brown University Alpert School of Medicine, Providence, RI, USA.
| | - Steven M Opal
- Critical Care Division, Miriam Hospital, Brown University Alpert School of Medicine, Providence, RI, USA; Infectious Disease Division, Rhode Island Hospital, Brown University Alpert School of Medicine, Providence, RI, USA
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6
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Bao Y, Li X, Wang K, Zhao C, Ji X, Jiang M. Central retinal artery occlusion and cerebral infarction associated with Mycoplasma pneumonia infection in children. BMC Pediatr 2016; 16:210. [PMID: 27938350 PMCID: PMC5148912 DOI: 10.1186/s12887-016-0750-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/02/2016] [Indexed: 03/13/2023] Open
Abstract
Background Central retinal artery occlusion (CRAO) is an arterial ischemic stroke, rarely occurred in children accompanied with asymptomatic cerebral infarction and almost never involved in severe pneumonia related to Mycoplasma pneumonia infection. Case presentation An 8-year-old boy with severe pneumonia related to Mycoplasma pneumonia infection that developed loss of vision in the left eye on the 14th day. No light perception and no pupillary reaction to light were found in the left eye. The fundus examination revealed a cherry red spot with severe retinal edema at the macular and peripapillary area, and the optic disc was pale in the left eye but normal in the right eye, suggesting CRAO in the left eye. No obvious neurological symptoms and signs were observed on presentation. Magnetic resonance imaging of the brain showed an abnormal signal of the left lentiform nucleus, caudate nucleus and within the temporal lobe, suggesting an acute cerebral infarction. The analysis of cerebrospinal fluid showed an increasing leukocyte count, but no any pathogenic microorganisms were found. His respiratory symptoms disappeared promptly after therapy, and the patient was discharged after 11 days later, but there was no light in the left eye 2 months after discharge. Conclusion M. pneumoniae infection could be developed the risk for cerebral ischemic stroke, including CRAO in children with severe pneumonia. CRAO is a devastating ophthalmologic event leading to a severe impairment of vision. Patients treated within about 6 h of vision loss had a better visual outcome after the onset of vision loss.
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Affiliation(s)
- Yunguang Bao
- Department of Pediatrics, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, 321000, Zhejiang Province, China
| | - Xiaobing Li
- Department of Pediatrics, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, 321000, Zhejiang Province, China
| | - Kaixuan Wang
- Department of Pediatrics, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, 321000, Zhejiang Province, China
| | - Chan Zhao
- Department of Pediatrics, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, 321000, Zhejiang Province, China
| | - Xiumei Ji
- Department of Pediatrics, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, 321000, Zhejiang Province, China
| | - Mizu Jiang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China.
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7
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Flateau C, Asfalou I, Deman AL, Ficko C, Andriamanantena D, Fontan E, Viant E, Bonnevie L, Rapp C. Aortic thrombus and multiple embolisms during a Mycoplasma pneumoniae infection. Infection 2013; 41:867-73. [PMID: 23696110 DOI: 10.1007/s15010-013-0475-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/29/2013] [Indexed: 11/24/2022]
Abstract
We report the case of a patient who presented with a thrombus of the aortic arch complicated with splenic, renal and peroneal artery embolisms, associated with transient lupus anticoagulant, during a Mycoplasma pneumoniae infection. The outcome was good under antibiotic and anticoagulant treatment. We also review the medical literature on M. pneumoniae-related thromboses.
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Affiliation(s)
- C Flateau
- Service des Maladies Infectieuses et Tropicales, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160, Saint-Mandé, France.
