|Year : 2015 | Volume
| Issue : 3 | Page : 463-464
Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report
S Kumar1, S Kapoor2, SR Saigal1
1 Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002, India
2 Department of Pediatrics, Maulana Azad Medical College, New Delhi - 110 002, India
|Date of Submission||27-Jan-2014|
|Date of Acceptance||02-Dec-2014|
|Date of Web Publication||12-Jun-2015|
Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar S, Kapoor S, Saigal S R. Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report. Indian J Med Microbiol 2015;33:463-4
|How to cite this URL:|
Kumar S, Kapoor S, Saigal S R. Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report. Indian J Med Microbiol [serial online] 2015 [cited 2019 Nov 15];33:463-4. Available from: http://www.ijmm.org/text.asp?2015/33/3/463/158610
Mycoplasma pneumoniae M. pneumoniae) causes 6-20% of the community-acquired lower respiratory tract infections in older children and adults.  One of the most common extrapulmonary manifestations is central nervous system (CNS) complications with encephalitis as the most common pediatric manifestations.  We report M. pneumoniae infection in an 11-year-old boy presented with fever, accompanied by bifrontal headache and nonprojectile, nonbilious vomiting for the last 12 days. A diagnostic lumbar puncture revealed colourless CSF, pleocytosis with total lymphocyte count of 27 cells/mm 3 (polymorphs 6% and lymphocytes 94%). The CSF sugar was within normal limits (50-80 mg/dl) and proteins (normal range 15-45 mg/dl) were raised. No organisms were seen on direct microscopy or culture. Magnetic resonance imaging (MRI) scan of the brain was suggestive of hemorrhagic encephalitis.
The CSF specimen tested by polymerase chain reaction to amplify a 345 base pair region on the P1 adhesin gene of M. pneumoniae was negative. The serum was positive by ELISA (Calbiotech, CA, USA) for IgM antibodies to M. pneumoniae and by M. pneumoniae Serodia Myco II gelatin particle agglutination test (Fujirebio, Japan). The child was managed with mannitol, ceftazidime, azithromycin and amikacin. Two weeks after admission, the patient was discharged from the hospital.
M. pneumoniae is responsible for at least 6.9% of cases of acute childhood encephalitis.  A study reported CNS manifestations associated with serologic evidence of acute infection with M. pneumoniae.  Several potential mechanisms include direct invasion of the CNS, immune complex formation, vascular injury, hypercoagulable state and toxic effects.  We suggest that M. pneumoniae should be considered as a potential cause of encephalitis in children. Serologic testing is more reliable for the diagnosis of the association between pediatric encephalitis and M. pneumoniae and should be used as a part of protocol for evaluation of the cause of encephalitis in this age-group.
| ~ References|| |
Kumar S, Saigal SR, Sethi GR. Rapid diagnosis of Mycoplasma pneumoniae
by polymerase chain reaction in community acquired lower respiratory tract infections. Trop Doct 2011;41:160-2.
Christie LJ, Honarmand S, Talkington DF, Gavali SS, Preas C, Pan CY, et al
. Pediatric encephalitis: What is the role of Mycoplasma pneumoniae?
Bitnun A, Ford-Jones EL, Petric M, MacGregor D, Heurter H, Nelson S, et al
. Acute childhood encephalitis and Mycoplasma pneumoniae
. Clin Infect Dis 2001;32:1674-84.
Lerer RJ, Kalavsky SM. Central nervous system disease associated with Mycoplasma pneumoniae:
Report of five cases and review of the literature. Pediatrics 1973;52:658-68.
Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae
infections. J Infect 2005;51:343-54.