Neuropediatrics 2016; 47(05): 308-317
DOI: 10.1055/s-0036-1584325
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Neurological Manifestations of Mycoplasma pneumoniae Infection in Hospitalized Children and Their Long-Term Follow-Up

Jessica Kammer
1   Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
Stefan Ziesing
2   Department of Microbiology and Hospital Hygiene, Hannover Medical School, Hannover, Germany
Lukas Aguirre Davila
3   Department of Biostatistics, Hannover Medical School, Hannover, Germany
Eva Bültmann
4   Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
Sabine Illsinger
1   Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
Anibh M. Das
1   Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
Dieter Haffner
1   Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
Hans Hartmann
1   Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
› Author Affiliations
Further Information

Publication History

02 December 2015

24 April 2016

Publication Date:
14 June 2016 (online)


Objective In this retrospective study, we aimed to assess frequency, types, and long-term outcome of neurological disease during acute Mycoplasma pneumoniae (M. pneumoniae) infection in pediatric patients.

Materials and Methods Medical records of patients hospitalized with acute M. pneumoniae infection were reviewed. Possible risk factors were analyzed by uni- and multivariate regression. Patients with neurological symptoms were followed up by expanded disability status score (EDSS) and the cognitive problems in children and adolescents (KOPKJ) scale.

Results Out of 89 patients, 22 suffered from neurological symptoms and signs. Neurological disorders were diagnosed in 11 patients: (meningo-) encephalitis (n = 6), aseptic meningitis (n = 3), transverse myelitis (n = 1), and vestibular neuritis (n = 1), 11 patients had nonspecific neurological symptoms and signs. Multivariate logistic regression identified lower respiratory tract symptoms as a negative predictor (odds ratio [OR] = 0.1, p < 0.001), a preexisting immune deficit was associated with a trend for a decreased risk (OR = 0.12, p = 0.058). Long-term follow-up after a median of 5.1 years (range, 0.6–13 years) showed ongoing neurological deficits in the EDSS in 8/18, and in the KOPKJ in 7/17.

Conclusion Neurological symptoms occurred in 25% of hospitalized pediatric patients with M. pneumoniae infection. Outcome was often favorable, but significant sequels were reported by 45%.

