Determining the Clinical Characteristics, Treatment Strategy and Prognostic Factors of Mycoplasma Pneumoniae Encephalitis in Children: A Multicenter Study from China

Abstract

Background Most of the knowledge on Mycoplasma pneumoniae encephalitis (MPE) in children is based on case reports or small case series.This study aimed to describe the clinical features, the efficacy of azithromycin with or without immunomodulatory therapy ,and prognostic factors of MPE .Methods The Medical data of eighty-seven MPE patients from three medical centers in southwestern China over a 7-years period were reviewed.Results MPE was noted in children of all ages except for neonates.The most common neurological manifestations include consciousness disturbance(90%) and headache(87.4%),the most common extra-neurological presentations include fever (96.5%)and respiratory system involvement(94.3%) ,multi-system involvement(98.2%) and elevated C-reactive protein(CRP) (90.8%)were also prominent.M. pneumoniae detection in CSF was less than in blood and respiratory tract secretions.Azithromycin with intravenous immunoglobulin (IVIG) or/and corticosteroids treatment can shorten the hospitalization duration and length of clinical improvement. Multivariate analysis revealed that onset during teenage years and high lactate dehydrogenase (LDH) and CSF protein levels were identified as independent prognostic factors for poor outcome.Conclusions In children having acute encephalitis with multi-system involvement, especially in those with respiratory tract manifestations, accompanied with prominently elevated CRP,M. pneumoniae should be given preference.Higher age,marked CSF protein and blood LDH were correlated with unfavorable outcomes. Multiplicity mechanisms ,especially immune-mediated inflammation involved in the pathogenesis. Immunomodulating therapies should be recommended regardless of the duration of prodromal period.

Psychiatric Manifestations Caused by Mycoplasma pneumoniae Encephalitis Mimicking Autoimmune Encephalitis

“…6 According to several case series studies, the administration of immune-modulating therapy with intravenous pulse methylprednisolone at a dose of 20 mg/kg/d intravenously for 3 to 5 days, either as a standalone treatment or in combination with oral prednisone at a dose of 1 mg/kg/d for 10 to 14 days, with a gradual withdrawal for 4 to 6 weeks, has a beneficial effect. 17,18 The role of antimicrobial treatment remains controversial because it depends on the associated mechanism. Azithromycin (10 mg/kg of body weight once per day for 5 to 7 days orally or intravenously) is the first-line agent due to its good CNS penetration and anti-inflammatory effect, which prevents immune system activation with fewer side effects.…”

“…Azithromycin (10 mg/kg of body weight once per day for 5 to 7 days orally or intravenously) is the first-line agent due to its good CNS penetration and anti-inflammatory effect, which prevents immune system activation with fewer side effects. 18,19 It is indicated in the direct invasion, while if an immune-mediated mechanism is suspected, the appropriateness of antimicrobial therapy, particularly after the resolution of the acute disease, remains uncertain, 1,4 but recent studies support its early use with reported significant clinical improvement. Despite the lack of established information regarding the optimal antibiotic, dosage, and length of therapy.…”

“…The study found that giving azithromycin along with IVIG or corticosteroid therapy led to shorter stays in the hospital and faster management of symptoms compared with giving azithromycin alone. 18 Various clinical reports have reported that the rare use of immunomodulatory medication, based on potential immune-related mechanisms, effectively reduces illness severity and improves outcomes. However, further studies on the efficacy of immunomodulatory treatment are necessary in the pediatric age group.…”