Predictive factors for sequelae of bronchitis obliterans in refractory Mycoplasma pneumoniae pneumonia / 中华儿科杂志

Objective: To investigate the predictive factors for bronchitis obliterans in refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods: A restrospective case summary was conducted 230 patients with RMPP admitted to the Department of No.2 Respiratory Medicine of Beijing Children's Hospital, Capital Medical University from January 2013 to June 2017 were recruited. Clinical data, laboratory results, imaging results and follow-up data were collected. Based on bronchoscopy and imaging findings 1 year after discharge, all patients were divided into two groups: one group had sequelae of bronchitis obliterans (sequelae group) and the other group had not bronchitis obliterans (control group), independent sample t-test and nonparametric test were used to compare the differences in clinical features between the two groups. Receiver operating characteristic (ROC) curve to explore the predictive value of Bronchitis Obliterans in RMPP. Results: Among 230 RMPP children, there were 115 males and 115 females, 95 cases had sequelae group, the age of disease onset was (7.1±2.8) years;135 cases had control group, the age of disease onset was (6.8±2.7) years. The duration of fever, C-reative protein (CRP) and lactate dehydrogenase (LDH) levels, the proportion of ≥2/3 lobe consolidation, pleural effusion and the proportion of airway mucus plug and mucosal necrosis were longer or higher in the sequelae group than those in the control group ((17±9) vs. (12±3) d, (193±59) vs. (98±42) mg/L,730 (660, 814) vs. 486 (452, 522) U/L, 89 cases (93.7%) vs. 73 cases (54.1%), 73 cases (76.8%) vs.59 cases (43.7%), 81 cases (85.3%) vs. 20 cases (14.8%), 67 cases (70.5%) vs. 9 cases (6.7%), t=5.76, 13.35, Z=-6.41, χ2=14.64, 25.04, 22.85, 102.78, all P<0.001). Multivariate Logistic regression analysis showed that the duration of fever ≥10 days (OR=1.200, 95%CI 1.014-1.419), CRP levels increased (OR=1.033, 95%CI 1.022-1.044) and LDH levels increased (OR=1.001, 95%CI 1.000-1.003) were the risk factors for sequelae of bronchitis obliterans in RMPP. ROC curve analysis showed that CRP 137 mg/L had a sensitivity of 82.1% and a specificity of 80.1%; LDH 471 U/L had a sensitivity of 62.7% and a specificity of 60.3% for predicting the development of bronchitis obliterans. Conclusions: The long duration of fever (≥10 d), CRP increase (≥137 mg/L) may be used to predict the occurrence of sequelae of bronchitis obliterans in RMPP. It is helpful for early recognition of risk children.

Clinical features of children with / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of children with @*METHODS@#A total of 310 MPP children who were hospitalized and underwent bronchoalveolar lavage from June 2018 to June 2019 were enrolled and divided into two groups: simple MPP group with 241 children (without peripheral lymphocytopenia) and MPP + peripheral lymphocytopenia group with 69 children. The two groups were compared in terms of clinical data and treatment outcome.@*RESULTS@#Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly longer duration of fever and length of hospital stay and significant increases in C-reactive protein, lactate dehydrogenase, and @*CONCLUSIONS@#Children with MPP and peripheral lymphocytopenia tend to have more severe immunologic injury. Peripheral blood lymphocyte count may be used to evaluate the severity of MPP.

Mycoplasma Pneumoniae, asociado a polineuropatía axonal autoinmune, ¿variante clínica del síndrome Guillain-Barré en niños? / Mycoplasma Pneumoniae, associated to autoimmune axonal polyneuropathy, clinical variant of Guillain-Barré Syndrome in children?

