Mucosal Respiratory Syndrome: A Systematic Literature Review

Abstract

<b><i>Background:</i></b> <i>Mycoplasma pneumoniae</i> atypical pneumonia is frequently associated with erythema multiforme. Occasionally, a mycoplasma infection does not trigger any cutaneous but exclusively mucosal lesions. The term mucosal respiratory syndrome is employed to denote the latter condition. Available reviews do not address the possible association of mucosal respiratory syndrome with further atypical bacterial pathogens such as <i>Chlamydophila pneumoniae</i>, <i>Chlamydophila psittaci</i>, <i>Coxiella burnetii</i>, <i>Francisella tularensis</i>, or <i>Legionella</i> species. We therefore performed a systematic review of the literature addressing this issue in the National Library of Medicine, Excerpta Medica, and Web of Science databases. <b><i>Summary:</i></b> We found 63 patients (≤18 years, <i>n</i> = 36; >18 years, <i>n</i> = 27; 54 males and 9 females) affected by a mucosal respiratory syndrome. Fifty-three cases were temporally associated with a <i>M. pneumoniae</i> and 5 with a <i>C. pneumoniae</i> infection. No cases temporally associated with <i>C. psittaci</i>, <i>C. burnetii</i>, <i>F. tularensis</i>, or <i>Legionella</i> species infection were found. Two cases were temporally associated with Epstein-Barr virus or influenzavirus B, respectively.

Recurrent reactive infectious mucocutaneous eruption (RIME) secondary to Chlamydophila pneumoniae infection in an adult

“…Almost 10% of the infected children develop skin lesions. A recent study by Luigi et al, 3 identified 63 patients who met the diagnostic criteria for MIRM/RIME: mucositis affecting at least two mucous membranes with limited cutaneous involvement (<1% of total body surface area) in the context of a respiratory infection. Of these cases, 53 were associated with M. pneumoniae , while only 5 were found to be secondary to Chl.…”

“…Molecular mimicry between bacterial antigens and keratinocyte proteins has also been hypothesized. ( 1,3,6,8 )…”

“…We conducted a comprehensive literature review that revealed an additional case published in 2020 by Mokashi et al, 4 bringing the total number of reported cases to date to 6. [4][5][6][7][8][9] Table 1 summarizes these cases, including ours (please note that we did not have access to one of the reported cases by Luigi et al 3 ). RIME was predominantly found in males (4 out of 6).…”

“…Molecular mimicry between bacterial antigens and keratinocyte proteins has also been hypothesized. (1,3,6,8) RIME is likely to be underreported in the literature. On the one hand, misclassification is probably often due to a lack of knowledge and standardization in the definition of RIME.…”

Case Report: A Chlamydia psittaci pulmonary infection presenting with migratory infiltrates

“…CT imaging often shows different degrees of exudation and patchy consolidation, unilateral involvement is more common, and the white blood cell count can be normal ( 8 ). Molecular diagnostic methods such as mNGS could lead to rapid diagnosis and treatment which can shorten the course of hospitalization and thus improve prognosis ( 9 ). In our case, mNGS provides basis for the accurate diagnosis of Chlamydia psittaci (The mNGS data indicated 16 sequences aligning to Chlamydia psittaci) .…”