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8
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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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9
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Alviar CL, Echeverri JG, Jaramillo NI, Figueroa CJ, Cordova JP, Korniyenko A, Suh J, Paniz-Mondolfi A. Infectious atherosclerosis: is the hypothesis still alive? A clinically based approach to the dilemma. Med Hypotheses 2011; 76:517-21. [PMID: 21216537 DOI: 10.1016/j.mehy.2010.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 11/22/2010] [Accepted: 12/08/2010] [Indexed: 01/12/2023]
Abstract
Among the multiple factors involved in the pathophysiology of heart disease, infections have been proposed to play a role in atherosclerosis with most of the available evidence implicating Chlamydia pneumonia, influenza virus and Mycoplasma pneumoniae. Based on a model case presentation, we speculate that in the absence of traditional risk factors and in the context of an ongoing respiratory infection caused by a pro-inflammatory pathogen (M. pneumoniae) along with a past positive serologic history for potentially proven atherogenic microorganism (C. pneumoniae) and infection may elicit potentially pathogenic events on vascular wall cells and leukocytes of atheromatous lesions, supporting the hypothesis that such infections may potentiate atherosclerotic cardiovascular disease (CVD).
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Affiliation(s)
- Carlos L Alviar
- St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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10
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Fusco C, Bonini E, Soncini G, Frattini D, Giovannini S, Della Giustina E. Transient basal ganglia and thalamic involvement following Mycoplasma pneumoniae infection associated with antiganglioside antibodies. J Child Neurol 2010; 25:1029-33. [PMID: 20305125 DOI: 10.1177/0883073809355823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of acute and reversible bilateral basal ganglia with thalami involvement associated with serological evidence of Mycoplasma pneumoniae infection is reported. Increased titers of immunoglobulin M antibodies against GM1 ganglioside components were found during an acute phase of neurological illness. Brain magnetic resonance imaging (MRI) showed bilateral involvement of the basal ganglia and thalamus, which disappeared 1 month later. The child recovered fully after corticosteroid and immunoglobulin therapy, and antiganglioside antibodies returned to within the normal range. The authors speculate on the diagnostic hypothesis regarding selective basal ganglia and thalamic involvement and the relationship with anti-GM1 ganglioside immunoglobulin M antibodies.
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Affiliation(s)
- Carlo Fusco
- Pediatric Neurology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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11
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Cunha BA. Legionnaires' disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin North Am 2010; 24:73-105. [PMID: 20171547 PMCID: PMC7127122 DOI: 10.1016/j.idc.2009.10.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, 259 First Street, Mineola, Long Island, NY 11501, USA
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12
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Senda J, Ito M, Atsuta N, Watanabe H, Hattori N, Kawai H, Sobue G. Paradoxical brain embolism induced by Mycoplasma pneumoniae infection with deep venous thrombus. Intern Med 2010; 49:2003-5. [PMID: 20847507 DOI: 10.2169/internalmedicine.49.3570] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 21-year-old man had sudden-onset right hemiplegia and aphasia with respiratory infection. A chest X-ray disclosed consolidation in both lungs and magnetic resonance imaging showed an embolism in the left middle cerebral artery. A pelvic computed tomography scan revealed deep venous thrombus in both femoral veins. Patent foramen ovale was detected by transesophageal echocardiogram. Antibodies to M. pneumoniae were highly elevated, and hypercoagulability was subsequently detected. This case suggests that the possible pathogenic mechanism for M. pneumoniae infection-related stroke might be paradoxical brain embolism with deep venous thrombus as a consequence of the hypercoagulability related to this infection.
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Affiliation(s)
- Joe Senda
- Department of Neurology, Nagoya University Graduate School of Medicine, Aichi
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13
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Hagiwara H, Sakamoto S, Katsumata T, Katayama Y. Acute disseminated encephalomyelitis developed after Mycoplasma pneumoniae infection complicating subclinical measles infection. Intern Med 2009; 48:479-83. [PMID: 19293551 DOI: 10.2169/internalmedicine.48.1740] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 26-year-old man developed acute disseminated encephalomyelitis (ADEM) after Mycoplasma pneumoniae infection, and was admitted after developing disturbed consciousness. Magnetic resonance images revealed lesions in the midbrain, bilateral internal capsules, left corona radiata, white matter of the left occipital lobe, and thoracic spinal cord. He was diagnosed with subclinical measles infection since no anthema was observed despite the fact that his serum and cerebrospinal fluid samples were positive for measles IgM antibodies. ADEM following mixed infection with measles and M. pneumoniae is rare, and it is not clear whether an additional infection with measles influenced the onset of ADEM after M. pneumoniae infection. Symptoms did not improve with steroid or immunoglobulin treatment, but improvement in symptoms was observed after plasmapheresis.