Introducción: Mycoplasma penumoniae es un patógeno reconocido como principal agente causal de neumonía atípica, así como también por generar diferentes tipos de complicaciones extrapulmonares, especialmente de carácter neurológico y afectar directamente el sistema nervioso, gracias a sus mecanismos de virulencia, mimetismo y de inmunomodulación en el huésped. Causa afecciones como neuropatías, polineuropatías, encefalopatías, síndrome de Guillain Barré y otros. Objetivo: Reforzar en el área pediátrica la necesidad de modificar criterios diagnósticos e incorporar variantes clínicas del síndrome de Guillain Barre, además de instrumentos para diagnóstico de afecciones neuropáticas. Presentación del caso: Paciente masculino, 9 años 8 meses de edad, quien consulta en repetidas ocasiones por: dispepsias, episodios de diarrea, constipación y fiebre. Se constató según consulta: disbiosis, resfriado común, y finalmente, neumonía atípica por Mycoplasma Pneumoniae. Paciente evoluciona, con debilidad muscular, paresia, hiperalgesia y alodinia de extremidades superiores e inferiores. Acude a neurólogo, quien indica exámenes neurofisiológicos (velocidad de conducción nerviosa, potenciales evocados y se descartó una electromiografía, debido a la hiperalgesia). Se diagnosticó una polineuropatía axonal, la que se caracterizó por presentar ciertos aspectos del síndrome de Guillain-Barré. Tanto la evolución clínica de este síndrome, así como sus variantes clínicas, tienen un curso en adultos, caracterizado por un comienzo y signos distintos, lo que puede retrasar y errar el diagnóstico en pacientes pediátricos. Conclusiones: Hace falta nuevos criterios diagnósticos y su amplitud y herramientas de abordaje, para hacer un diagnóstico rápido y eficaz, y contribuir a la recuperación optima del paciente(AU)

Introduction: Mycoplasma pneumoniae is a pathogen know as to the main causal agent of atypical pneumonia, as well as to generate different extrapulmonary sickness, especially in neurological ways, directing to the nervous system, thanks to all its different mechanisms, like: virulence, mimetysm and immunomodulation in to the host. Producing, pathologies like neuropathies, polyneuropathies, encephalopathies, Guillain Barré Syndrome. Objetives: To highlight in the pediatric area, the need to modificate diagnosis criteria and incorporate Guillain-Barre Syndrome clinicals variants, also instruments to diagnosis of neuropathic pathologies. Case presentation: Male patient, 9 years, 8 months old, who consulted in repeated occasions for: dyspepsia, diarrhea and constipation episodes and fiber. Confirmed according to consultation: dysbiosis, common cold, and finally, atypical pneumonia by Mycoplasma Pneumoniae. The patient evolves with: muscular weakness, hyperalgesia and allodynia of upper and inferior extremities. Then, the Neurologist, indicates neurophysiological exams (nerve conduction velocity, evoked potentials, discarding an electromyography, due to hyperalgesia). Diagnosing an axonal polyneuropathy. Which was characterized to present some same aspects, from clinical course of Guillain-Barre Syndrome. Highlighting that the clinical evolution, as also, the syndrome clinical variants, has it a course in adults, characterized by a different beginning and signs, than in children. Retarding and do a wrong diagnosis in pediatric patients. Conclusion: Lack of new diagnosis criteria, the amplitude of these and tools of approach to give a fast and effective diagnosis, and contribute to the optimal recovery of the patient(AU)

Prevalencia de la infección por Mycoplasma pneumoniae en pacientes pediátricos con exacerbación aguda del asma / Prevalence of Mycoplasma pneumoniae infection in pediatric patients with acute asthma exacerbation

Introducción. El Mycoplasma pneumoniae puede estar implicado en la exacerbación refractaria del asma, Objetivo. Establecer la prevalencia de la infección por Mycoplasma pneumoniae en pacientes con exacerbación aguda del asma. Material y método. Se realizó un estudio prospectivo, transversal, observacional, caso-control, en pacientes mayores de 2 años y menores de 12. Se determinaron anticuerpos inmunoglobulina M (IgM) para M. pneumoniae por serología por técnica de ensayo por inmunoabsorción ligado a enzima (enzyme-linked immunosorbent assay; ELISA en sus siglas en inglés), utilizando el kit NovaLisa® NovaTec. Se consideró prueba positiva a valores > 11 NTU (NovaTec unidades). El análisis estadístico fue análisis de la varianza (analysis of variance; ANOVA, por sus siglas en inglés) y chi cuadrado con un nivel de significancia de p < 0,05. Resultados. Se estudiaron 180 niños, 130 correspondieron al grupo de niños asmáticos y 50, al grupo control. La IgM específica fue positiva en 60 pacientes, que correspondió al 46,15% de niños asmáticos (p < 0,001). La gravedad de la exacerbación estuvo relacionada directamente con los niveles de IgM (p < 0,001). La tasa de hospitalización fue de 75%, asociada de forma significativa con los niveles de IgM específica (p < 0,001). Conclusión. Nuestros datos sugieren que en los niños con asma aguda, tienen alta prevalencia (46%) de infección por Mycoplasma pneumoniae y estrecha relación entre la exacerbación aguda grave del asma y la infección por Mycoplasma pneumoniae. Estos resultados podrían tener implicaciones terapéuticas orientadas hacia la utilización de antibióticos específicos contra este microorganismo atípico.

