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Xue Y, Yu Z, Cheng M, Li X, Jiang L, Han W. Concomitant Central and Peripheral Nervous System Involvement Associated With Mycoplasma pneumoniae Infection in Pediatric Patients: Two Case Reports and Literature Review. Pediatr Infect Dis J 2024:00006454-990000000-00869. [PMID: 38754001 DOI: 10.1097/inf.0000000000004394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen for community-acquired pneumonia and is also implicated in a broad array of extra-pulmonary manifestations. M. pneumoniae infection is rarely associated with concurrent central nervous system (CNS) and peripheral nervous system (PNS) involvement in children. METHODS We report 2 patients who presented with acute encephalitis and polyradiculitis due to M. pneumoniae infection and review the literature to discuss the pathogenesis and treatment of concomitant CNS and PNS involvement associated with M. pneumoniae infection. RESULTS We report two 6-year-old boys with M. pneumoniae antecedent infection who presented initially with impaired consciousness followed by limb weakness, limb pain and urinary retention, and responded well to immunotherapy. CONCLUSIONS We described 2 patients who presented symptomatic combined CNS and PNS involvement with persistent urinary retention associated with M. pneumoniae infection. We found autoimmunity plays an important role and recommend that antibiotics and immunomodulators should be administered with concurrent CNS and PNS involvement associated with M. pneumoniae.
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Affiliation(s)
- Yuan Xue
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders
- Ministry of Education Key Laboratory of Child Development and Disorders
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Zhiwei Yu
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders
- Ministry of Education Key Laboratory of Child Development and Disorders
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Min Cheng
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders
- Ministry of Education Key Laboratory of Child Development and Disorders
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Xiujuan Li
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders
- Ministry of Education Key Laboratory of Child Development and Disorders
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Li Jiang
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders
- Ministry of Education Key Laboratory of Child Development and Disorders
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Wei Han
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders
- Ministry of Education Key Laboratory of Child Development and Disorders
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
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2
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Kumar S, Kumar S. Mycoplasma pneumoniae: Among the smallest bacterial pathogens with great clinical significance in children. Indian J Med Microbiol 2023; 46:100480. [PMID: 37741157 DOI: 10.1016/j.ijmmb.2023.100480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Mycoplasmas are the smallest prokaryotic microorganisms found in nature. Mycoplasma pneumoniae (M. pneumoniae) is the most commonly studied among human mycoplasmas. OBJECTIVES In this review, we briefly focus on the recent developments that have enhanced our understanding of M. pneumoniae, one of the smallest pathogenic bacteria of great clinical importance in children. CONTENT M. pneumoniae infections may involve either upper or lower respiratory tract or both of them. Extrapulmonary manifestations have been reported in almost every organ, including the skin and the hematologic, cardiovascular, musculoskeletal, and nervous system due to direct local effects, after dissemination of bacteria or indirect effects. The correct identification of M. pneumoniae infections is vital for prescription of the appropriate therapy.There are scarce specific findings of clinical laboratory results for the diagnosis of M. pneumoniae infection. Detection of M. pneumoniae infections can be achieved using culture, serology, or molecular-based methods. Culture is time-consuming, laborious, and expensive. The major types of serological tests for M. pneumoniae include the microtiter plate enzyme immunoassay (EIA), the membrane EIA, indirect immunofluorescence, and particle agglutination. Nucleic acid amplification tests (NAATs) include traditional PCR, nested PCR, real-time quantitative PCR, nucleic acid sequence-based amplification (NASBA), loop-mediated isothermal amplification (LAMP) technology, and RNA simultaneous amplification and testing (SAT). Macrolides have been the drug of choice for treating M. pneumoniae infection in past years. Clinically significant acquired macrolide-resistant M. pneumoniae (MRMP)has emerged worldwide which may be associated with more extrapulmonary complications, and severe clinical and radiological features. Since molecular-based assays can detect M. pnueumoniae in clinical specimens, there is a need for real point of care testing for fast detection of M. pneumoniae or its DNA and mutations in macrolide resistance gene. It is necessary to develop safe vaccines that provide protective immunity against M.pneumoniae infection.
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Affiliation(s)
- Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, 110002, India.
