Original articleClinical features, risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia: A review of the Japanese literature
Introduction
Mycoplasma pneumoniae is one of the most common causes of atypical pneumonia worldwide occurring in all populations especially youths. Transmission of M. pneumoniae occurs via infected respiratory droplets during close contact between the source and the recipient. Atypical pneumonia is considered to account for 7–20% of community-acquired pneumonia (CAP) [1], [2]. Previous Japanese epidemiological studies of CAP have also indicated a prevalence of 5.2–15.4%, which does not differ from the data of studies carried out in other countries [3], [4], [5]. The actual incidence of M. pneumoniae pneumonia (MPP), however, may be higher in patients with mild symptoms that can be managed without hospital admission. Commonly, patients with mycoplasma respiratory infection may have nonproductive, persistent cough, pharyngitis, rhinorrhea, and occasional extrapulmonary manifestations such as hemolysis, skin reactions (e.g. the Stevens–Johnson syndrome), and central nervous system complications. Although MPP is sometimes self-limiting, and macrolides are effective against it, numerous fulminant cases of MPP, including that of acute respiratory distress syndrome (ARDS), have been reported to date [6], [7]. The major clinical manifestation of fulminant MPP is respiratory failure with diffuse consolidation or an abnormal interstitial pattern that can be observed on a chest radiograph. The incidence of fulminant MPP is relatively rare despite the high prevalence of M. pneumoniae infection, and its etiology has not been fully described. The clinical features of fulminant MPP have not been clearly elucidated either.
We reviewed 52 cases of fulminant MPP with respiratory failure; we obtained their reports from multiple institutes and clinics in Japan and analyzed their clinical characteristics, risk factors, and treatment.
Section snippets
Case collection
Using PubMed and abstracts from the proceedings of several domestic Japanese academic societies, we searched the Japanese and English literature for cases of fulminant or severe MPP reported in Japan before February, 2010. Fulminant MPP was defined as the apparent presence of MP infection with hypoxia. All cases must fulfilled following conditions; (1) the patients should be diagnosed with MPP after obtaining positive findings from any of microbiological laboratory tests such as culturing or
Patient characteristics
We found and analyzed 52 cases in the literature between September, 1979 and February, 2010. All cases involved Japanese patients and MP infection was diagnosed by serological antibody tests such as PA, CF, and IHA. PA, CF, and IHA diagnosed 15, 27, and 20 cases, respectively, and confirmed single titer elevation in 2, 3, and 4 cases, respectively. The remaining cases were diagnosed by paired titer elevation in serum samples. MP was isolated in 2 of 3 cases in which culture was attempted. No
Discussion
The incidence of respiratory failure in cases of fulminant MPP has rarely been reported despite the high prevalence of MPP [6]. Among 295 MPP cases, we have encountered only 3 patients (1.0%), which presented respiratory failure (data not published).
MPP is sometimes a self-limiting disease; however, the following are considered virulence-associated factors of MP: 1) direct interaction between human host cells caused by toxicity (e.g., adherence to bronchoepithelial cells, toxin production,
Conflicts of interest
Koichi Izumikawa received honorarium from Pfizer Japan Inc., Dainippon Sumitomo Pharma Co., Ltd., MSD K. K., Astellas Pharma Inc., Taisho Toyama Pharmaceutical Co., Ltd., and Daiichi Sankyo Co., Ltd. Yoshifumi Imamura received honorarium from Pfizer Japan Inc., Dainippon Sumitomo Pharma Co., Ltd., MSD K. K., Taisho Toyama Pharmaceutical Co., Ltd., and Daiichi Sankyo Co., Ltd. Shigeru Kohno and Katsunori Yanagihara received honorarium and research grant from Pfizer Japan Inc., Dainippon Sumitomo
Acknowledgments
We appreciated for acceptance of using data of the articles written by following authors; Naofumi Suyama, Niro Okimoto, Toshihiro Shirai, Yohsuke Miyagawa, Masamitsu Nakajima, Kohji Hashiguchi, Hiromi Tomioka, Mitsuhide Ohmichi, Haruko Taniguchi, Yosuke Aoki, Midori Fujishiro, Noboru Uchiyama, Hiroshi Yoshida, Mayumi Inoue, Shigeyuki Aoki, Shouhei Nagaoka, Maki Wakasa, Shigeki Yokoyama, Tsuneaki Shiraishi, Masahiro Miyai, Shoji Ohno, Shigeo Takizawa, Hiroshi Tanaka, Hideo Mashimoto, Nobue
References (15)
- et al.
A 3-year prospective study of a urinary antigen-detection test for Streptococcus pneumoniae in community-acquired pneumonia: utility and clinical impact on the reported etiology
J Infect Chemother
(2004) - et al.
Prospective multicenter study of the causative organisms of community-acquired pneumonia in adults in Japan
J Infect Chemother
(2006) - et al.
Role of interleukin-18 and T-helper type 1 cytokines in the development of Mycoplasma pneumoniae pneumonia in adults
Chest
(2002) - et al.
Clinical utility of the polymerase chain reaction to diagnose Mycoplasma pneumoniae infection
Pathology
(1995) - et al.
Community-acquired pneumonia
N Engl J Med
(1995) Mycoplasma pneumoniae infections
Curr Opin Infect Dis
(2001)- et al.
Community-acquired pneumonia in Japan: a prospective ambulatory and hospitalized patient study
J Med Microbiol
(2005)
Cited by (76)
Bakuchiol reduces the severity of Mycoplasma pneumoniae-induced pneumonia in mice by attenuating inflammatory responses
2023, Arabian Journal of ChemistryThe clinical significance of and the factors associated with macrolide resistance and poor macrolide response in pediatric Mycoplasma pneumoniae infection: A retrospective study
2023, Journal of Microbiology, Immunology and InfectionDevelopment of an immunochromatographic test for the detection of Mycoplasma pneumoniae GroES antigen
2021, Journal of Microbiological MethodsCitation Excerpt :M. pneumoniae is a well-known pathogen that causes respiratory infections, particularly community-acquired pneumonia (CAP), mainly in children and young adults (Principi et al., 2001; Waites and Talkington, 2004). The initial symptoms of M. pneumoniae infection include upper respiratory tract infection with cough and pharyngitis, with approximately 3%–13% of patients progressing to bronchitis or pneumonia (Izumikawa et al., 2014; Miyashita et al., 2007; Saraya, 2017). Moreover, extrapulmonary complications may develop in 25% of infected patients (Waites and Talkington, 2004; Yoon et al., 2020).
Efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods
2024, Italian Journal of PediatricsPeripheral blood microR-146a and microR-29c expression in children with Mycoplasma pneumoniae pneumonia and its clinical value
2023, Italian Journal of Pediatrics