Introduction. Mycoplasma pneumoniae may be involved in refractory asthma exacerbation. Objective. To determine the prevalence of Mycoplasma pneumoniae infection in patients with acute asthma exacerbation. Material and method. A prospective, crosssectional, observational, case-control study was carried out in patients older than 2 years old and younger than 12. Immunoglobulin M (IgM) antibodies were serologically determined for M. pneumoniae, using the NovaLisa® NovaTec kit for enzyme-linked immunosorbent assay (ELISA). Test results ≥ 11 NTU (NovaTec units) were regarded as positive. The statistical analysis was performed by means of the analysis of variance (ANOVA) and the χ² test, with a significance level of p < 0.05. Results. One hundred and eighty children were studied, of which 130 had asthma and 50 comprised the control group. Specific IgM was positive for 60 patients, that is 46.15% of the asthmatic children (p < 0.001). The severity of the exacerbation was directly related to IgM levels (p < 0.001). Hospitalization rate was 75%, and it was significantly associated to specific IgM levels (p < 0.001). Conclusion. Our data suggest that children with acute asthma show a high prevalence (46%) of Mycoplasma pneumoniae infection and that there is a close relation between severe acute asthma exacerbation and the presence of Mycoplasma pneumoniae infection. These findings might result in therapeutic implications centered in the use of specific antibiotics to fight this atypical organism.

Miositis aguda benigna de la infancia: Serie clínica y revisión de la literatura / Benign acute childhood myositis: Clinical series and literature review

La miositis aguda benigna de la infancia (MABI) es una entidad clínica autolimitada, infrecuente, que afecta a niños en edad preescolar y escolar. Dada su asociación a cuadros virales, se sugiere una relación con este tipo de agentes, entre los que predomina el virus influenza. OBJETIVO: Describir un brote de casos de MABI presentados en un servicio pediátrico. PACIENTES Y MÉTODO: Serie clínica retrospectiva de pacientes que consultaron por un cuadro clínico compatible con MABI en el período agosto-noviembre de 2012, en el Servicio de Urgencia pediátrico de un centro asistencial. RESULTADOS: Se presentan una serie de 9 niños, edades entre 4 y 12 años, con un pródromo de fiebre asociado a síntomas respiratorios, seguido de dolor agudo intenso de ambas pantorrillas y claudicación. En los exámenes de laboratorio destacaba un alza de creatincinasa, con un valor promedio de 4.066 UI/L. El estudio etiológico evidenció influenza B en 3 pacientes y Mycoplasma pneumoniae en uno. El manejo consistió en hidratación y antiinflamatorios no esteroidales, con favorable evolución clínica y de laboratorio. CONCLUSIONES: La MABI es una entidad benigna, autolimitada, de excelente pronóstico, con una presentación clínica que en la mayoría de los casos requiere manejo ambulatorio. Deben evitarse estudios invasivos y hospitalizaciones innecesarias.

Benign acute childhood myositis (BACM) is a rare clinical condition that mainly affects pre-school and school age-children. It is usually preceded by a viral illness, particularly influenza virus infection. OBJECTIVE: To describe a cluster of BACM cases that were seen in a paediatric unit. PATIENTS AND METHODS: A retrospective series of cases that presented with a clinical picture suggestive of BACM between August and November 2012 in the paediatric emergency department of a private clinic. RESULTS: Nine children, between 4 and 12 years, presented with a history of a recent febrile upper viral respiratory infection, followed by intense calf pain and claudication. They all recovered without complications. Laboratory results showed a marked increase in CK, with a mean of 4,066 IU/l. Three of the cases had influenza B infection and one Mycoplasma pneumonia infection. They were managed conservatively with hydration and non-steroidal anti-inflammatory drugs. CONCLUSIONS: BACM is a benign entity with a characteristic clinical presentation that can be managed most of the time in the ambulatory setting, avoiding invasive studies and unnecessary hospital admission.

