Polyradiculoneuritis and Mycoplasma pneumoniae infection

Carditis associated with mycoplasma pneumoniae infection

Among 560 patients with serologically confirmed Mycoplasma pneumoniae infection, 25 (4.5%) had carditis (19 perimyocarditis, 6 pericarditis). During the acute phase 9 patients required intensive care. After an average of 16 months follow-up 11 patients with no previous signs of heart disease still had cardiac symptoms or signs. Thus carditis associated with M. pneumoniae infection is a serious disease, having cardiac sequelae more often than has hitherto been supposed. The pathogenesis of the carditis associated with M. pneumoniae infection is discussed, including the possibility that in some cases the elevated titre in the complement fixation test is non-specific. A summary is given of the 33 cases previously presented in the literature.

Critical illness neuromuscular abnormalities

CINMAs occur commonly in acutely critically ill inflamed patients, and can prolong respiratory failure, lead to ventilator dependency, and contribute to the development of chronic critical illness. The etiology of NMDs are diverse and overlap, and distinguishing different disease entities by clinical exam and electrophysiologic studies can be difficult. CIP, which has been the most widely studied CINMA, represents the peripheral nervous system manifestation of the MODS. Patients with CIP, particularly those with severely reduced nerve function, have a prolonged rehabilitation and a high mortality rate. Although there are no definitive treatments, diagnosing a CINMA may provide helpful prognostic information. Future preventative measures may include immunoglobulin, nerve growth factors, or strict glycemic control, although in the CCI phase general supportive care is given, including prevention of iatrogenic complications, nutritional support, psychosocial support, and physical therapy. The early recognition of CINMAs and prevention of associated complications are important to enabling CCI patients with CINMAs to recover and return home with an acceptable functional level and quality of life.

Methyl-prednisolone in neurologic complications of Mycoplasma pneumonia

In patients with Mycoplasma pneumonia extrapulmonary manifestations such as encephalitis, meningitis, cerebellar and brain stem involvement, cranial nerve lesions, peripheral neuropathy, polymyositis have been observed. We report a 16-year-old girl with M. pneumonia infection, acute behavioral changes and coma. Treatment with high dose methyl-prednisolone and clarithromycin led to rapid clinical improvement.

Miller Fisher syndrome associated with Mycoplasma pneumoniae infection: report of a case

We report a 38-year-old male patient who developed a Miller Fisher syndrome following a respiratory tract disorder associated with a serologically proven Mycoplasma pneumoniae infection. Although several neurologic manifestations have been reported after Mycoplasma pneumonia infection, Miller Fisher syndrome has not been reported previously. No evidence of CNS involvement could be demonstrated on repeated MRI of the brain.

Critical illness polyneuropathy. A review of the literature, definition and pathophysiology

We present a review of the clinical characteristics, and electromyographical and pathological findings of critical illness polyneuropathy by a comparison of ten studies, leading to a definition. Controversies about the nature of CIP, the interpretation of neurophysiological and pathological findings, and differential diagnoses are discussed.

Guillain-Barré syndrome after varicella-zoster infection. Case report

The authors report a case of Guillain-Barrè syndrome (GBS) following a varicella infection in a 13 year-old boy. During his admission he developed respiratory insufficiency and dysautonomic events, as well as a severe sensitive peripheral neuropathy. Some aspects related to the etiology and pathogenesis of GBS are discussed.

Role of infection in Guillain-Barré syndrome: laboratory confirmation of herpesviruses in 41 cases

Serological evidence of either acute cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infection was sought in a large series of patients with Guillain-Barré syndrome (GBS) and control subjects. Using an indirect immunofluorescent technique, IgM antibody directed against CMV was found in the serum of 33 of 220 GBS patients. The CMV-positive patients were mainly young adults (average age, 25.6 years), previously healthy, and the most common prodromal illness was mild coryza. Alternations in serum CMV IgM antibody level closely paralleled the patients' clinical course. Persistently elevated titers were found in patients with severe and protracted paralysis, whereas rapid disappearance of virus-specific IgM characterized benign cases. Striking time clusters of CMV-seropositive patients were found during three periods between January, 1971, and October, 1973. In a parallel study, EBV-specific IgM was found in 8 of 100 GBS patients (8%). All 8 also had heterophil antibodies. Thus, EBV and CMV appear related to a substantial number of cases of this primary demyelinating disease and, to date, are the two most common agents we have been able to link with GBS.

Central nervous system manifestations associated with serologically verified Mycoplasma pneumoniae infection

Among 560 hospitalized patients with serologically verified Mycoplasma pneumoniae infection (significant titre rise of complement-fixing antibodies in paired sera), 27 (4.8%) had central nervous system (CNS) manifestations for which no evidence incriminating any other causal agent could be found. Of these patients 18 had encephalitis or meningoencephalitis, 8 aseptic meningitis and 1 polyradiculitis. Of the patients with meningoencephalitis 4 died and 3 had permanent sequelae. The cases of aseptic meningitis were benign without any deaths or sequelae. There was a predominance of young age groups, 13 patients (48%) being below 10 years of age. Neither erythromycin nor tetracycline had a beneficial effect on the course of the illness in a few patients treated. Another 15 patients had CNS manifestations for which an alternative aetiology was suspected. The specificity of the M. pneumoniae CF test in the diagnostics of CNS manifestations is discussed, as well as the pathogenesis of the CNS complications associated with M. pneumoniae infection. Some features are summarized from 87 case reports presented earlier in the literature.

Pleocytosis and immunoglobulin changes in cerebrospinal fluid and herpesvirus serology in patients with Guillain-Barré syndrome

In a follow-up study of 24 patients with Guillain-Barré syndrome, 55% developed a cerebrospinal fluid (CSF) mononuclear pleocytosis, which persisted for 4 months or more. Raised index values of CSF-immunoglobulin G (IgG), CSF-IgA, and CSF-IgM, indicating synthesis of the immunoglobulin in question in the central nervous system, were found in 63, 35, and 25%, respectively. Agarose gel eletrophoresis revealed oligoclonal immunoglobulin in CSF in 21% and in both CSF and serum in another 21% of the patients. Twenty-five percent had abnormally low kappa/lambda ratios of CSF and/or serum, indicating synthesis of oligoclonal immunoglobulin, mainly of the lambda light-chain type. The inflammatory reaction in the central nervous system, as reflected by pleocytosis, immunoglobulin synthesis, and oligoclonal immunoglobulin, was not correlated to the severity or course of Guillain-Barré syndrome. A raised CSF-IgM index and oligoclonal immunoglobulin were found more often in the Guillain-Barré syndrome patients who displayed pleocytosis. All patients had or developed antibodies to Epstein-Barr virus. Three patients had serology indicating a primary infection, 11 patients had antibody changes indicating a reactivated infection, and 10 had serology indicating previous exposure. Two patients showed serological evidence for a primary cytomegalovirus infection, 2 had serology indicative of a reactivated infection, 12 had titers as caused by previous exposure, and 8 remained seronegative. Virus-specific IgM was measurable in all cases of primary infection. Neither primary or reactivated Epstein-Barr virus nor cytomegalovirus infections were obviously related to CSF pleocytosis.