Correlation between Radiological and Pathological Findings in Patients with Mycoplasma pneumoniae Pneumonia

Abstract

Studies focused on the pathological–radiological correlation of human Mycoplasma (M) pneumoniae pneumonia have rarely been reported. Therefore, we extensively reviewed the literature regarding pathological and radiological studies of Mycoplasma pneumonia, and compared findings between open lung biopsy specimen and computed tomography (CT). Major three correlations were summarized. (1) Peribronchial and perivascular cuffing characterized by mononuclear cells infiltration was correlated with bronchovascular bundles thickening on CT, which was the most common finding of this pneumonia. (2) Cellular bronchitis in the small airways accompanied with exudates or granulation tissue in the lumen revealed as centrilobular nodules on CT. (3) Neutrophils and exudates in the alveolar lumen radiologically demonstrated as air-space consolidation or ground-glass opacities. In M. pulmonis-infected mice model, pathologic patterns are strikingly different according to host cell-mediated immunity (CMI) levels; treatment with interleukin-2 lead to marked cellular bronchitis in the small airways and treatment with prednisolone or cyclosporin-A lead to neutrophils and exudates in the alveolar lumen. Patients with centrilobular nodules predominant radiologic pattern have a high level of CMI, measuring by tuberculin skin test. From these findings, up-regulation of host CMI could change radiological pattern to centrilobular nodules predominant, on the other hand down-regulation of host CMI would change radiological pattern to ground-glass opacity and consolidation. It was suggested the pathological features of M. pneumoniae pneumonia may be altered by the level of host CMI.

Relationship Between Clinical Features and Computed Tomographic Findings in Hospitalized Adult Patients With Community-Acquired Pneumonia

“…30 M. pneumoniae has an affinity for airway cilia and bronchioles and causes peribronchial and perivascular infiltration of mononuclear cells and edematous and ulcerative lesions in bronchial walls. 28 In the present study, more than 40% of cases in the bronchiolitis group were caused by M. pneumoniae, which concurs with the findings of a previous study, in which M. pneumoniae was determined to be the most common pathogen of diffuse acute infectious bronchiolitis in adults. 19 Interestingly, common CAP pathogens, such as C. pneumoniae, S. pneumoniae and K. pneumoniae, also cause a bronchiolitis pattern.…”

“…Centrilobular nodules on CT correspond pathologically to cellular infiltration in bronchioles with exudates or granulation tissue in bronchiolar lumens, whereas consolidation reflects neutrophils and exudates in alveolar lumen. 28 A previous study showed the microbiological features of CAP patients with a tree-inbud pattern share similarities with those of pneumonia in the general population. 29 In another study, M. pneumoniae infection was frequently associated with a bronchiolitis pattern.…”

Relationships between Th1/Th2 cytokine profiles and chest radiographic manifestations in childhood<em> Mycoplasma pneumoniae</em> pneumonia

“…Chest radiography for MPP can be manifested as bronchial pneumonia, segmental/lobar pneumonia, and pleural effusion 18. To a certain extent, the manifestation of chest radiograph can reflect the severity of the disease and is more conducive to distinguish the disease.…”

Advanced Role of Neutrophils in Common Respiratory Diseases

“…Mycoplasma pneumoniae pneumonia may be altered by the level of host cell-mediated immunity [154]. Mycoplasma pneumoniae pneumonia has an increase of neutrophils and IL-6, especially in severe group.…”