Exantema laterotorácico unilateral en un adulto: reporte de un caso relacionado a infección por mycoplasma pneumoniae / Unilateral laterothoracic exanthem in an adult: report of a case related to mycoplasma pneumoniae infection

El exantema laterotorácico unilateral de la infancia (ULE) es una condición benigna, de etiología desconocida, que se caracteriza por un exantema maculopapular que típicamente afecta, de forma unilateral, un pliegue axilar con posterior diseminación centrífuga. Paciente de 19 años, sin antecedentes mórbidos que presentó una erupción cutánea pruriginosa de inicio en la axila derecha con posterior diseminación a la axila contralateral y pliegues inguinales. Acude con exámenes de laboratorios en los que destaca serología positiva para Mycoplasma pneumoniae. El exantema laterotorácico unilateral de la infancia es una erupción benigna de presentación característica en niños pero que también se puede presentar en adultos. Su etiología es desconocida, pero su presentación en relación a fiebre, síntomas infecciosos respiratorios y gastrointestinales antes o durante el exantema, sugieren un origen viral o bacteriano. En este caso, planteamos como posible agente etiológico a Mycoplasma pneumoniae.

Unilateral laterothoracic exanthem of childhood, is a benign condition of unknown etiology that is characterized by a maculopapular exanthema that typically affects one axillary fold followed by centrifugal dissemination. A 19-yearold male patient, healthy, who developed an axillary pruritic rash followed by dissemination to contralateral axillar and inguinal folds. He had laboratory tests with positive serology for Mycoplasma pneumoniae. Unilateral laterothoracic exanthem of childhood is a benign condition that characteristically presents during childhood but can also affect adults. It has an unknown etiology but its presentation in relation with fever, infectious symptoms respiratory and gastrointestinal diseases, suggest a viral or bacterial origin. In this case we raise Mycoplasma pneumoniae as possible etiologic agent.

Hemólisis, exantema, serositis. Manifestaciones extrapulmonares del Mycoplasma pneumoniae: Reporte de un caso / Hemolysis, serositis and exanthema induced by Mycoplasma pneumoniae infection: Report of one case

Mycoplasma infections have extrapulmonary manifestations that may be associated with respiratory symptoms and may have skin, heart, gastrointestinal, rheumatologic, neurologic, hematologic involvement. Cold agglutinin mediated autoimmune hemolytic anemia is the most common hematological manifestation. We report a 27-year-old woman infected with Mycoplasma pneumoniae, who presented respiratory involvement with pneumonia, exanthema, serositis and acute hemolytic anemia that required transfusion. The key for the diagnosis were the extrapulmonary manifestations associated with respiratory involvement after five days of hospitalization.

Necrólisis epidérmica tóxica asociada a infección aguda por Mycoplasma pneumoniae / Toxic epidermal necrolysis associated with acute infection by Mycoplasma pneumoniae

El eritema multiforme, el síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica representan diferentes manifestaciones de un mismo espectro de graves reacciones cutáneas idiosincrásicas a fármacos y, en menor medida, están asociados a agentes infecciosos. De estos últimos, Mycoplasma pneumoniae es uno de los más frecuentes. Se presenta el caso de una niña de 5 años, con una necrólisis epidérmica tóxica asociada a infección aguda por Mycoplasma pneumoniae, que comenzó con un cuadro febril acompañado de un exantema generalizado y compromiso de todas las mucosas. Se obtuvo serología IgM positiva para Mycoplasma pneumoniae y una biopsia inicial compatible con eritema multiforme mayor. La paciente fue tratada con corticosteroides, gammaglobulina intravenosa, plasmaféresis y estrictos cuidados para la prevención de sobreinfección y posibles secuelas. Después de 31 días de internación fue dada de alta hospitalaria.

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis represent different manifestations of the same spectrum of severe idiosyncratic cutaneous reactions to drugs and to a lesser extent are associated with infectous agents. Among these, Mycoplasma pneumoniae is one of the most frequent. We report the case of a female patient aged 5 years, with a toxic epidermal necrolysis associated with Mycoplasma pneumoniae infection, which begins with a fever accompanied by a generalized rash with involvement of the mucous membranes. IgM serology for Mycoplasma pneumoniae was positive and initial biopsy was compatible with erythema multiforme major. The patient was treated with corticosteroids, intravenous immunoglobulin, plasmapheresis and strict care to prevent superinfection and sequels. After 31 days of hospitalization the patient was discharged from hospital.