| | - Sourabh Kumar
- Department of Pathology, Government Medical College & Hospital, Sector 32, Chandigarh, 160030, India
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3
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Sim KY, Byeon Y, Bae SE, Yang T, Lee CR, Park SG. Mycoplasma fermentans infection induces human necrotic neuronal cell death via IFITM3-mediated amyloid-β (1-42) deposition. Sci Rep 2023; 13:6864. [PMID: 37100873 PMCID: PMC10132800 DOI: 10.1038/s41598-023-34105-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/24/2023] [Indexed: 04/28/2023] Open
Abstract
Mycoplasma fermentans is a proposed risk factor of several neurological diseases that has been detected in necrotic brain lesions of acquired immunodeficiency syndrome patients, implying brain invasiveness. However, the pathogenic roles of M. fermentans in neuronal cells have not been investigated. In this study, we found that M. fermentans can infect and replicate in human neuronal cells, inducing necrotic cell death. Necrotic neuronal cell death was accompanied by intracellular amyloid-β (1-42) deposition, and targeted depletion of amyloid precursor protein by a short hairpin RNA (shRNA) abolished necrotic neuronal cell death. Differential gene expression analysis by RNA sequencing (RNA-seq) showed that interferon-induced transmembrane protein 3 (IFITM3) was dramatically upregulated by M. fermentans infection, and knockdown of IFITM3 abolished both amyloid-β (1-42) deposition and necrotic cell death. A toll-like receptor 4 antagonist inhibited M. fermentans infection-mediated IFITM3 upregulation. M. fermentans infection also induced necrotic neuronal cell death in the brain organoid. Thus, neuronal cell infection by M. fermentans directly induces necrotic cell death through IFITM3-mediated amyloid-β deposition. Our results suggest that M. fermentans is involved in neurological disease development and progression through necrotic neuronal cell death.
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Affiliation(s)
- Kyu-Young Sim
- Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
| | - Yeongseon Byeon
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
| | - So-Eun Bae
- Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Taewoo Yang
- Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
| | - Cho-Rong Lee
- Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Sung-Gyoo Park
- Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Republic of Korea.
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4
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Akbar A, Ahmad S. Atypical case of mild encephalopathy/encephalitis with reversible splenial lesion of the corpus callosum (MERS) associated with Mycoplasma pneumoniae infection in a paediatric patient. BMJ Case Rep 2021; 14:e242791. [PMID: 34389590 PMCID: PMC8365810 DOI: 10.1136/bcr-2021-242791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/04/2022] Open
Abstract
Mild encephalopathy with reversible splenial lesion (MERS) is a disorder characterised by prodromal symptoms such as fever, cough, vomiting or diarrhoea, followed by mild encephalopathy 1-7 days later with a documented reversible corpus callosum splenial lesion. MERS is mostly reported in children in the region of East Asia. To the best of our knowledge, this is the first reported case of MERS associated with mycoplasma infection in a child in North America. A brief review of literature is also a part of this report.
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Affiliation(s)
- Asra Akbar
- Pediatric Neurology, UICOMP, Peoria, Illinois, USA
| | - Sharjeel Ahmad
- Internal Medicine, Section of Infectious Diseases, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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5
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Liu L, Maharjan S, Sun JL, Li YC, Cheng HJ. Prevalence and clinical characteristics of septicemia in children with Mycoplasma pneumoniae pneumonia. J Int Med Res 2021; 49:3000605211021733. [PMID: 34167353 PMCID: PMC8236790 DOI: 10.1177/03000605211021733] [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] [Indexed: 12/04/2022] Open
Abstract
Background Mycoplasma pneumoniae (MP) pneumonia in children can be challenging to treat, and the impact of MP blood infection is unclear. The present study aims to determine the prevalence and clinical characteristics of MP septicemia among pediatric patients. Methods Children hospitalized at our center for MP pneumonia between October 2017 and June 2018 were included. Healthy controls visiting our outpatient clinic for regular physical examinations were also enrolled. MP was detected by real-time polymerase chain reaction (qPCR) analysis of plasma and peripheral blood mononuclear cell (PBMC) samples. Results Sixty-one children with MP pneumonia and 30 healthy children were included. Among children with MP infection, 31 (50.8%) were positive for MP by qPCR (19 in plasma samples, 8 in PBMC samples, and 4 in both). All healthy controls were negative for MP by qPCR. Conclusions The prevalence of MP septicemia in children with MP pneumonia is moderate. However, detection of MP in blood samples may have limited clinical value for guiding treatment.
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Affiliation(s)
- Li Liu
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Shobha Maharjan
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jia-Liang Sun
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yan-Chun Li
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Huan-Ji Cheng
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
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6
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Gómez Rufo D, García Sánchez E, García Sánchez JE, García Moro M. [Clinical implications of the genus Mycoplasma]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2021; 34:169-184. [PMID: 33735544 PMCID: PMC8179937 DOI: 10.37201/req/014.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dentro del género Mycoplasma, las especies que tradicionalmente se han relacionado con cuadros infecciosos han sido principalmente M. pneumoniae, M. genitalium, M. hominis o U. urealyticum. Sin embargo, existen otras muchas que están implicadas y, que muchas veces, son desconocidas para los profesionales sanitarios. El objetivo de esta revisión es identificar todas las especies del género Mycoplasma que se han aislado en el hombre y determinar su participación en la patología infecciosa humana.
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Affiliation(s)
| | - E García Sánchez
- Enrique García Sánchez, Departamento de Ciencias Biomédicas. Facultad de Medicina. Universidad de Salamanca. Spain.
