Statistical Analysis of Stevens-Johnson Syndrome Caused by Mycoplasma pneumonia Infection in Japan

Kunimi, Yuko; Hirata, Yuko; Aihara, Michiko; Yamane, Yumiko; Ikezawa, Zenrō

doi:10.2332/allergolint.11-oa-0309

Cited by 58 publications

(62 citation statements)

References 20 publications

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“…8 Mucositis was predominant, with multiple mucus membranes involved, including ocular lesions. 38,39 We observed a less severe distribution of skin involvement in the Mp-SJS group. Mucous membrane involvement was similar between groups, but severity and distribution were more difficult to quantify.…”

Section: Case-control Analysismentioning

confidence: 57%

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Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

et al. 2015

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BACKGROUND: Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado.METHODS: Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection.RESULTS: During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 10.0, confidence interval [CI] 1.3-5.1), preceding respiratory symptoms (OR 30.0, CI 1.6-72.6), an erythrocyte sedimentation rate $35 mg/dL (OR 22.8, CI 2.1-244.9), and #3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23). CONCLUSIONS:We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.WHAT'S KNOWN ON THIS SUBJECT: StevensJohnson syndrome (SJS) is a rare and severe immunologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such as Mycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare. WHAT THIS STUDY ADDS:We describe the largest SJS outbreak reported in children, which was also Mp-associated. In the first case-control study of this disease, we identify predictors of Mp-associated SJS versus non-Mp-associated SJS, including fewer skin lesions, pneumonia, and elevated erythrocyte sedimentation rate.

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Section: Case-control Analysismentioning

confidence: 57%

“…37 The clinical spectrum of disease in our pediatric outbreak and retrospective case-control study was similar to previous published case series of Mpassociated SJS. 8,38,39 Prodromal respiratory illness and fever were common. 8 Mucositis was predominant, with multiple mucus membranes involved, including ocular lesions.…”

Section: Case-control Analysismentioning

confidence: 99%

Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

et al. 2015

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“…2 Several research groups have presented reports on drugs implicated in SJS/TEN (selective cyclooxygenase-2 inhibitors, lamotrigine, anti-epileptic drugs, sulfonamide antibiotics, and allopurinol, etc.). 3,4 SJS associated with Mycoplasma pneumoniae infection is observed mainly in children, 5,6 while another group reported the effects of the genetic background of patients. 7 The relationship between aging and SJS/TEN is still not clear.…”

Section: Dear Editormentioning

confidence: 97%

Stevens–Johnson syndrome and toxic epidermal necrolysis: The Food and Drug Administration adverse event reporting system, 2004–2013

Abe

Mataki

Umetsu

et al. 2015

Allergology International

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“…It will be considered of infectious origin if such a process is presented in the week prior to the rash, and if IgM to infectious agents can be demonstrated. 30,31 It has been seen that the latency time between the introduction of the drug and the start of SJS/TEN varies depending on the drug, being much shorter in the case of antibiotics and Severe delayed reactions to drugs in childhood 7 sulphonamides, 44 even days, as in the case of a 6-year-old girl who developed TEN after 5 days of receiving procaine penicillin and 2 days ceftriaxone, 45 In both cases presented here, the interval in the first one was 7---8 days and in the second was 48---72 h. Sometimes both infectious agents and drugs are identified as potential precipitants of the disease. It is biologically plausible that the interaction between the infectious agent and the drug or its metabolite can precipitate severe skin reactions.…”

Section: Sjs/tenmentioning

confidence: 98%

Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens–Johnson syndrome, toxic epidermal necrolysis and DRESS)

Belver

Michavila

Bobolea

et al. 2016

Allergologia et Immunopathologia

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Severe delayed drug-induced skin reactions in children are not common but potentially serious. This article describes aspects concerning the etiology, pathogenesis and clinical manifestations of these processes; it presents three paediatric cases, namely STS (Steven Johnson Syndrome), TEN (toxic epidermal necrolysis), probably related to amoxicillin/clavulanate and ibuprofen and DRESS (a drug reaction with eosinophilia and systemic symptoms) secondary to phenytoin; and in relation to them, the diagnosis and the treatment of these processes are discussed and reviewed. The AGEP (acute generalised exanthematous pustulosis) is also reviewed. The aetiological diagnosis of severe non-immediate reactions is difficult, and the value of current allergological testing is not well defined in these cases. Diagnosis is based on clinical history, the empirical risk of drugs to trigger SJS/TEN or DRESS, and the in vivo and in vitro testing of the suspect drug. Skin biopsy confirms that the clinical diagnosis and delayed hypersensitivity tests, especially the patch test and the lymphoblastic transformation test (LTT), may be important to confirm the aetiological diagnosis, in our cases emphasising the latter. These diseases can be life threatening (especially DRESS and TEN) and/or have a high rate of major complications or sequelae (SJS/TEN). The three cases described progressed well without sequelae. All were treated with corticosteroids, which is the most currently accepted treatment although the effect has not been clearly demonstrated.

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Statistical Analysis of Stevens-Johnson Syndrome Caused by Mycoplasma pneumonia Infection in Japan

Abstract: In order to prevent ocular sequelae in adult patients when M. pneumoniae infection is suspected, more intensive treatment may be needed in adult patients than in younger patients.

Cited by 58 publications

References 20 publications

Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

Stevens–Johnson syndrome and toxic epidermal necrolysis: The Food and Drug Administration adverse event reporting system, 2004–2013

Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens–Johnson syndrome, toxic epidermal necrolysis and DRESS)

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