Clinical features, risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia: A review of the Japanese literature

Abstract

Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children and young adults. Although MP sometimes causes self-limiting pneumonia, severe and fulminant cases with hypoxia occur, but their clinical features have rarely been reported. This study aimed to reveal the clinical manifestations, risk factors, and treatment of fulminant MP pneumonia (MPP). Using PubMed and abstracts from the proceedings of several domestic Japanese academic societies, we reviewed the Japanese and English literature for cases of fulminant or severe MPP reported in Japan. All clinical information such as sex, age, underlying diseases, clinical symptoms, clinical course, laboratory and radiological findings, and treatment was collected and analyzed. In total, 52 fulminant MPP cases were reported between September, 1979 and February, 2010. The dominant population of fulminant MPP was young adults without severe underlying diseases. Cough (97.3%), fever (100.0%), and dyspnea (83.3%) with diffuse abnormal findings in radiological examinations were noted. Antibiotics without anti-mycoplasmal activity were used in 32 cases (61.5%) as initial treatment prior to the onset of hypoxia. Anti-mycoplasmal drugs were appropriately used in 41 cases (78.8%) after onset of respiratory failure with steroids (23 cases, 45.1%) and effective. The majority of patients improved within 3-5 3 days after steroid administration. There were only 2 fatal cases. Although this small retrospective study did not reveal the apparent risk factors of fulminant MPP, initial inappropriate use of antibiotics may be a risk factor, and early administration of appropriate anti-mycoplasmal drugs with steroids as a cellular immune suppressor is required.4

Successful Additional Corticosteroid Treatment in a Patient with <i>Mycoplasm</i>a <i>pneumoniae</i> Pneumonia in whom a Monobacterial Infection was Confirmed by a Molecular Method Using Bronchoalveolar Lavage Fluid

“…Furthermore, treatment with the combination of clarithromycin and a corticosteroid, compared to clarithromycin alone, resulted in a significant reduction of IL-12, p40 and regulated on activation, normal T cell expressed and secreted (RANTES) (16). Izumikawa reported that the respiratory functions of a majority of fulminant M. pneumoniae pneumonia patients were successfully improved with corticosteroid treatment within 3-5 days, which was also considered to be due to a suppressive effect of the corticosteroids on hyper-activated cellular immunity (17). In children, You et al (18) demonstrated that three-day methylprednisolone pulse therapy improved the clinical symptoms, radiological findings and CRP levels in severe refractory childhood M. pneumoniae pneumonia.…”

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report

“…However, corticosteroids may have a desirable effect on MPP by down-regulating cell-mediated immunity. Clinical evidence supporting this hypothesis has been reported by several groups (2,3,6,7). Although about half of previously reported patients with fulminant MPP were treated with methylprednisolone pulse therapy probably following typical ARDS (6), the optimal dose and duration of steroid therapy remain unclear.…”

iTRAQ-based Quantitative Proteomics Study in Patients with Refractory <i>Mycoplasma pneumoniae</i> Pneumonia

“…However, the relationships between ZNF623 or AZGP1 and RMPP have not been studied. Dyspnea and hypoxia are major (over 80 ) clinical symptoms of MP pneumonia (34). The close association between MP and the respiratory epithelial tissue of the host induces ciliostasis and apoptosis of epithelial cells, resulting in damage to the respiratory system and hypoxia (3).…”