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7
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Ahmed AOE, Babikir MMI, Khojali AEM, Arachchige SNM, Abdirahman AM, Mohamed MFH. Central Nervous System Vasculitis as a Rare Presentation of Mycoplasma pneumoniae: A Case Report. Case Rep Neurol 2020; 12:402-409. [PMID: 33362518 PMCID: PMC7747063 DOI: 10.1159/000510632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
Mycobacteria pneumoniae (MP) commonly causes upper and lower respiratory tract infections. The clinical manifestation is classified as pulmonary and extrapulmonary. These manifestations vary according to the involved system. MP may affect one system or more at a time. Commonly prodromal respiratory symptoms precede systemic involvement. Central nervous system involvement in uncommon. This report is presenting a rare case of central nervous system vasculitis secondary to MP, highlighting the diagnosis and management with a succinct literature review.
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8
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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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9
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Cadario ME, Ellis A, Garea M, Cairnie A, Mistchenko A, García Roig C, Freire MC, Savy V, Sciarrotta JA. [Acute disseminated encephalomyelitis due to Mycoplasma pneumoniae in a previously healthy boy]. Rev Argent Microbiol 2019; 51:153-156. [PMID: 30236414 DOI: 10.1016/j.ram.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/20/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022] Open
Abstract
We present here the case of a previously healthy 5 year-old boy hospitalized in an intensive care unit due to tonic-clonic seizures focused on the face and right side of the body, and axillary temperature of 37.4°C. Common bacterial and viral etiology was ruled out through studies of cerebrospinal fluid (CSF) samples. Mycoplasma pneumoniae was suspected by a positive immunofluorescence serum test for IgM class antibodies. Finally, with a brain biopsy, M. pneumoniae was confirmed by polymerase chain reaction (PCR) and acute disseminated encephalomyelitis by pathological anatomy. The patient was treated with clarithromycin and had an uneventful evolution. At least to our knowledge, this is the first case in which M. pneumoniae DNA was detected by PCR in a brain biopsy.
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Affiliation(s)
| | - Alejandro Ellis
- Servicio de Pediatría, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Mónica Garea
- Servicio de Pediatría, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Antonio Cairnie
- Servicio de Pediatría, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Alicia Mistchenko
- Servicio de Virología, Hospital de Niños «Dr. Ricardo Gutiérrez», Buenos Aires, Argentina
| | | | | | - Vilma Savy
- INEI-ANLIS «Dr. Carlos G. Malbrán», Buenos Aires, Argentina
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10
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Armstrong-Javors A, Berndtson K, Naureckas Li C, Schwartz K. Focal Neurologic Deficits in a Febrile Adolescent. Clin Pediatr (Phila) 2018; 57:1597-1601. [PMID: 30024277 DOI: 10.1177/0009922818790048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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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.
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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
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12
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Laila A, El-Lababidi RM, Hisham M, Mooty M. A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection. IDCases 2018; 12:41-43. [PMID: 29942745 PMCID: PMC6011136 DOI: 10.1016/j.idcr.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/23/2022] Open
Abstract
We report a case of acute disseminated encephalomyelitis (ADEM) secondary to Mycoplasma pneumoniae infection that failed to improve with methylprednisolone and intravenous immunoglobulin (IVIG); who responded with plasmapheresis. A 21- year- old female with an unremarkable medical history, initially presented to an outside hospital with fever and an influenza-like illness and was subsequently intubated for worsening sensorium. Brain magnetic resonance imaging was suggestive of ADEM or vasculitis for which she received five days of pulse steroids and IVIG. She showed no signs of improvement and was transferred to our hospital for plasmapheresis. Her work up revealed an elevated IgM antibody and positive sputum for Mycoplasma pneumonia by polymerase chain reaction, suggesting the pathogen as the culprit for her ADEM. Intravenous azithromycin and daily plasmapheresis were initiated for seven consecutive days. Following commencement of her treatment, the patient experienced good recovery and was subsequently extubated. She continued to improve with physical therapy and gained mobility, with the help of a walker. Patients commonly present with ADEM following viral infection or vaccination and less frequently post bacterial infection. The current treatment of ADEM due to Mycoplasma pneumoniae is based on limited case reports. Our patient poorly responded to pulse steroids and IVIG, while she markedly improved on azithromycin and plasmapheresis. In patients presenting with encephalopathic signs and neurological manifestations following pneumonia; Mycoplasma pneumoniae infection and subsequent immune-mediated demyelination should be considered.
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Affiliation(s)
- Alla Laila
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Rania M. El-Lababidi
- Pharmacy Education and Training, Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohamed Hisham
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohammad Mooty
- Infectious Diseases, Medical Subspecialty Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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13
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Hu J, Chen C, Ou G, You X, Tan T, Hu X, Zeng Y, Yu M, Zhu C. Nrf2 regulates the inflammatory response, including heme oxygenase-1 induction, by mycoplasma pneumoniae lipid-associated membrane proteins in THP-1 cells. Pathog Dis 2018; 75:3738187. [PMID: 28430965 DOI: 10.1093/femspd/ftx044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/15/2017] [Indexed: 11/14/2022] Open
Abstract
A series of inflammatory responses caused by Mycoplasma pneumoniae largely depend on the lipid-associated membrane proteins (LAMPs). Nuclear factor E2-related factor 2 (Nrf2), a transcription factor, is considered to be a critical modulator of inflammatory responses and cellular redox homeostasis. Monocytes play an important role in the invasion and immunity to resist pathogens. Here, we investigated the role of Nrf2 in the anti-inflammatory response stimulated by LAMPs using the human monocyte cell line THP-1. LAMPs were shown to affect the localization of Nrf2, and the levels of reactive oxygen species and inflammatory reactants, including nitric oxide (NO), prostaglandin E2 (PGE2) and cytokines (IL-6, IL-8), were highly elevated in LAMP-stimulated Nrf2-silenced THP-1 cells. Moreover, LAMPs induced the levels of mRNA and the expression of heme oxygenase-1 (HO-1). In summary, our results demonstrated that LAMPs cause nuclear translocation of Nrf2, which further suppresses the expression of inflammatory reactants in THP-1 cells.
