1
|
Georgakopoulou VE, Lempesis IG, Sklapani P, Trakas N, Spandidos DA. Exploring the pathogenetic mechanisms of Mycoplasmapneumoniae (Review). Exp Ther Med 2024; 28:271. [PMID: 38765654 PMCID: PMC11097136 DOI: 10.3892/etm.2024.12559] [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: 12/17/2023] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Mycoplasmas, the smallest self-replicating prokaryotes without a cell wall, are the most prevalent and extensively studied species in humans. They significantly contribute to chronic respiratory tract illnesses and pneumonia, with children and adolescents being particularly vulnerable. Mycoplasma pneumoniae (M. pneumoniae) infections typically tend to be self-limiting and mild but can progress to severe or even life-threatening conditions in certain individuals. Extrapulmonary effects often occur without pneumonia, and both intrapulmonary and extrapulmonary complications operate through separate pathological mechanisms. The indirect immune-mediated damage of the immune system, vascular blockages brought on by vasculitis or thrombosis and direct harm from invasion or locally induced inflammatory cytokines are potential causes of extrapulmonary manifestations due to M. pneumoniae. Proteins associated with adhesion serve as the primary factor crucial for the pathogenicity of M. pneumoniae, relying on a specialized polarized terminal attachment organelle. The type and density of these host receptors significantly impact the adhesion and movement of M. pneumoniae, subsequently influencing the pathogenic mechanism and infection outcomes. Adjacent proteins are crucial for the proper assembly of the attachment organelle, with variations in the genetic domains of P1, P40 and P90 surfaces contributing to the variability of clinical symptoms and offering new avenues for developing vaccines against M. pneumoniae infections. M. pneumoniae causes oxidative stress within respiratory tract epithelial cells by adhering to host cells and releasing hydrogen peroxide and superoxide radicals. This oxidative stress enhances the vulnerability of host cells to harm induced by oxygen molecules. The lack of superoxide dismutase and catalase of bacteria allows it to hinder the catalase activity of the host cell, leading to the reduced breakdown of peroxides. Lung macrophages play a significant role in managing M. pneumoniae infection, identifying it via Toll-like receptor 2 and initiating the myeloid differentiation primary response gene 88-nuclear factor κΒ signaling cascade. However, the precise mechanisms enabling M. pneumoniae to evade intracellular host defenses remain unknown, necessitating further exploration of the pathways involved in intracellular survival. The present comprehensive review delves into the pathogenesis of M. pneumoniae infection within the pulmonary system and into extrapulmonary areas, outlining its impact.
Collapse
Affiliation(s)
- Vasiliki Epameinondas Georgakopoulou
- Department of Pathophysiology, Laiko General Hospital, National and Kapodisttrian University of Athens, 11527 Athens, Greece
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Ioannis G. Lempesis
- Department of Pathophysiology, Laiko General Hospital, National and Kapodisttrian University of Athens, 11527 Athens, Greece
| | - Pagona Sklapani
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| |
Collapse
|
2
|
Park CL, Margaria B, Husnain M. Secondary Immune Thrombocytopenia Due to Mycoplasma pneumoniae Without Clinically Significant Evidence of Active Infection. Cureus 2022; 14:e23551. [PMID: 35494983 PMCID: PMC9042787 DOI: 10.7759/cureus.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 11/06/2022] Open
Abstract
Immune thrombocytopenia (ITP) is a leading cause of isolated thrombocytopenia characterized by autoantibody-mediated destruction of platelets, impaired megakaryocyte function, and pathologic T-cell recognition of platelet antigens. Several triggers for ITP have been identified. Treatment of the inciting cause decreases the antibodies responsible for molecular mimicry, and these cases are usually associated with a better outcome with a decreased probability of progression to chronic ITP. Mycoplasma pneumoniae infection is known to have extrapulmonary manifestations, and growing evidence suggests it can be a cause of secondary ITP. Many of the described cases report evidence of a pulmonary infection with severe mucosal bleeding. Here, we describe an interesting case of a patient presenting with isolated thrombocytopenia with mild mucosal bleeding, later found to be positive for Mycoplasma immunoglobulin M without clinically significant evidence of active infection. Currently, mycoplasma testing is not routinely performed as a workup for ITP. However, clinicians may consider this before proceeding with more aggressive treatment for refractory ITP (i.e., prolonged immunosuppression, splenectomy). This case illustrates that mild/asymptomatic Mycoplasma infection can also be associated with ITP.