Neumonías atípicas / Atypical pneumoniae

Atypical pneumonias are a significant percentage of causal agents of pneumonia in children. Dominate over 5years of age, although in the last three years there is an increase in cases in children three years of age, especially secondary to Mycoplasma. In this review, we will refer to Mycoplasma pneumoniae, as the atypical germ most common and important in the epidemiology of children with pulmonary involvement. Mycoplasma pneumonia, can explain 20-25 percent of pneumonia in children, especially in preschool and school age.

Las neumonías atípicas constituyen un porcentaje importante de agentes causales de neumonía en niños. Predominan en mayores de 5 años de edad, aunque en los últimos años, existe un incremento de casos en niños de 3años de edad, sobre todo secundario al Mycoplasma. En esta revisión, nos referiremos al Mycoplasma pneumoniae, como el germen de los atípicos más frecuente e importante en la epidemiología del niño con afectación pulmonar. Las neumonías por mycoplasma, pueden explicar del 20 al 25 por ciento de las neumonías en niños, sobre todo en edades preescolares y escolares.

An Adult Case of Fisher Syndrome Subsequent to Mycoplasma pneumoniae Infection

Reported herein is an adult case of Fisher syndrome (FS) that occurred as a complication during the course of community-acquired pneumonia caused by Mycoplasma pneumoniae. A 38-yr-old man who had been treated with antibiotics for serologically proven M. pneumoniae pneumonia presented with a sudden onset of diplopia, ataxic gait, and areflexia. A thorough evaluation including brain imaging, cerebrospinal fluid examination, a nerve conduction study, and detection of serum anti-ganglioside GQ1b antibody titers led to the diagnosis of FS. Antibiotic treatment of the underlying M. pneumoniae pneumonia was maintained without additional immunomodulatory agents. A complete and spontaneous resolution of neurologic abnormalities was observed within 1 month, accompanied by resolution of lung lesions.

Metaneumovirus humano en niños: primeros casos en Colombia / Human metapneumovirus in children: first cases in Colombia

El metaneumovirus humano es un nuevo patógeno asociado a infecciones respiratorias, principalmente en niños, que produce cuadros clínicos que van desde leves hasta graves, los cuales pueden incluso requerir tratamiento en unidades de cuidados intensivos. Hasta el momento, la reacción en cadena de la polimerasa con transcripción inversa y el cultivo celular son los métodos más usados para su diagnóstico. Se presentan los seis primeros casos de metapneumovirus humano en niños de Medellín, Colombia.

Human metapneumovirus is a newly discovered pathogen associated with respiratory disease and occurring mainly in children. It produces an acute viral respiratory disease picture that varies from mild disease to severe, and which can require strict surveillance in intensive care units. Currently, reverse transcriptase polymerase chain reaction and cell culture are the most common methods for its diagnosis. The first six cases of human metapneumovirus in Colombia are presented from Medellín.

Infección por Mycoplasma neumoniae: microangeitis cerebral, síndrome de Bickerstaff y anemia hemolítica autoinmune / Mycoplasma pneumoniae infection: cerebral microangeitis, bickerstaff syndrome and autoimmune hemolytic anemia

Mycoplasma pneumoniae produce 10 to 20 percent of atypical pneumonia, and secondarily affects by autoimmune mechanisms the central and peripheral nervous system. This presentation prospects to understand others pathologies than pneumonia, originated by mycoplasma pneumonia, like hemorrhagic cerebral microvasculitis, Bickerstaff syndrome and autoimmune hemolytic anemia expressed by an adolescent. They were an immunomimetic manifestation of this bacteria, same days after pulmonary box. The microvasculitis shows blood in the CSF, retinal hemorrhages and special MR imaging s. Protuberancia! syndrome was identified by a multidirectional nystagmus, facial diplegia, involvement of the sixth cranial nerve and quadriplegia with pyramidal signs. The autoimmune hemolytic anemia was the last complication. Generally all these syndromes have been isolated described in relation to this bacterial infection. In this case they occurred simultaneously. The cerebral vasculitis took a special way, apparently not described before with these characteristics. Our conclusions are that mycoplasma pneumoniae can affect simultaneously different parenchyma expressing immunomimetic responses.