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Affiliation(s)
- Jihong Hu
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Chunyan Chen
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China
| | - Guangli Ou
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China
| | - Xiaoxing You
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China
| | - Tianping Tan
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China
| | - Xinnian Hu
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China
| | - Yihua Zeng
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China
| | - Minjun Yu
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China
| | - Cuiming Zhu
- Institute of Pathogenic Biology, Medical College, University of South China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
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14
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Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev 2017; 30:747-809. [PMID: 28539503 PMCID: PMC5475226 DOI: 10.1128/cmr.00114-16] [Citation(s) in RCA: 350] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mycoplasma pneumoniae is an important cause of respiratory tract infections in children as well as adults that can range in severity from mild to life-threatening. Over the past several years there has been much new information published concerning infections caused by this organism. New molecular-based tests for M. pneumoniae detection are now commercially available in the United States, and advances in molecular typing systems have enhanced understanding of the epidemiology of infections. More strains have had their entire genome sequences published, providing additional insights into pathogenic mechanisms. Clinically significant acquired macrolide resistance has emerged worldwide and is now complicating treatment. In vitro susceptibility testing methods have been standardized, and several new drugs that may be effective against this organism are undergoing development. This review focuses on the many new developments that have occurred over the past several years that enhance our understanding of this microbe, which is among the smallest bacterial pathogens but one of great clinical importance.
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Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China, and Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | | | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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15
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Chaudhry R, Ghosh A, Chandolia A. Pathogenesis of Mycoplasma pneumoniae: An update. Indian J Med Microbiol 2016; 34:7-16. [PMID: 26776112 DOI: 10.4103/0255-0857.174112] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genus Mycoplasma, belonging to the class Mollicutes, encompasses unique lifeforms comprising of a small genome of 8,00,000 base pairs and the inability to produce a cell wall under any circumstances. Mycoplasma pneumoniae is the most common pathogenic species infecting humans. It is an atypical respiratory bacteria causing community acquired pneumonia (CAP) in children and adults of all ages. Although atypical pneumonia caused by M. pneumoniae can be managed in outpatient settings, complications affecting multiple organ systems can lead to hospitalization in vulnerable population. M. pneumoniae infection has also been associated with chronic lung disease and bronchial asthma. With the advent of molecular methods of diagnosis and genetic, immunological and ultrastructural assays that study infectious disease pathogenesis at subcellular level, newer virulence factors of M. pneumoniae have been recognized by researchers. Structure of the attachment organelle of the organism, that mediates the crucial initial step of cytadherence to respiratory tract epithelium through complex interaction between different adhesins and accessory adhesion proteins, has been decoded. Several subsequent virulence mechanisms like intracellular localization, direct cytotoxicity and activation of the inflammatory cascade through toll-like receptors (TLRs) leading to inflammatory cytokine mediated tissue injury, have also been demonstrated to play an essential role in pathogenesis. The most significant update in the knowledge of pathogenesis has been the discovery of Community-Acquired Respiratory Distress Syndrome toxin (CARDS toxin) of M. pneumoniae and its ability of adenosine diphosphate (ADP) ribosylation and inflammosome activation, thus initiating airway inflammation. Advances have also been made in terms of the different pathways behind the genesis of extrapulmonary complications. This article aims to comprehensively review the recent advances in the knowledge of pathogenesis of this organism, that had remained elusive during the era of serological diagnosis. Elucidation of virulence mechanisms of M. pneumoniae will help researchers to design effective vaccine candidates and newer therapeutic targets against this agent.