Collapse
|
3
|
He CB, Lee JR, Kahana M. Mycoplasma pneumoniae Associated Acute Transverse Myelitis: An Atypical Clinical Presentation in an Adolescent Child. Cureus 2021; 13:e17259. [PMID: 34540483 PMCID: PMC8445634 DOI: 10.7759/cureus.17259] [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] [Accepted: 08/17/2021] [Indexed: 11/30/2022] Open
Abstract
We report an atypical case of a 15-year-old pediatric patient diagnosed with Mycoplasma pneumoniae associated acute transverse myelitis (ATM). The patient had no prodromal or pulmonary symptoms that are commonly associated with mycoplasma infection. Yet, the patient exhibited acute bilateral lower extremity paralysis, paresthesia, decreased sensation at the level of T11 and below, bowel and bladder dysfunction, and thrombocytopenia. Magnetic resonance imaging of the spinal cord revealed transverse myelitis from T10 to the end of the conus medullaris. The patient showed only slow clinical improvement despite therapy consisting of azithromycin, high-dose intravenous methylprednisolone, intravenous immunoglobulin, and plasmapheresis. This report calls attention to the importance of early identification of mycoplasma as an underlying cause of ATM and the potential consequences of delayed detection and treatment: more severe neurologic complications, prolonged hospitalization, and unfavorable clinical outcomes.
Collapse
Affiliation(s)
- Chong Bin He
- Pediatrics, University of Central Florida College of Medicine, Orlando, USA
| | - James R Lee
- Emergency Medicine, North Florida Regional Medical Center, Gainesville, USA
| | - Madelyn Kahana
- Pediatric Critical Care Medicine, Nemours Children's Hospital, Orlando, USA
| |
Collapse
|
4
|
Tian Z, Gao H, Xiao D, Li X. Immune thrombocytopenia associated with Hashimoto thyroiditis in a pediatric patient: A case report. Medicine (Baltimore) 2021; 100:e26140. [PMID: 34087867 PMCID: PMC8183690 DOI: 10.1097/md.0000000000026140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Immune thrombocytopenia (ITP) is one of the most commonly acquired bleeding diseases in children. Infection and autoimmune disorders are the most common causes of ITP. The pathogenic mechanism of ITP is complex and is not completely understood. Understanding the underlying causes or disorders of ITP will improve the prognosis and make therapy more targeted. PATIENT CONCERNS An 8-year-old girl with ITP responded poorly to first- and second-line treatment. The patient showed multiple scattered petechiae, ecchymoses, and purpura in the skin and blood clots in the oral mucous membrane. DIAGNOSES The patient was diagnosed with ITP associated with Hashimoto thyroiditis. INTERVENTIONS The patient was admitted to our emergency department and received platelet transfusion, IVIG, glucocorticoids and eltrombopag. The patient's thrombocytopenia resolved within 18 days after the administration of levothyroxine treatment. OUTCOMES The patient was diagnosed with Hashimoto thyroiditis, and the platelet count recovered on the 3rd day of levothyroxine treatment. The platelet count became steadily normal with levothyroxine and prednisone treatment within 2 months of follow-up. LESSONS Early identification of the underlying reasons and treatment with multiple modalities may be useful in improving the prognosis of ITP. The treatment of thyroid disease and restoration of the euthyroid state impact the clinical outcome of ITP in children.
Collapse
|
5
|
Tuncer H, Hincal SO, Cam B. Thrombotic Complications of Nose and Toe Associated With Mycoplasma pneumoniae Infection. J Med Cases 2019; 10:302-304. [PMID: 34434295 PMCID: PMC8383517 DOI: 10.14740/jmc3349] [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: 07/23/2019] [Accepted: 08/06/2019] [Indexed: 11/11/2022] Open
Abstract
Thrombosis is a very rare complication of Mycoplasma pneumoniae (M. pneumoniae) infection. We report a case of a woman who has thrombotic complications associated with mycoplasma infection in distal body parts. A 79-year-old female patient applied to the emergency department with complaints of the pain and discoloration at the nose tip and distal toes of the feet. Those symptoms have occurred in 10 days after the onset of the respiratory problems. The venous obstruction was diagnosed by venous Doppler ultrasound related to the distal part of the toes. The occurrence of the thrombosis associated with M. pneumoniae could be explained with some reaction of the inflammatory products in the blood circulation.