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Affiliation(s)
- Hiroshi Hagiwara
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo.
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14
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Atypical pneumonias: current clinical concepts focusing on Legionnaires' disease. Curr Opin Pulm Med 2008; 14:183-94. [PMID: 18427241 DOI: 10.1097/mcp.0b013e3282f79678] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review provides clinicians with an overview of the clinical features of the atypical pneumonias. Atypical community-acquired pneumonia pathogens cause systemic infections with pneumonia. The key to the clinical diagnosis of atypical pneumonias depends on recognizing the characteristic pattern of extrapulmonary organ involvement different for each pathogen. As Legionella is likely to present as severe pneumonia and does not respond to beta-lactams, it is important to presumptively diagnose Legionnaires' disease clinically so that Legionella coverage is included in empiric therapy. This study reviews the clinical features and nonspecific laboratory markers of atypical pathogens, focusing on Legionnaires' disease. RECENT FINDINGS Case reports/outbreaks increase our understanding of Legionnaires' disease transmission. Both Mycoplasma pneumoniae and Chlamydophilia pneumoniae may cause asthma. Antimicrobial therapy of Chlamydophilia pneumoniae/Mycoplasma pneumoniae is important to decrease person-to-person spread and to decrease potential long-term sequelae. SUMMARY Atypical pulmonary pathogens cause systemic infections accompanied by a variety of characteristic extrapulmonary features. Clinically, it is possible to differentiate Legionnaires' disease from the other typical/atypical pneumonias. Rapid clinical diagnosis of atypical pathogens, particularly Legionnaires' disease, is important in selecting effective empiric therapy and prompting definitive laboratory testing.
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16
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Abstract
Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system that usually occurs in children and young adults. We report the case of an 8-year-old girl who presented to the emergency department with acutely altered mental status. Standard workup including head computed tomography, lumbar puncture, and routine chemistries was unrevealing. Magnetic resonance imaging revealed findings consistent with acute disseminated encephalomyelitis. Response to treatment with steroids was dramatic. Both the rapidity of onset and resolution of this patient's symptoms are unusual for the course of this disease.
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Affiliation(s)
- Shaun D Carstairs
- Department of Emergency Medicine, Naval Medical Center, San Diego, CA 92134-5000, USA.
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17
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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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18
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Stüve O, Nessler S, Hartung HP, Hemmer B, Wiendl H, Kieseier BC. [Acute disseminated encephalomyelitis. Pathogenesis, diagnosis, treatment, and prognosis]. DER NERVENARZT 2005; 76:701-7. [PMID: 15580467 DOI: 10.1007/s00115-004-1842-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Acute disseminated encephalomyelitis (ADEM) is typically a monophasic, demyelinating disease of the CNS that predominantly affects children. Typically, its clinical symptoms follow an infection or vaccination. In this regard, numerous viral and bacterial pathogens as well as several vaccinations have been associated with ADEM. Studies from animal models suggest that primary and secondary autoimmune responses may contribute to CNS inflammation and demyelination in ADEM. The diagnosis of ADEM is strongly suggested by a close temporal relationship between a viral infection or immunization and the onset of neurologic symptoms, and it is supported by extensive, multifocal, subcortical white-matter disease on brain magnetic resonance imaging. While mild lymphocytic pleocytosis and elevated proteins are detectable in the CSF in ADEM, oligoclonal bands are not always present. Treatment of this disorder consists of anti-inflammatory and immunosuppressive therapies, and the prognosis is generally considered favorable.
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Affiliation(s)
- O Stüve
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf.