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Affiliation(s)
- R Chaudhry
- Department of Microbiology, AIIMS, New Delhi, India
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16
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Narita M. Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis. Front Microbiol 2016; 7:23. [PMID: 26858701 PMCID: PMC4729911 DOI: 10.3389/fmicb.2016.00023] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/11/2016] [Indexed: 01/22/2023] Open
Abstract
The list of extrapulmonary manifestations due to Mycoplasma pneumoniae infection can be classified according to the following three possible mechanisms derived from the established biological activity of M. pneumoniae; (1) a direct type in which the bacterium is present at the site of inflammation and local inflammatory cytokines induced by the bacterium play an important role (2) an indirect type in which the bacterium is not present at the site of inflammation and immune modulations, such as autoimmunity or formation of immune complexes, play an important role, and (3) a vascular occlusion type in which obstruction of blood flow induced either directly or indirectly by the bacterium plays an important role. Recent studies concerning extrapulmonary manifestations have prompted the author to upgrade the list, including cardiac and aortic thrombi as cardiovascular manifestations; erythema nodosum, cutaneous leukocytoclastic vasculitis, and subcorneal pustular dermatosis as dermatological manifestations; acute cerebellar ataxia, opsoclonus-myoclonus syndrome, and thalamic necrosis as neurological manifestations; pulmonary embolism as a respiratory system manifestation; and renal artery embolism as a urogenital tract manifestation. Continuing nosological confusion on M. pneumoniae–induced mucositis (without skin lesions), which may be called M. pneumoniae-associated mucositis or M. pneumoniae-induced rash and mucositis separately from Stevens-Johnson syndrome, is argued in the dermatological manifestations. Serological methods are recommended for diagnosis because pneumonia or respiratory symptoms are often minimal or even absent in extrapulmonary manifestations due to M. pneumoniae infection. Concomitant use of immunomodulators, such as corticosteroids or immunoglobulins with antibiotics effective against M. pneumoniae, can be considered as treatment modalities for most severe cases, such as encephalitis. Further studies would be necessary to construct a comprehensive therapeutic strategy, covering microbiology (antibiotics), immunology (immunomodulators), and hematology (anticoagulants). The possible influence of the emergence of macrolide-resistant M. pneumoniae on extrapulmonary manifestations, which can be considered of limited clinical threat in Japan where the resistant rate has currently decreased, is discussed on the basis of unique biological characteristics of M. pneumoniae, the smallest self-replicating organism.
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Affiliation(s)
- Mitsuo Narita
- Department of Pediatrics, Sapporo Tokushukai Hospital Sapporo, Japan
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Magun R, Verschoor CP, Bowdish DME, Provias J. Mycoplasma pneumoniae, a trigger for Weston Hurst syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e187. [PMID: 26819961 PMCID: PMC4723134 DOI: 10.1212/nxi.0000000000000187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/03/2015] [Indexed: 11/28/2022]
Abstract
Objective: We report a case of Mycoplasma pneumoniae infection as one possible trigger for Weston Hurst syndrome (acute hemorrhagic leukoencephalitis), a rare disorder of microvascular injury often described as a postinfectious complication of an upper respiratory illness. Methods: This is a case of a 27-year-old man presenting with a Glasgow Coma Scale score of 3 and an acute head CT revealing extensive vasogenic edema in the right hemisphere associated with mass effect in the context of a recent upper respiratory illness. Right frontal biopsy was performed on day 2, which showed acute cerebritis, and the patient was aggressively treated with antibiotics. However, over the next 5 days from presentation, the vasogenic edema increased, leading ultimately to brain herniation and death. Results: A full autopsy was performed at 5 days from presentation, which showed areas of vessel wall fibrinoid necrosis throughout the right hemisphere as well as, but less so, in the left frontal lobe and pons. Chest x-ray on presentation revealed atypical pneumonia, blood tests were positive for cold agglutinins, and at full autopsy, there was myocarditis, all in keeping with recent M pneumoniae infection. DNA obtained from lung and diseased brain (postmortem) was positive for Mycoplasma providing more direct evidence for brain invasion by this organism as the ultimate trigger for Weston Hurst syndrome. Conclusions: This is a rare case report of Weston Hurst syndrome having both initial brain biopsy on day 2 and full autopsy results on day 5 of presentation revealing important clinical clues about the pathogenesis of this often fatal disorder.
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Affiliation(s)
- Rick Magun
- Department of Neurology (R.M.), McMaster Immunology Research Centre (C.P.V., D.M.E.B.), and Department of Pathology and Molecular Medicine (Neuropathology) (J.P.), McMaster University, Hamilton, Ontario, Canada
| | - Chris P Verschoor
- Department of Neurology (R.M.), McMaster Immunology Research Centre (C.P.V., D.M.E.B.), and Department of Pathology and Molecular Medicine (Neuropathology) (J.P.), McMaster University, Hamilton, Ontario, Canada
| | - Dawn M E Bowdish
- Department of Neurology (R.M.), McMaster Immunology Research Centre (C.P.V., D.M.E.B.), and Department of Pathology and Molecular Medicine (Neuropathology) (J.P.), McMaster University, Hamilton, Ontario, Canada
| | - John Provias
- Department of Neurology (R.M.), McMaster Immunology Research Centre (C.P.V., D.M.E.B.), and Department of Pathology and Molecular Medicine (Neuropathology) (J.P.), McMaster University, Hamilton, Ontario, Canada
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Zhong A. Recent Progress in Mycoplasma pneumoniae Infection. INFECTION INTERNATIONAL 2015. [DOI: 10.1515/ii-2017-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractMycoplasma pneumoniae(Mp) is a definite respiratory pathogen affecting people of all ages. This organism is adsorbed on host cell surface through extreme adherent organelles, generating peroxide ions and possible exotoxins. Mp may directly invade host cells and cause latent infections. Induced immunoreactive injury is one of the main factors resulting in clinical symptoms of Mp infection. Polymerase chain reaction (PCR) and serological detection should be combined for diagnosis of Mp infection when nasopharyngeal and oropharyngeal specimens are simultaneously obtained and detected by PCR. The most reliable basis for diagnosis can be obtained with two serological tests in different courses of the disease. Culture methods also bear significance in diagnosing Mp infections andin vitrodrug sensitivity tests.