Collapse
Affiliation(s)
- Hakan Tuncer
- Department of Emergency Medicine, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sakir Omur Hincal
- Department of Emergency Medicine, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Betul Cam
- Department of Emergency Medicine, Bagcilar Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Bajantri B, Venkatram S, Diaz-Fuentes G. Mycoplasma pneumoniae: A Potentially Severe Infection. J Clin Med Res 2018; 10:535-544. [PMID: 29904437 PMCID: PMC5997415 DOI: 10.14740/jocmr3421w] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 01/07/2023] Open
Abstract
Mycoplasma pneumoniae infections remain one of the most common etiologies of community-acquired pneumonia (CAP). The clinical presentation and manifestations vary widely and can affect all organs of the body. Diagnosis is challenging because there are no constant findings in physical exams or laboratory or radiological assessments that indicate Mycoplasma pneumoniae pneumonia, and specific diagnostic tools are not readily available. Extrapulmonary manifestations and severe pulmonary manifestations can lead to long-term sequelae. The increasing emergence of Mycoplasma pneumoniae that is resistant to macrolides in some areas of the world and increased world travel could add to the difficulty of controlling and treating Mycoplasma pneumoniae infections. We present a concise and up-to-date review of the current knowledge of Mycoplasma pneumoniae pneumonia.
Collapse
Affiliation(s)
- Bharat Bajantri
- Division of Pulmonary Critical Care, Department of Medicine, Bronx Care Health System, Bronx, NY 10457, USA
| | - Sindhaghatta Venkatram
- Division of Pulmonary Critical Care, Department of Medicine, Bronx Care Health System, Bronx, NY 10457, USA
| | - Gilda Diaz-Fuentes
- Division of Pulmonary Critical Care, Department of Medicine, Bronx Care Health System, Bronx, NY 10457, USA
| |
Collapse
|
7
|
Barge L, Pahn G, Weber N. Transient immune-mediated agranulocytosis following Mycoplasma pneumoniaeinfection. BMJ Case Rep 2018; 2018:bcr-2018-224537. [DOI: 10.1136/bcr-2018-224537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
8
|
Gouveia C, Evangelista V, Almeida R, Baptista AM. Immune Thrombocytopenia Associated with Mycoplasma pneumoniae Infection. Eur J Case Rep Intern Med 2018; 5:000817. [PMID: 30756019 PMCID: PMC6346952 DOI: 10.12890/2018_000817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022] Open
Abstract
Immune thrombocytopenia (ITP) related to Mycoplasma pneumoniae infection is a rare condition and usually associated with a severe clinical course. We here report a case of a young man with a clinical diagnosis of severe ITP secondary to M. pneumoniae infection. The clinical features, therapy and outcome are presented.
Collapse
|
9
|
Jeong HT, Oh JY, Song JE, Kim BS, Lee CH. Mycoplasma pneumoniae-associated Hepatitis without Lung Involvement. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:50-53. [DOI: 10.4166/kjg.2017.70.1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Han Taek Jeong
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jae Young Oh
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jung Eun Song
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Byung Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chang Hyeong Lee
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
10
|
He J, Liu M, Ye Z, Tan T, Liu X, You X, Zeng Y, Wu Y. Insights into the pathogenesis of Mycoplasma pneumoniae (Review). Mol Med Rep 2016; 14:4030-4036. [PMID: 27667580 PMCID: PMC5101875 DOI: 10.3892/mmr.2016.5765] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/25/2016] [Indexed: 11/08/2022] Open
Abstract
Mycoplasma are the smallest prokaryotic microbes present in nature. These wall-less, malleable organisms can pass through cell filters, and grow and propagate under cell-free conditions in vitro. Of the pathogenic Mycoplasma Mycoplasma pneumoniae has been examined the most. In addition to primary atypical pneumonia and community-acquired pneumonia with predominantly respiratory symptoms, M. pneumoniae can also induce autoimmune hemolytic anemia and other diseases in the blood, cardiovascular system, gastrointestinal tract and skin, and can induce pericarditis, myocarditis, nephritis and meningitis. The pathogenesis of M. pneumoniae infection is complex and remains to be fully elucidated. The present review aimed to summarize several direct damage mechanisms, including adhesion damage, destruction of membrane fusion, nutrition depletion, invasive damage, toxic damage, inflammatory damage and immune damage. Further investigations are required for determining the detailed pathogenesis of M. pneumoniae.
