CNS Manifestations Associated with Mycoplasma pneumoniae Infections: Summary of Cases at the University of Helsinki and Review

Koskiniemi, Marjaleena

doi:10.1093/clinids/17.supplement_1.s52

Cited by 176 publications

(130 citation statements)

References 64 publications

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“…Approximately 6 to 7% of hospitalized patients with serologically confirmed cases of M. pneumoniae pneumonia may experience neurological complications of varying severity (237,294,332,387). Such complications have included encephalitis, cerebellar syndrome and polyradiculitis, cranial nerve palsies, aseptic meningitis or meningoencephalitis, acute disseminated encephalomyelitis, coma, optic neuritis, diplopia, mental confusion, and acute psychosis secondary to encephalitis (39,98,159,226,264,331,386,392).…”

Section: Extrapulmonary Manifestationsmentioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur

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Section: Extrapulmonary Manifestationsmentioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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“…Other reported presentations include coma, ataxia, psychosis, and stroke. There are also some reported cases of psychosis following resolution of mycoplasma pneumonia [28]- [31]. New manifestations have been described following Mycoplasma pneumoniae infection such as KluverBucy syndrome & intracranial hypertension which need to be confirmed.…”

Section: Mycoplasma Pneumoniamentioning

confidence: 99%

Psychiatric Aspects of Infectious Diseases

Mufaddel¹,

Omer²,

Salem³

2014

OJPsych

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Psychiatric symptoms can be associated with several systemic and central nervous system infections and they can be the initial presenting symptoms, occurring in the absence of neurological symptoms in some disorders as in some cases of viral encephalitis. They could also be part of the clinical picture in other cases such as psychosis or mood symptoms secondary to brucellosis or toxoplasmosis. Late-onset neuropsychiatric complications may also occur several years following the infection such as in the case of subacute sclerosing panencephalitis due to measles. Some Infectious diseases may have possible etiological role for major psychiatric disorders, based on yet unconfirmed reports for viral infectious diseases (e.g. Influenza virus and HSV-1) which are thought to have risk for developing schizophrenia and psychosis. Neuropsychiatric adverse effects can occur due to drugs (e.g. mefloquine, interferon-alpha) that are used for treatment of infectious diseases. Psychiatric symptoms can also be reactivated resulting from chronic, complicated and serious infections such as HIV that can lead to depression, anxiety or adjustment disorders, although CNS involvement can also be a possible etiological factor. Patients suffering from primary and severe psychiatric disorders are at increased risk of contracting infection; that is mainly related to high risk behaviors in patients with mania or schizophrenia. It is also important to consider that the co-occurrence of psychiatric symptoms and infection can be incidental (i.e. infectious diseases can occur in psychiatric patients regardless of the above mentioned factors). Early identification of the underlying etiology for organic/secondary psychiatric symptoms is essential for appropriate intervention and early treatment of the primary condition that could be the etiology of psychiatric symptoms so as to avoid unnecessary long-term psychiatric treatment and to avoid complications of possible misdiagnosis or delayed diagnosis of the primary condition.

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“…It can develop as long as three weeks after the onset of the respiratory illness, and in up to 20% of cases with neurological features there is no history of respiratory symptoms. Most patients make a full neurological recovery 2,3 .…”

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confidence: 99%

“…Autoantibodies to several host tissues, including brain, have been identi®ed in infected patients with and without neurological complications 5 . CSF ®ndings in M. pneumoniae neurological disease have included a raised protein, normal to low glucose and pleocytosis with lymphocytes predominating 2,3 .…”

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confidence: 99%

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Cerebellar syndrome complicating Mycoplasma pneumoniae pneumonia

et al. 2000

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Acute self-limiting cerebellar syndrome is a poorly recognized complication of Mycoplasma pneumoniae infection 1 . CASE HISTORYA woman aged 60, who 27 years earlier had had her mitral valve replaced with a prosthesis, developed '¯u-like symptoms and a productive cough for which her general practitioner prescribed amoxycillin. On day 6 he found signs of consolidation at the right lung base with continued fever, so clarithromycin was added. She had well-controlled atrial ®brillation and was on warfarin and digoxin; the prosthetic valve was functioning normally.On day 8 the international normalized ratio (INR) was checked and had risen to 8.2. On the advice of a haematologist she was given intravenous vitamin K. Because of concern over the anticoagulation, together with continuing fever, anorexia and persistent signs at the right base, she was admitted to hospital on day 9. On admission the chest X-ray con®rmed right basal consolidation. The INR was 2; clarithromycin was stopped because it was thought to be interfering with anticoagulant control. White cell count showed a slight lymphopenia (0.6610 9 /L). She was treated with intravenous ceftriaxone for 7 days and improved clinically and radiologically. On day 17 she was switched to oral co-amoxiclav and was discharged.On day 18 she was readmitted with relapse of her productive cough, fever and continued anorexia and weight loss. White cell count was 13.7610 9 /L (neutrophils 12.2, lymphocytes 0.4), erythrocyte sedimentation rate was 40 mm/h and C-reactive protein 97 mg/dL. Chest X-ray now showed left basal consolidation with resolution of the right basal consolidation. Increased antibody to M. pneumoniae was detected by the complement ®xation and gelatin particle agglutination tests, con®rmed by the presence of speci®c IgM by enzyme-linked immunosorbent assay in all samples apart from that collected on day 8. No signi®cant antibodies were detected by the complement ®xation test to adenovirus, in¯uenza virus type A, herpes simplex, Coxiella burnetii and/or Chlamydia psittaci, and speci®c IgM to Epstein±Barr virus was absent. Pseudomonas aeruginosa was grown from a sputum sample. She was treated with intravenous ceftazidime and gentamicin and with oral azithromycin.On day 20 she required catheterization for urinary retention and on day 21 she was noted to be very weak with slurred speech and complaining of double vision. Examination revealed bilateral horizontal nystagmus, upbeat nystagmus, slurring dysarthria, bilateral upper and lower limb ataxia and bilateral dysdiadochokinesis; the central and peripheral nervous systems were otherwise normal. A computed tomographic head scan and magnetic resonance imaging of the brain and cerebellum showed nothing abnormal. Thyroid function tests were normal. C-reactive protein peaked at 135 mg/dL. A lumbar puncture was not done because it seemed unlikely to help diagnostically and her INR was 4.6. On day 22 she no longer exhibited dysdiadochokinesis and on day 24 her nystagmus was less pronounced and she was able to walk aided....

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CNS Manifestations Associated with Mycoplasma pneumoniae Infections: Summary of Cases at the University of Helsinki and Review

Cited by 176 publications

References 64 publications

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

Psychiatric Aspects of Infectious Diseases

Cerebellar syndrome complicating Mycoplasma pneumoniae pneumonia

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