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Ficko C, Andriamanantena D, Mangouka L, Bigaillon C, Flateau C, Mérens A, Rapp C. Méningo-encéphalite aiguë à Mycoplasma pneumoniae de l’adulte traitée avec succès par lévofloxacine. Rev Med Interne 2015; 36:47-50. [DOI: 10.1016/j.revmed.2013.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 07/24/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- Dennis W Simon
- Department of Critical Care Medicine, The Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Noska A, Nasr R, Williams DN. Closed trauma, Mycoplasma hominis osteomyelitis, and the elusive diagnosis of Good's syndrome. BMJ Case Rep 2012. [PMID: 23188847 DOI: 10.1136/bcr-2012-007056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycoplasma hominis septic arthritis has a well-established association with hypogammaglobulinaemia, but is rarely seen in immunocompetent hosts. An association also exists with a closed trauma and a predisposition to M hominis bone infections. In this clinical case report, a patient with M hominis osteomyelitis following a closed trauma was diagnosed using 16S ribosomal studies, and led to the diagnosis of a severe underlying immunodeficiency syndrome known as Good's syndrome.
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Affiliation(s)
- Amanda Noska
- Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
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Powers JM, Johnson MD. Mycoplasmal panencephalitis: a neuropathologic documentation. Acta Neuropathol 2012; 124:143-8. [PMID: 22370906 DOI: 10.1007/s00401-012-0960-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/05/2012] [Accepted: 02/11/2012] [Indexed: 10/28/2022]
Abstract
Mycoplasmas, particularly Mycoplasma pneumoniae, have been implicated as causative agents in a large variety of central nervous system diseases, especially acute childhood encephalitis. Postulated pathomechanisms for mycoplasma-mediated neurological disease have included: direct infection, autoimmunity, and vascular occlusion. Neuropathologic data are meager and are reviewed. We report a 3-year-old boy, who developed signs and symptoms of encephalitis 7 days after the onset of fever with cough and death 5 days later. At autopsy, he displayed diffuse vasogenic edema and perivascular to infiltrative inflammatory cells, the latter most prominent in gray matter of brainstem and amygdala. The predominant cell was the CD68-positive macrophage, followed by the T-lymphocyte. Cells immunolabeled with a polyclonal antibody to M. pneumoniae included perivascular to parenchymal macrophages/microglia, occasional oligodendrocytes, and neurons, particularly in brainstem. Affected neurons varied from morphologically normal to profoundly degenerate and necrotic. Ultrastructural study of the inferior olive confirmed the presence of 260-600 nm cell-wall-free microorganisms, consistent with mycoplasma, in perivascular cells and neurons. Foci of acute disseminated encephalomyelitis also were rarely identified. This case report confirms the postulated role of direct infection of brain by mycoplasma in acute childhood encephalitis, but also reveals a virus-like infection of central neurons. The pathogenesis of acute childhood encephalitis due to mycoplasma seems to be multifactorial.
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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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Bitnun A, Richardson SE. Mycoplasma pneumoniae: Innocent Bystander or a True Cause of Central Nervous System Disease? Curr Infect Dis Rep 2011; 12:282-90. [PMID: 21308543 DOI: 10.1007/s11908-010-0105-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The consistency with which Mycoplasma pneumoniae has been implicated as a cause of encephalitis, and the increased incidence of central nervous system (CNS) disease observed during M. pneumoniae respiratory outbreaks, support the role of M. pneumoniae as a CNS pathogen. Three pathophysiologic mechanisms have been proposed: direct infection, autoimmunity, and vascular occlusion. Recent evidence demonstrating the organism's ability to survive intracellularly, presence of its DNA in the serum of individuals with acute encephalitis, case reports in which the organism is detected in brain parenchyma or cerebrospinal fluid (CSF), and animal data demonstrating CNS invasion by several Mycoplasma species support the contention that M. pneumoniae is capable of direct infection of the CNS. Because of limitations of current serologic assays and difficulty in interpreting the significance of positive polymerase chain reaction results in regard to acuity of infection and viability of the organism, the diagnosis of M. pneumoniae-associated CNS disease should be based on a combination of positive tests and exclusion of alternative diagnoses.
