NEUROLOGICAL COMPLICATIONS OF MYCOPLASMA INFECTION IN CHILDREN AND ADOLESCENTS

Objectives: Neurological complications are the most frequent extrapulmonary complications of mycoplasma pneumoniae (MP) infections. From hospitalized patients with serologically confirmed MP infections 1–10% is associated with neurologic manifestations. However, the overall incidence of CNS complications from MP infections are much lower taking into consideration that most children with mycoplasma infections are treated on an outpatient bases. The clinical phenotype is characterized by encephalitis, encephalopathy, aseptic meningitis, transverse myelitis, polyneuropathy and cerebellitis.

Methods: Using our department's archival database, we identified 205 C/A patients with encephalitis/encephalopathy and 21 patients with mycoplasma pneumoniae complications admitted to the Cleveland Clinic Foundation between January 1995 to December 2004. Out of these 2 group of patients we were able to identify 13 C/A with a neurological disease attributed to Mycoplasma pneumoniae infection. Patients were included in the study based on a high positive MP IgM in the absence of other infectious or non-infectious etiologies identified as a probable cause of their neurological disease.

Results: During this period 205 patients were admitted for encephalitis/encephalopathy, of which 13 (6.3%) patients, 8 males and 5 females with an age range 2.5–16 years were identified with MP infection. Seven (54%) had encephalitis, 4 (31%) had acute disseminated encephalomyelitis (ADEM) and 2 (15%) had acute myelitis. Ten patients (77%) had full recovery, 3 patients (23%) had sequlae; 2 had epilepsy and 1 had severe generalized dystonia. All patients had CSF studies; none showed evidence of invasive MP infection. All patients had MRI brain studies with 8 showing abnormalities ranging from a single hyperintense lesion on Flair to multiple lesions affecting both the brain and the spinal cord. Six of these patients had total resolution and 2 had residual findings at last follow-up. EEG was performed in 8 patients with 4 having significant slow wave activity (3 had generalized slowing and 1 patient had focal slowing). The other 4 patients had normal EEG.

Conclusion: MP is one of the most important infectious etiologies of central and peripheral nervous system pathology in C/A. In the present study it constituted 6.3% of patients with encephalitis/encephalopathy admitted to the hospital with 23% having long-term complications. Seizures and abnormal EEG during acute illness seemed to carry a bad prognostic outcome. Its exact pathogenesis remains unclear, and the debate whether it is autoimmune or direct invasion still continues.