El Mycoplasma neumoniae es una bacteria productora del 10 al 20 por ciento de las neumonías atípicas, que secundariamente y por patomecanismos inmunomiméticos afecta al sistema nervioso central y periférico. Con esta presentación se busca dar significado a las variadas alteraciones que originó una neumonía por mycoplasma en un adolescente, que además presentó una micro vasculitis cerebral hemorrágica, un síndrome de Bickerstaffy una anemia hemolítica autoimune, como expresión de una respuesta inmunomimética desencadenada por la bacteria, días después de cuadro pulmonar. La microvasculitis produjo presencia de sangre en el LCR, hemorragias retinianas y una RM con imágenes características. El síndrome rombencefálico se identificó por un nistagmus multidireccional, diplejia facial, compromiso del sexto par y cuadriparesia con signos piramidales, que secuencial mente se complicaron con una anemia hemolítica autoimune. Todos estos síndromes han sido descritos aisladamente en relación a esta infección bacteriana, sin embargo, en este caso se produjeron simultáneamente y la vasculitis cerebral tomó un modo especial, al parecer no descrito antes con esas características. Se concluye que el mycoplasma neumoniae puede afectar con respuestas inmunomiméticas diversos parénquimas simultáneamente.

Mycoplasma Pneumoniae: evaluación de la pobración hospitalaria / Mycoplasma Pneumoniae: evaluation in the hospital population

Mycoplasma pneumoniae es un patógeno común del tracto respiratorio, en niños y adultos. Causa entre un 10 y un 30% de las neumonías atípicas de la comunidad. La edad clásicamente descripta de primoinfección es entre 5 y 9 años. Las manifestaciones extrapulmonares son menos frecuentes. Las técnicas de laboratorio apropiadas para el diagnóstico son los ensayos serológicos, que detectan anticuerpos específicos y la reacción en cadena de la polimerasa (PCR) que detecta directamente el material genético de la bacteria. Objetivo: Determinar la edad promedio de la primoinfección, la entidad clínica más frecuente que motiva el análisis y el porcentaje de pacientes con manifestaciones pulmonares y extrapulmonares. Materiales y métodos: Se efectuó el análisis de 180 pacientes, de 7 meses a 15 años, que consultaron en este hospital, y que tuvieron un resultado positivo para anticuerpos IgM anti M. pneumoniae. Se clasificaron en 4 grupos: de 7 meses a 2 años (A), >2 a 5 años (B), >5 a 10 años (C), >10 a 15 años (D). Las IgM se detectaron en suero por inmunofluorescencia indirecta, luego de un pre-tratamiento con absorbente para eliminar IgG y factor reumatoideo. Resultados: La edad promedio de los pacientes fue de 8,7 años. Un 9% correspondió al al grupo A, 23% al grupo B, 31% al grupo C y 37% al grupo D. Las manifestaciones respiratorias representaron el 39,4% de todos los casos, 40% correspondieron a manifestaciones extrapulmonares, y 20,6% a pacientes con síndrome febril prolongado. Conclusiones: M. pneumoniae es considerado un patógeno de niños en edad escolar, pero en nuestro estudio un 32% correspondió a niños menores a 5 años. A pesar de ser un patógeno típicamente respiratorio, observamos un alto porcentaje de manifestaciones extrapulmonares que motivaron la consulta (40%) y de pacientes con síndrome febril prolongado (20,6%) como único síntoma asociado a la primoinfección por M. pneumoniae (AU)

Mycoplasma pneumoniae is a common pathogen of the human respiratory tract of in children and young adults. It causes 10 to 30% of community-acquired atypical pneumonia. Primary infection classically is considered to occur during the first 5 or 9 years of life. Extrapulmonary symptoms are less frequent. Appropriate diagnostic techniques are serological assays for the detection of specific antibodies, and polymerase chain reaction (PCR) for the direct detection of DNA. Aims: To determine: the median age of primary infection, the most frequent clinical entity that motivated the analysis, and the percentage of patients with respiratory or extrapulmonary manifestations. Materials y Methods: Analysis of 180 patients of the hospital, from 7 months to 15 years with positive result for IgM anti M. pneumoniae was performed. They were classified in 4 groups: 7 months to 2 years (A),> 2 to 5 years (B),> 5 to 10 years (C),> 10 to 15 years (D). IgM were detected by indirect inmunofluorescent assay in serum specimens, pre-treated with absorbent to eliminate IgG and rheumatoid factor. Results: Patients median age was 8,7 years; 9% corresponding to group A, 23% to group B, 31% to group C and 37% to group D. Respiratory manifestations represented 39,4 % of all cases, 40% with extrapulmonary symptoms and prolonged febrile syndrome accounted for 20,6 % as the only symptom associated with primary infection by M. pneumoniae. Conclusions: M. pneumoniae is generally considered to be a pathogen of school-aged children, but in our study 32% of cases corresponded to less than 5 year-old children. Although this agent is typically described as a respiratory pathogen, we observed a high percentage of extrapulmonary manifestations that motivated the analysis (40 %) and prolonged febrile syndrome (20,6 %) as the only symptom associated with primary infection by M. pneumoniae (AU)

