Mycoplasma pneumoniae-Associated Encephalitis in Childhood – Nervous System Disorder During or After a Respiratory Tract Infection

Abstract

Background: Mycoplasma pneumoniae is an important aetiological agent of encephalitis in children, with encephalitis being the most frequent paediatric extrapulmonary manifestation of M. pneumoniae infections. Evidence of M. pneumoniae involvement in childhood encephalitis is difficult to obtain, because M. pneumoniae is seldom detected in the cerebrospinal fluid and the clinical picture shows gradual onset. Therefore, we present a small case-study as a paradigm of M. pneumoniae-associated encephalitis in childhood and illustrate the importance of this entity based on a review of previously published cases.

Patients: We describe neurological signs and symptoms of 2 patients with M. pneumoniae-associated encephalitis in childhood. Respiratory symptoms with fever occurred in both children. They were seropositive for M. pneumoniae, but did not have the organism detected by PCR from cerebrospinal fluid. No long-term neurologic sequelae occurred.

Conclusion: M. pneumoniae has to be considered as a responsible pathogen of encephalitis in children, even if respiratory symptoms do not occur. Due to the seldom detection of M. pneumoniae in cerebrospinal fluid, evidence of M. pneumoniae involvement in childhood encephalitis is difficult to obtain. Faced with a neurological disease with no organism detected in CNS in the majority of cases assumes that M. pneumoniae-associated encephalitis is most likely a paradigm for an autoimmune disease with uniform pathogenesis mediated by an immunologic response to an antecedent antigenic stimulus from M. pneumoniae. It is important to relate this organism to this relatively common and potentially devastating clinical syndrome.

Zusammenfassung

Hintergrund: Mycoplasma pneumoniae ist ein wichtiger Erreger der Enzephalitis bei Kindern. Die Enzephalitis ist die häufigste extrapulmonale Manifestation einer Mykoplasmeninfektion. Eine Mykoplasmenbeteiligung bei Kindern mit Enzephalitis ist schwierig zu diagnostizieren, weil M. pneumoniae selten im Liquor nachgewiesen werden kann und die Krankheit schleichend verläuft. Wir präsentieren 2 Patienten mit Diagnose einer M.-pneumoniae-assoziierten Enzephalitis als Engramm und zeigen die Bedeutung von M. pneumoniae als Ursache der akuten Enzephalitis anhand einer kurzen Literaturübersicht auf.

Patienten: Beide Patienten mit M.-pneumoniae-assoziierter Enzephalitis zeigten Fieber, Somnolenz, Verhaltensänderungen und Ataxie. In beiden Fällen ging ein Luftwegsinfekt voraus. Sie hatten erhöhte Mykoplasmentiter mit Titerablauf im Intervall, jedoch konnte der Erreger im Liquor nicht nachgewiesen werden. Es zeigten sich keine Folgeschäden.

Schlussfolgerung: M. pneumoniae muss bei der Enzephalitis im Kindesalter auch bei fehlenden respiratorischen Symptomen als Ursache in Betracht gezogen werden. Eine Beteiligung von M. pneumoniae ist schwierig zu beweisen, da der Erreger im Liquor selten nachgewiesen wird. Eine neurologische Erkrankung ohne Erregernachweis im ZNS bei gleichzeitiger Serokonversion gegen M. pneumoniae suggeriert eine parainfektiöse Autoimmunreaktion. Eine Assoziation zwischen M. pneumoniae und diesem relativ häufigen und potenziell gefährlichen Krankheitsbild der Enzephalitis muss differenzialdiagnostisch in Betracht gezogen werden.

Key words

mycoplasma pneumoniae - children - neurologic complication - encephalitis - para-infectious - autoimmune reaction

Schlüsselwörter

Mycoplasma pneumoniae - Kinder - neurologische Komplikation - Enzephalitis - parainfektiös - Autoimmunreaktion

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