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Affiliation(s)
- Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada,
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May M, Brown DR. Retrospective survey for sialidase activity in Mycoplasma pneumoniae isolates from cases of community-acquired pneumonia. BMC Res Notes 2011; 4:195. [PMID: 21676241 PMCID: PMC3138463 DOI: 10.1186/1756-0500-4-195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 06/15/2011] [Indexed: 01/20/2023] Open
Abstract
Background Sialidase is a well-known virulence factor of other respiratory pathogens, but was only recently documented to occur in some species of Mycoplasma. The sialidase activity expressed can vary quantitatively among strains within a species of mycoplasma, from undetectable to amounts that correlate positively with strain virulence. Very few isolates of Mycoplasma pneumoniae had ever been examined for sialidase activity, so it was unknown whether sialidase may contribute to diseases involving this species. Findings No sialidase activity was detected by spectrofluorometric assay of 15 laboratory strains and 91 clinical isolates of M. pneumoniae banked over many years from patients having radiologically-confirmed, uncomplicated community-acquired pneumonia. Conclusions The annotated genome of strain M129 (GenBank NC_000912, ATCC 29342), also isolated from a patient with pneumonia, accurately represents the absence of sialidase genes from strains of M. pneumoniae typically associated with uncomplicated community-acquired pneumonia. A possible involvement of sialidase in neurologic or other extra-respiratory manifestations of M. pneumoniae mycoplasmosis remains to be investigated.
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Affiliation(s)
- Meghan May
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville FL, USA.
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Xu F, Dai CL, Wu XM, Chu P. Overwhelming postsplenectomy infection due to Mycoplasma pneumoniae in an asplenic cirrhotic patient: case report. BMC Infect Dis 2011; 11:162. [PMID: 21651767 PMCID: PMC3118146 DOI: 10.1186/1471-2334-11-162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 06/08/2011] [Indexed: 11/22/2022] Open
Abstract
Background Mycoplasma pneumoniae infection is usually self-limited, but some fulminant cases are fatal, even when occurring in previously healthy individuals. It can also be the cause of overwhelming postsplenectomy infection (OPSI). Case presentation We report a case of OPSI in a 41-year-old woman with hypersplenism associated with hepatitis B cirrhosis. We detected a significant Mycoplasma pneumoniae agglutination titer, but no evidence of infection with Chlamydia pneumoniae, Legionnella spp., or any other bacterial or fungal pathogens. She eventually died despite aggressive therapy. Conclusions M. pneumoniae could be an underestimated cause of OPSI, and should be suspected in fulminant infectious cases in asplenic patients.
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Affiliation(s)
- Feng Xu
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang, Liaoning, P,R,China
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Simpkins A, Strickland SM, Oliver J, Murray DL, Steele JCH, Park YD, Sharma S. Complete resolution of advanced Mycoplasma pneumoniae encephalitis mimicking brain mass lesions: report of two pediatric cases and review of literature. Neuropathology 2011; 32:91-9. [PMID: 21615517 DOI: 10.1111/j.1440-1789.2011.01225.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mycoplasma pneumoniae is a well-known cause of atypical pneumonia. CNS involvement is a relatively frequent extrapulmonary manifestation, most commonly manifesting as encephalitis in the pediatric population. We present two unusual cases of M. pneumoniae encephalitis that presented with symptoms and imaging findings suggesting mass occupying lesions, and worsening altered mental status. Biopsy of the lesions was necessary in both cases to aid with diagnosis. Histopathologic features excluded neoplasm, and established the diagnosis of encephalitis, but did not point toward its etiology. The only finding that indicated M. pneumoniae as the most likely pathogen was serum IgM positivity in the absence of any other identifiable infectious source, and complete neurologic recovery following specific anti-mycoplasmal treatment. The patients were successfully treated with antibiotics and steroids, with the second case also requiring intravenous immunoglobulin and anti-epileptics. The clinical presentation and histopathologic findings suggested an immune-mediated pathogenesis, but acute disseminated encephalomyelitis was excluded due to extensive gray matter involvement. Disease resolution despite status epilepticus and herniation in case 2 is a novel finding of the study. Current principles of diagnosis and management of encephalitis as the presenting manifestation of mycoplasmal infection are discussed.