Características clínicas de la enfermedad respiratoria causada por Mycoplasma pneumoniae en niños hospitalizados / Clinical characterizes of respiratory infection due to Mycoplasma pneumoniae in hospitalized children

Introduction: Studies onMycoplasmapneumoniae infection are scarce in Chile. Objective: To describe clinical characteristics associated withM. pneumoniae in children requiring hospitalization. Material and Methods: All children with a respiratory infection requiring hospitalizations between 2000-2005, whom had aM. pneumoniae specific IgM ≥ 1:32, were analyzed. Results: Fifty children meeting study criteria were identified with an ave-rage length of hospitalization of 4 days (range: 1-10); mean age was 5.4 years (46 percent were younger than 5 years). Common clinical features were cough (92 percent), fever (82 percent), malaise (74 percent) and respiratory distress (72 percent). At admission 40/45 children had hypoxemia. Chest-X ray showed interstitial pattern (69.3 percent), consolidation (51 percent) and hyperinsuflation (28.5 percent). Six patients had pleural effusion. Eighty four percent of patients had a favorable clinical outcome; eight children required admission to the PICU all of whom recovered. Conclusión: Respiratory infections associated withM. pneumoniae in our series of children had a highly variable and non-specific clinical spectrum. Chest-X rays showed different pattern in concordance with previous publications.

Introducción: La infección por Mycoplasma pneumoniae es una condición respiratoria poco estudiada en nuestro medio. Objetivo: Describir las características clínicas de los niños hospitalizados porM. pneumoniae. Materiales y Métodos: Se analizaron todos los pacientes hospitalizados por infecciones respiratorias durante el 2000-2005, con IgM específica; se utilizó como diagnóstico de enfermedad por M. pneumoniae la presencia de fluorescencia verde manzana 2 a 3 positivo en títulos ≥ 1:32 diluciones. Resultados: Se analizaron 50 hospitalizaciones, con estadía promedio de 4 días (rango: 1-10); la edad promedio fue 5,4 años (46 por ciento bajo 5 años). Los síntomas más frecuentes fueron tos (92 por ciento), fiebre (82 por ciento), compromiso del estado general (74 por ciento) y dificultad respiratoria (72 por ciento). Al momento del ingreso 40/45 presentaron hipoxemia. La radiografía de tórax (RT) reveló infiltrado intersticial (69,3 por ciento), foco de consolidación (51 por ciento) e hi-perinsuflación (28,5 por ciento). Seis presentaron efusión pleural asociada. En 84 por ciento la evolución fue favorable; sin embargo, 8 niños ingresaron a la Unidad de Paciente Critico para monitorización. No hubo decesos Conclusiones: La infección respiratoria asociada aM. pneumoniae en niños produjo manifestaciones inespecíficas y variables de un caso a otro. La RT reveló una variedad de presentaciones similar a lo mostrado en la literatura médica.

Transient Acquired Hemophilia Associated with Mycoplasma Pneumoniae Pneumonia

Acquired hemophilia is a rare disorder caused by autoantibodies to factor VIII (FVIII) (also referred to as factor VIII inhibitors or anti-FVIII) and may be associated with pregnancy, underlying malignancy, or autoimmune disorders. A 33-month-old girl who presented with hematochezia and ecchymotic skin lesions was diagnosed with Mycoplasma pneumoniae pneumonia by serology and polymerase chain reaction. Hematologic studies showed a prolonged activated partial thromboplastin time (aPTT), partially corrected mixing test for aPTT, reduced levels of FVIII, and the presence of antibodies against FVIII. She was treated conservatively with prednisone and intravenous immunoglobulin (IVIG) without FVIII transfusion and recovered without sequelae. This report provides the first description of acquired hemophilia due to anti-FVIII in association with M. pneumoniae in Korea. We discuss this case in the context of the current literature on acquired hemophilia in children.

