A case of meningoencephalitis associated with macrolide‐resistant <i>Mycoplasma pneumoniae</i> infection

Koga, Shunsuke; Ishiwada, Naruhiko; Honda, Yoshiko; Okunushi, Tomoko; Hishiki, Haruka; Ouchi, Kazunobu; Kohno, Yoichi

doi:10.1111/j.1442-200x.2012.03588.x

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…They speculated that milder disease in their patients or a difference in blood sampling times could explain the apparent discrepancy with other studies. Life-threatening pneumonia and meningoencephalitis due to MRMP have also been reported (397,398).…”

Section: Macrolide Resistancementioning

confidence: 99%

Mycoplasma pneumoniae from the Respiratory Tract and Beyond

et al. 2017

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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 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. 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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Section: Macrolide Resistancementioning

confidence: 99%

Mycoplasma pneumoniae from the Respiratory Tract and Beyond

et al. 2017

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“…Therefore, they suffer from less efficient protein synthesis and are deficient in growth ability (Narita, 2011b ). In fact, no excessive morbidity has been observed particularly ascribed to the drug resistance in the reported cases (Atkinson et al, 2011 ; Koga et al, 2012 ; Oishi et al, 2012 ). In addition to that, serum levels of IL-18, which represent disease activity of M. pneumoniae infection (Narita et al, 2000 ; Tanaka et al, 2002 ; Oishi et al, 2011 ; Miyashita et al, 2015a ), were rather lower in patients with pneumonia infected by the resistant strains than in patients infected by the sensitive strains (Matsuda et al, 2013 ).…”

Section: Possible Influence Of the Emergence Of Macrolide-resistant mentioning

confidence: 79%

“…Since 2000, when the first case of pneumonia due to macrolide-resistant M. pneumoniae was diagnosed in Japan (Okazaki et al, 2001 ), macrolide resistance has grown to be a significant problem in some countries, particularly in eastern Asia. A few cases of extrapulmonary manifestations due to macrolide-resistant M. pneumoniae have been reported (Atkinson et al, 2011 ; Koga et al, 2012 ; Oishi et al, 2012 ; Shen et al, 2013 ; Zhou et al, 2014 ). While the studies from China have reported that a substantial number of complications (most frequently liver and myocardial dysfunctions) occurred in patients infected by resistant strains (Shen et al, 2013 ; Zhou et al, 2014 ), no appreciable increase in the number of extrapulmonary manifestations has been observed in Japan in conjunction with a significant increase in the number of pneumonia patients infected by the resistant strains.…”

Section: Possible Influence Of the Emergence Of Macrolide-resistant mentioning

confidence: 99%

Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis

2016

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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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“…In 25% of M. pneumoniae infections, gastrointestinal symptoms (nausea, diarrhea, vomiting) have been described. Other clinical extrapulmonary symptomatology involving central nervous system, such as encephalitis and meningoencephalitis have been reported as well [23]. Complications affecting cardiac, hepatic, renal, skin and muscular systems (erythema multiforme) were reported less frequently [9].…”

Section: Mycoplasma Pneumoniaementioning

confidence: 99%

Mycoplasma Infections in Humans

Sleha

Boštíková²,

Salavec³

et al. 2013

MMSL

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Members of the genus Mycoplasma are parasitic bacteria that are widespread in nature. Several Mycoplasma species are important causative agents of various infections of mucosal surfaces in humans, especially in the urogenital or respiratory tracts. Pathogenetic mechanisms of mycoplasmas are intensively studied. The "gold" standard of mycoplasma detection is cultivation, which is very difficult and time-consuming. The other options for identifying mycoplasmas include direct antigen detection or molecular-biology methods, such as polymerase chain reaction, DNA-hybridization and sequencing. Mycoplasmas are naturally resistant to beta-lactam antibiotics because of lack of cell wall. Tetracyclines or fluoroquinolones are regarded as the first choice in the treatment of mycoplasma infections. Several reports have documented resistance of mycoplasmas to macrolides worldwide. This report summarizes our current knowledge of laboratory diagnosis and treatment of mycoplasma infections.

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A case of meningoencephalitis associated with macrolide‐resistant Mycoplasma pneumoniae infection

Cited by 9 publications

References 10 publications

Mycoplasma pneumoniae from the Respiratory Tract and Beyond

Mycoplasma pneumoniae from the Respiratory Tract and Beyond

Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis

Mycoplasma Infections in Humans

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