  • References

  • 1 Foy HM. Infections caused by Mycoplasma pneumoniae and possible carrier state in different populations of patients. Clin Infect Dis 1993; 17 (Suppl. 01) S37-S46
  • 2 Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004; 17 (4) 697-728 table of contents
  • 3 Garnier JM, Noël G, Retornaz K, Blanc P, Minodier P. Extrapulmonary infections due to Mycoplasma pneumoniae [in French]. Arch Pediatr 2005; 12 (Suppl. 01) S2-S6
  • 4 Guleria R, Nisar N, Chawla TC, Biswas NR. Mycoplasma pneumoniae and central nervous system complications: a review. J Lab Clin Med 2005; 146 (2) 55-63
  • 5 Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections: summary of cases at the University of Helsinki and review. Clin Infect Dis 1993; 17 (Suppl. 01) S52-S57
  • 6 Waites KB. New concepts of Mycoplasma pneumoniae infections in children. Pediatr Pulmonol 2003; 36 (4) 267-278
  • 7 Pönkä A. Central nervous system manifestations associated with serologically verified Mycoplasma pneumoniae infection. Scand J Infect Dis 1980; 12 (3) 175-184
  • 8 Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005; 51 (5) 343-354
  • 9 Bitnun A, Ford-Jones E, Blaser S, Richardson S. Mycoplasma pneumoniae ecephalitis. Semin Pediatr Infect Dis 2003; 14 (2) 96-107
  • 10 Al-Zaidy SA, MacGregor D, Mahant S, Richardson SE, Bitnun A. Neurological complications of PCR-proven M. pneumoniae infections in children: Prodromal illness duration may reflect pathogenetic mechanism. Clin Infect Dis 2015; 61 (7) 1092-1098
  • 11 Thomas NH, Collins JE, Robb SA, Robinson RO. Mycoplasma pneumoniae infection and neurological disease. Arch Dis Child 1993; 69 (5) 573-576
  • 12 Lin JJ, Hsia SH, Wu CT, Wang HS, Lin KL. Mycoplasma pneumoniae-related postencephalitic epilepsy in children. Epilepsia 2011; 52 (11) 1979-1985
  • 13 Loewenbrück KF, Pütz V, Schäfer J, Reichmann H, Storch A. Parainfectious polyneuropathy and miller-fisher-syndrome in combination with anemia in Mycoplasma pneumoniae infection [in German]. Fortschr Neurol Psychiatr 2008; 76 (6) 361-365
  • 14 Daxboeck F, Blacky A, Seidl R, Krause R, Assadian O. Diagnosis, treatment, and prognosis of Mycoplasma pneumoniae childhood encephalitis: systematic review of 58 cases. J Child Neurol 2004; 19 (11) 865-871
  • 15 Yiş U, Kurul SH, Cakmakçi H, Dirik E. Mycoplasma pneumoniae: nervous system complications in childhood and review of the literature. Eur J Pediatr 2008; 167 (9) 973-978
  • 16 Ferwerda A, Moll HA, de Groot R. Respiratory tract infections by Mycoplasma pneumoniae in children: a review of diagnostic and therapeutic measures. Eur J Pediatr 2001; 160 (8) 483-491
  • 17 Vikerfors T, Brodin G, Grandien M, Hirschberg L, Krook A, Pettersson CA. Detection of specific IgM antibodies for the diagnosis of Mycoplasma pneumoniae infections: a clinical evaluation. Scand J Infect Dis 1988; 20 (6) 601-610
  • 18 Meyer Sauteur PM, Moeller A, Relly C, Berger C, Plecko B, Nadal D ; Swiss Pediatric Surveillance Unit Spsu. Swiss national prospective surveillance of paediatric Mycoplasma pneumoniae-associated encephalitis. Swiss Med Wkly 2016; 146: w14222
  • 19 Alvarez-Elcoro S, Enzler MJ. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc 1999; 74 (6) 613-634
  • 20 Candler PM, Dale RC. Three cases of central nervous system complications associated with Mycoplasma pneumoniae. Pediatr Neurol 2004; 31 (2) 133-138
  • 21 Gücüyener K, Simşek F, Yilmaz O, Serdaroğlu A. Methyl-prednisolone in neurologic complications of Mycoplasma pneumonia. Indian J Pediatr 2000; 67 (6) 467-469
  • 22 Carpenter TC. Corticosteroids in the treatment of severe mycoplasma encephalitis in children. Crit Care Med 2002; 30 (4) 925-927
  • 23 Sakoulas G. Brainstem and striatal encephalitis complicating Mycoplasma pneumoniae pneumonia: possible benefit of intravenous immunoglobulin. Pediatr Infect Dis J 2001; 20 (5) 543-545
  • 24 Cotter FE, Bainbridge D, Newland AC. Neurological deficit associated with Mycoplasma pneumoniae reversed by plasma exchange. Br Med J (Clin Res Ed) 1983; 286 (6358) 22
  • 25 Virion/Serion. SERION ELISA classic mycoplasma pneumoniae IgA/IgG/IgM. Available at: . Accessed May 25, 2016
  • 26 Venkatesan A, Tunkel AR, Bloch KC , et al; International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 2013; 57 (8) 1114-1128
  • 27 Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33 (11) 1444-1452
  • 28 Lechner-Scott J, Kappos L, Hofman M , et al. Can the Expanded Disability Status Scale be assessed by telephone?. Mult Scler 2003; 9 (2) 154-159
  • 29 Hennes E, Zotter S, Dorninger L , et al. Long-term outcome of children with acute cerebellitis. Neuropediatrics 2012; 43 (5) 240-248
  • 30 Gleissner U, Lendt M, Mayer S, Elger CE, Helmstaedter C. A new questionnaire for recognizing cognitive problems in children and adolescents [in German]. Nervenarzt 2006; 77 (4) 449-465
  • 31 Beersma MF, Dirven K, van Dam AP, Templeton KE, Claas EC, Goossens H. Evaluation of 12 commercial tests and the complement fixation test for Mycoplasma pneumoniae-specific immunoglobulin G (IgG) and IgM antibodies, with PCR used as the “gold standard”. J Clin Microbiol 2005; 43 (5) 2277-2285
  • 32 Sugeno N, Kawaguchi N, Hasegawa T , et al. A case with anti-galactocerebroside antibody-positive Mycoplasma pneumoniae meningoencephalitis presenting secondary hypersomnia. Neurol Sci 2012; 33 (6) 1473-1476
  • 33 Hanzawa F, Fuchigami T, Ishii W , et al. A 3-year-old boy with Guillain-Barré syndrome and encephalitis associated with Mycoplasma pneumoniae infection. J Infect Chemother 2014; 20 (2) 134-138
  • 34 Christie LJ, Honarmand S, Talkington DF , et al. Pediatric encephalitis: what is the role of Mycoplasma pneumoniae?. Pediatrics 2007; 120 (2) 305-313
  • 35 DuBray K, Anglemyer A, LaBeaud AD , et al. Epidemiology, outcomes and predictors of recovery in childhood encephalitis: a hospital-based study. Pediatr Infect Dis J 2013; 32 (8) 839-844
  • 36 Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis 2012; 54 (7) 899-904
  • 37 Meyer Sauteur PM, Jacobs BC, Spuesens EB , et al. Antibody responses to Mycoplasma pneumoniae: role in pathogenesis and diagnosis of encephalitis?. PLoS Pathog 2014; 10 (6) e1003983
  • 38 Saiki S, Ueno Y, Moritani T , et al. Extensive hemispheric lesions with radiological evidence of blood-brain barrier integrity in a patient with neuromyelitis optica. J Neurol Sci 2009; 284 (1–2) 217-219