Infection by Mycoplasma pneumoniae and its importance as an etiological agent in childhood community-acquired pneumonias

This manuscript reviewed the literature on infection by Mycoplasma pneumoniae with emphasis on etiological aspects of childhood community-acquired pneumonias. Bibliographical research was carried out from Pubmed Medline, MDConsult, HighWire, LILACS, and direct research over the past 10 years with the following keywords: Mycoplasma pneumoniae, pneumonia, and childhood. Fifty-four articles were selected. Mycoplasma pneumoniae has a high incidence in childhood. Clinical presentation includes respiratory and extrarespiratory symptoms. Mycoplasma pneumoniae lung infection can be confused with viral or bacterial pneumonia and is unresponsive to beta-lactams. In addition, co-infections have been reported. Mycoplasma pneumoniae infection occurs in all age groups, being less frequent and more severe in children under the age of five. Its incidence as a causal agent is high. Mycoplasma pneumoniae infections constitute 20 percent-40 percent of all community-acquired pneumonias; the severity is highly variable, and this condition may lead to severe sequelae. Mycoplasma pneumoniae frequency is underestimated in clinical practice because of the lack of specific features and a diagnosis that needs serology or PCR. Effective management of M. pneumoniae infections can usually be achieved with macrolides. In Brazil, epidemiological studies are needed in order to assess the incidence of this bacterium.

Infección por Mycoplasma pneumoniae / Mycoplasma pneumoniae infection

La infección por Mycoplasma de infecciones respiratorias agudas en niños, siendo responsable de hasta 40 por ciento de las neumonías adquiridas en la comunidad (NAC). El grupo de mayor riesgo son los escolares, sin embargo también lo constituyen los menores de 5 años. Si bien las manifestaciones clínicas son inespecíficas, los síntomas más frecuentes son fiebre, tos, compromiso del estado general y cefalea. El diagnóstico se puede establecer determinando niveles de IgM en fase aguda, aunque recientemente se ha sugerido el rol de la reacción de polimerasa en cadena para efectos clínicos, permitiendo aumentar la sensibilidad diagnóstica. Las alteraciones de laboratorio son inespecíficas y no permiten distinguir la infección por M. pneumoniae de la producida por otros microorganismos. Los hallazgos radiológicos pueden sugerir el diagnóstico, destacando la presencia de infiltrados pulmonares focales, de predominio intersticial. El cuadro clínico tiende a ser benigno y autolimitado, aunque en ocasiones puede producir neumonía fulminante o manifestaciones extrapulmonares con compromiso neurológico, dermatológico, hematológico, cardiaco, renal yosteoarticular. El tratamiento antibiótico ha demostrado que disminuye la morbilidad asociada a NAC, acorta la duración de síntomas y disminuye la frecuencia de episodios de sibilancias recurrentes; sin embargo no ha demostrado disminuir el riesgo de contagio o transmisión a otras personas.

Guillain-Barré syndrome: association with Campylobacter jejuni and Mycoplasma pneumoniae infections in India.

BACKGROUND: Guillain-Barré syndrome is the most common cause of acute neuromuscular paralysis and is considered a post-infectious disease. METHODS: Twenty patients with Guillain-Barré syndrome admitted to the Neurosciences Centre at the All India Institute of Medical Sciences from November 1997 to August 1998 were investigated for evidence of antecedent infections. This case-control study included 2 controls for each patient, one a household control and the other an age- and sex-matched hospital control suffering from a neurological illness other than Guillain-Barré syndrome. Evidence of recent Campylobacter jejuni infection was investigated by culture and serology, and for Mycoplasma pneumoniae by serology. RESULTS: There was evidence of recent C. jejuni infection in 35% of the patients compared with 25% of household controls and none of the hospital controls. M. pneumoniae infection was seen in 50% of patients compared with 25% of household controls and 15% of hospital controls. About one-third of the patients (30%) had evidence of both infections. The association of both infections in patients was found to be statistically significant as compared to hospital controls. CONCLUSION: C. jejuni and M. pneumoniae may be important antecedent illnesses in patients with Guillain-Barré syndrome in India.

Mycoplasma pneumonia associated with rhabdomyolysis and the Guillain-Barre syndrome.

A 25-year-old housewife who presented with Mycoplasma pneumonia who developed acute respiratory distress syndrome (ARDS) and required assisted ventilation. During her hospital stay, she developed acute renal failure because of rhabdomyolysis and was put on haemodialysis. She also had difficulty in weaning from ventilator because of acute motor-sensory axonal neuropathy (AMSAN) variant of the Guillain-Barre syndrome. The patient was treated with antibiotics and corticosteroids. The patient recovered from both the complications gradually.