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19
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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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20
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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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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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Nour M, Trabelsi A, Maatouk N, Hammami M. Amplification of P1 and 16S rRNA genes by nested PCR for detection of Mycoplasma pneumoniae in paediatric patients. ACTA ACUST UNITED AC 2005; 53:9-14. [PMID: 15620603 DOI: 10.1016/j.patbio.2004.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Accepted: 01/16/2004] [Indexed: 10/26/2022]
Abstract
Mycoplasma (M.) pneumoniae is the most frequent atypical pathogen responsible for community-acquired respiratory infection in children and adults. The etiologic diagnosis of these infections still remains difficult. This is mainly due to the absence of characteristic clinical findings, and to the available detection methods (serology and culture) which are time consuming, insensitive and non-specific. To improve the detection of this infectious agent, nested polymerase chain reaction (PCR) analysis was developed. A total of 46 nasal aspirates, from children hospitalised with severe lower respiratory tract infection and in whom M. pneumoniae was suspected, were analysed for the presence of M. pneumoniae DNA by PCR. Routine microbiological investigations revealed no virus in these 46 samples. Using nested PCR, two targets were amplified: the sequences of 16S ribosomal (r) RNA gene (rDNA) and P1 adhesin gene. Evidence of M. pneumoniae infection was identified in four paediatric patients. The amplification of 16S rDNA was found to be more sensitive for the detection of M. pneumoniae. Our results suggest that amplification of the 16S rDNA by nested PCR and detection of the amplification products by visual inspection of the polyacrylamide gel should allow the rapid diagnosis of M. pneumoniae in respiratory tract infection in paediatric patients.
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Affiliation(s)
- Mohamed Nour
- Laboratoire de Microbiologie, Institut Supérieur de Biotechnologie de Monastir, B.P. 74, Avenue de l'Environnement, 5000 Monastir, Tunisia.
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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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Ngeh J, Gupta S, Goodbourn C, McElligott G. Mycoplasma pneumoniae in elderly patients with stroke. a case-control study on the seroprevalence of M. pneumoniae in elderly patients with acute cerebrovascular disease - the M-PEPS Study. Cerebrovasc Dis 2004; 17:314-9. [PMID: 15026614 DOI: 10.1159/000077342] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2003] [Accepted: 11/18/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested certain infections as potential risk factors for stroke. Chlamydia pneumoniae, an atypical respiratory pathogen, has been linked to atherosclerotic vascular diseases. Mycoplasma pneumoniae, another atypical respiratory micro-organism, can rarely cause stroke. We investigated whether serological markers of M. pneumoniae infection were associated with acute stroke or transient ischaemic attack (TIA) in elderly patients. METHODS This case-control study was nested within the C-PEPS study - a case-control study on the seroprevalence of C. pneumoniae in elderly stroke and medical patients. Ninety-five incident cases of patients admitted consecutively with acute stroke or TIA, and 82 control subjects admitted concurrently with acute non-cardiopulmonary, non-infective disorders, were included in this study (both groups aged 65 years or older). Using commercial enzyme-linked immunosorbent assay (ELISA) kits, the presence of M. pneumoniae immunoglobulins IgA, IgG and IgM in patients' sera was determined. RESULTS The seroprevalence of M. pneumoniae IgA, IgG and IgM in the stroke or TIA group (median age = 80) were 79, 61 and 6%, respectively. In the control group (median age = 80), the seroprevalence of respective M. pneumoniae IgA, IgG and IgM were 84, 50 and 11%. Using a logistic regression statistical model, adjusting for history of hypertension, smoking, diabetes mellitus, age and sex, history of ischaemic heart disease, and ischaemic electrocardiogram, the odds ratios of having a stroke or TIA in relation to M. pneumoniae IgA, IgG and IgM were 0.63 (95% confidence interval (CI) = 0.26-1.52, p = 0.31), 1.32 (95% CI = 0.66-2.64, p = 0.43) and 0.52 (95% CI = 0.14-1.92, p = 0.32), respectively. CONCLUSIONS The study showed a high seroprevalence of M. pneumoniae in an elderly hospital population, using ELISA. Although the study ruled out M. pneumoniae seropositivity as a major risk factor for stroke in this elderly population, a smaller effect could not be excluded due to the small sample size. Future larger studies may be required to determine the precise role of M. pneumoniae infection in the pathogenesis of different subtypes of ischaemic stroke, in all age groups, and in different ethnic populations.
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Affiliation(s)
- Joseph Ngeh
- Department of Medicine for Elderly People, Whipps Cross University Hospital, London, UK.
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