Collapse
Affiliation(s)
- Jun He
- Department of Clinical Laboratory, Nanhua Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Mihua Liu
- Department of Clinical Laboratory, Nanhua Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Zhufeng Ye
- Department of Clinical Laboratory, Nanhua Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Tianping Tan
- Department of Clinical Laboratory, Nanhua Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Xinghui Liu
- Department of Clinical Laboratory, Nanhua Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Xiaoxing You
- Pathogenic Biology Institute, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Yanhua Zeng
- Pathogenic Biology Institute, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Yimou Wu
- Pathogenic Biology Institute, University of South China, Hengyang, Hunan 421001, P.R. China
| |
Collapse
|
11
|
Nishikawa A, Mimura K, Kanagawa T, Maeda T, Tomimatsu T, Kimura T. Thrombocytopenia associated with Mycoplasma
pneumonia during pregnancy: Case presentation and approach for differential diagnosis. J Obstet Gynaecol Res 2015; 41:1273-7. [DOI: 10.1111/jog.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/02/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Aiko Nishikawa
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Takeshi Kanagawa
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Tetsuo Maeda
- Hematology and Oncology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| |
Collapse
|
12
|
Sawhney V, Maksunova O, Ahsan S, Ozkor M, Westwood M. Lesson of the month 1: Pericardial mass and cardiac tamponade associated with Mycoplasma pneumoniae. Clin Med (Lond) 2014; 14:549-51. [PMID: 25301923 PMCID: PMC4951971 DOI: 10.7861/clinmedicine.14-5-549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mycoplasma pneumoniae primarily causes respiratory tract infections. Extrapulmonary manifestations are seen in 20-25% of cases. Cardiac involvement is rarely reported. We present a unique case of a pericardial mass and cardiac tamponade associated with a Mycoplasma pneumoniae pneumonia. This required emergency pericardial fenestration. The patient improved dramatically postoperatively on antibiotics and there was no recurrence of the pericardial effusion on follow up. This case highlights the often forgotten invasive properties of a common respiratory tract pathogen and emphasises the need to consider this easily treatable entity in the differential diagnosis of idiopathic pericardial effusions.
Collapse
Affiliation(s)
- Vinit Sawhney
- Cardiology, North Middlesex University Hospital, London, UK
| | | | - Syed Ahsan
- Cardiology, North Middlesex University Hospital, London, UK
| | - Muhiddin Ozkor
- Cardiology, North Middlesex University Hospital, London, UK
| | - Mark Westwood
- Cardiology, North Middlesex University Hospital, London, UK
| |
Collapse
|
13
|
Vujic I, Shroff A, Grzelka M, Posch C, Monshi B, Sanlorenzo M, Ortiz-Urda S, Rappersberger K. Mycoplasma pneumoniae-associated mucositis--case report and systematic review of literature. J Eur Acad Dermatol Venereol 2014; 29:595-8. [PMID: 24665876 DOI: 10.1111/jdv.12392] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae, a bacterium known to be a common cause of pneumonia, has been documented to cause complications such as debilitating mucositis previously described as an atypical Stevens-Johnson syndrome without skin lesions. However, in the spectrum of epidermal dermatopathies, the condition is increasingly recognized as a separate entity, now termed M. pneumoniae-associated mucositis (MPAM). OBJECTIVES We present a case of MPAM and systemically review the literature to discuss diagnostic and therapeutic options. METHODS A systematic literature search was performed to find studies reporting MPAM in adults. We extracted and analysed patient demographics, disease symptomatology, diagnostic testing and treatment. RESULTS Eleven articles, describing 12 patients and our own patient met the predefined criteria and were analysed. Respiratory, ocular and oral symptoms were present in all patients. Therapies predominantly included antibiotics (10 of 13) and immunosuppressive treatment (9 of 13) leading to complete resolution of symptoms in all patients. CONCLUSION Our findings highlight that MPAM should be recognized as a distinct disease entity within the spectrum of epidermal dermatopathies. We discuss and show in our patient why M. pneumoniae IgA serum levels could prove to be more reliable diagnostic tools in the MPAM diagnosis than the widely used IgG and IgM titre levels.
Collapse
Affiliation(s)
- I Vujic
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA; Department of Dermatology, The Rudolfstiftung Hospital, Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Tomaino J, Keegan T, Miloh T, Kerkar N, Mercer S, Birge M, Rocca J, Suchy F, Arnon R. Stevens-Johnson syndrome after Mycoplasma pneumonia infection in pediatric post-liver transplant recipient: case report and review of the literature. Pediatr Transplant 2012; 16:E74-7. [PMID: 21176015 DOI: 10.1111/j.1399-3046.2010.01424.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although Mycoplasma pneumonia infection is relatively common among school-aged children, it rarely leads to SJS. Herein, we report a seven-yr-old girl who presented with a Mycoplasma pneumonia infection that progressed to SJS five months after liver transplant. We suggest that children presenting with symptoms of Mycoplasma pneumonia infection in the immunosuppressed post-liver transplant setting be properly diagnosed and treated rapidly, as well as observed for symptoms of SJS and potentially serious extrapulmonary complications.
Collapse
Affiliation(s)
- J Tomaino
- Mount Sinai Medical Center, New York, NY 10029, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010; 16:162-9. [DOI: 10.1007/s10156-010-0044-x] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Indexed: 12/30/2022]
|