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Affiliation(s)
- Alexis Simpkins
- Department of Pathology, Medical College of Georgia, Augusta, Georgia 30912, USA
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Kandasamy P, Zarini S, Chan ED, Leslie CC, Murphy RC, Voelker DR. Pulmonary surfactant phosphatidylglycerol inhibits Mycoplasma pneumoniae-stimulated eicosanoid production from human and mouse macrophages. J Biol Chem 2011; 286:7841-7853. [PMID: 21205826 DOI: 10.1074/jbc.m110.170241] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Mycoplasma pneumoniae is a human pathogen causing respiratory infections that are also associated with serious exacerbations of chronic lung diseases. Membranes and lipoproteins from M. pneumoniae induced a 4-fold increase in arachidonic acid (AA) release from RAW264.7 and a 2-fold increase in AA release from primary human alveolar macrophages. The bacterial lipoprotein mimic and TLR2/1 agonist Pam3Cys and the TLR2/6 agonist MALP-2 produced effects similar to those elicited by M. pneumoniae in macrophages by inducing the phosphorylation of p38(MAPK) and p44/42(ERK1/2) MAP kinases and cyclooxygenase-2 (COX-2) expression. M. pneumoniae induced the generation of prostaglandins PGD(2) and PGE(2) from RAW264.7 cells and thromboxane B(2) (TXB(2)) from human alveolar macrophages. Anti-TLR2 antibody completely abolished M. pneumoniae-induced AA release and TNFα secretion from RAW264.7 cells and human alveolar macrophages. Disruption of the phosphorylation of p44/42(ERK1/2) or inactivation of cytosolic phospholipase A(2)α (cPLA(2)α) completely inhibited M. pneumoniae-induced AA release from macrophages. The minor pulmonary surfactant phospholipid, palmitoyl-oleoyl-phosphatidylglycerol (POPG), antagonized the proinflammatory actions of M. pneumoniae, Pam3Cys, and MALP-2 by reducing the production of AA metabolites from macrophages. The effect of POPG was specific, insofar as saturated PG, and saturated and unsaturated phosphatidylcholines did not have significant effect on M. pneumoniae-induced AA release. Collectively, these data demonstrate that M. pneumoniae stimulates the production of eicosanoids from macrophages through TLR2, and POPG suppresses this pathogen-induced response.
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Affiliation(s)
| | - Simona Zarini
- the Department of Pharmacology, University of Colorado Denver School of Medicine, Aurora, Colorado 80011
| | | | - Christina C Leslie
- the Department of Pharmacology, University of Colorado Denver School of Medicine, Aurora, Colorado 80011; Pediatrics, National Jewish Health, Denver, Colorado, 80206 and
| | - Robert C Murphy
- the Department of Pharmacology, University of Colorado Denver School of Medicine, Aurora, Colorado 80011
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Is Mycoplasma pneumoniae adherence to erythrocytes a factor in extrapulmonary dissemination? PLoS Pathog 2010; 6:e1001219. [PMID: 21203479 PMCID: PMC3009594 DOI: 10.1371/journal.ppat.1001219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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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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Abstract
Mycoplasma pneumoniae continues to be the most frequent cause of atypical pneumonia. Fortunately, the antibiotics listed in this article are generally very effective. Major skills are needed to detect M pneumoniae extrapulmonary diseases, which require a special heightened awareness and sensitivity. It is not known whether early therapy prevents dreaded complications.
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Affiliation(s)
- Leon G Smith
- Infectious Disease Foundation of Saint Michael's Medical Center, 111 Central Avenue, Newark, NJ 07102, USA.
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Narita M. Pathogenesis of neurologic manifestations of Mycoplasma pneumoniae infection. Pediatr Neurol 2009; 41:159-66. [PMID: 19664529 DOI: 10.1016/j.pediatrneurol.2009.04.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/09/2009] [Accepted: 04/13/2009] [Indexed: 11/16/2022]
Abstract
Mycoplasma pneumoniae has been associated with various neurologic manifestations, but exactly how the organism can cause such a wide variety of diseases is a long-standing mystery. In this respect, although pneumonia has been considered the hallmark of Mycoplasma pneumoniae infection, emerging accumulations of data have revealed that the infection can cause a number of extrapulmonary manifestations even in the absence of pneumonia. The importance of host immune response in the pathomechanism of pneumonia has been established, but the pathomechanisms of extrapulmonary manifestations remain largely unknown. For this review, extrapulmonary manifestations due to M. pneumoniae infection were classified into three categories: a direct type, in which locally induced cytokines must play a role; an indirect type, in which immune modulation such as autoimmunity must play a role; and a vascular occlusion type, in which vasculitis or thrombosis (either or both, and with or without systemic hypercoagulable state) must play a role. This classification was then applied within a literature review for neurologic manifestations. Most neurologic manifestations due to M. pneumoniae infection could be reasonably classified into and explained by one of the three types of pathomechanisms.
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Affiliation(s)
- Mitsuo Narita
- Department of Pediatrics, Sapporo Tetsudo Hospital, N 3 E 1 Chuo-ku, Sapporo 060-0033, Japan.
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Waites KB, Balish MF, Atkinson TP. New insights into the pathogenesis and detection of Mycoplasma pneumoniae infections. Future Microbiol 2008; 3:635-48. [PMID: 19072181 PMCID: PMC2633477 DOI: 10.2217/17460913.3.6.635] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mycoplasma pneumoniae is a common cause of upper and lower respiratory tract infections in persons of all ages and may be responsible for up to 40% of community-acquired pneumonias. A wide array of extrapulmonary events may accompany the infections caused by this organism, related to autoimmunity or direct spread. This review includes a discussion of the latest knowledge concerning the molecular pathological basis of mycoplasmal respiratory disease, how the organism interacts with the host immune system and its association with the development of chronic conditions such as asthma, recent emergence of macrolide resistance and the status of laboratory diagnostic methods.
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Affiliation(s)
- Ken B Waites
- University of Alabama at Birmingham, WP 230, 619 19th Street South, Birmingham, AL 35249, USA.
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