Pediatric encephalitis:: What is the role of Mycoplasma pneumoniae?
Pediatric encephalitis:: What is the role of Mycoplasma pneumoniae?
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DOI：
10.1542/peds.2007-0240
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发表时间：
2007-08-01
期刊：
影响因子：
8
通讯作者：
Glaser, Carol A.
中科院分区：
文献类型：
--
作者：
Christie, Laura J.;Honarmand, Somayeh;Glaser, Carol A.
背景癫痫是一种复杂的，使人衰弱的，有时是致命的神经系统疾病，儿童特别容易患上。肺炎支原体是一种常见的呼吸道病原体，被认为是脑炎的病因。近期或急性肺炎支原体感染的证据已在有限的儿童和成人脑炎患者的研究中得到证实。不明原因的脑炎病例被转介到加州脑炎项目进行诊断测试。通过聚合酶链反应和血清学方法检测血清、脑脊液和呼吸道标本中是否存在多种病原体，包括肺炎支原体。将肺炎支原体相关脑炎病例与其他细菌病原体、单纯疱疹病毒1型和肠道病毒进行比较。在1988例转诊至加州Encephaly项目的患者中，111例患者发现急性肺炎支原体感染的证据，其中84例（76%）为儿科患者。84例患者中有80%仅通过血清学检测为肺炎支原体阳性。肺炎支原体的脑脊液聚合酶链反应很少呈阳性（2%）。肺炎支原体相关的儿童脑炎患者的中位年龄为11岁，进展迅速（中位时间：从发病到住院2天），经常在ICU（55%）。症状包括发热（70%）、嗜睡（68%）和意识改变（58%）。胃肠道（45%）和呼吸道（44%）症状不太常见。与其他细菌和病毒感染者相比，肺炎支原体相关脑炎患者癫痫发作较少，住院期间病情较轻。肺炎支原体是加州Encephalitis项目中最常见的病原体。肺炎支原体相关性脑炎患者主要是儿科患者，其临床表现与肠道病毒脑炎相似，尽管他们经常需要长期住院的重症监护。鉴于肺炎支原体感染比任何其他病原体都多，应更加重视阐明肺炎支原体在脑炎中的作用和机制。
Background. Encephalitis is a complex, debilitating, and sometimes fatal neurologic condition to which children are especially prone. Mycoplasma pneumoniae, a common respiratory pathogen, has been implicated as an etiology of encephalitis. Evidence for recent or acute M pneumoniae infection has been demonstrated in limited studies of both pediatric and adult patients with encephalitis.Patients and Methods. Unexplained encephalitis cases are referred to the California Encephalitis Project for diagnostic testing. Serum, cerebrospinal fluid, and respiratory specimens are tested by polymerase chain reaction and serology methods for the presence of multiple pathogens, including M pneumoniae. M pneumonia associated cases of encephalitis were compared with other bacterial agents, herpes simplex virus 1, and enterovirus.Results. Of 1988 patients referred to the California Encephalitis Project, evidence of acute M pneumoniae infection was found in 111 patients, of which 84 (76%) were pediatric patients. Eighty percent of the 84 patients were positive for M pneumoniae by serology alone. Cerebrospinal fluid polymerase chain reaction for M pneumoniae was rarely positive (2%). Patients with M pneumoniae-associated pediatric encephalitis were a median of 11 years old, progressed rapidly (median: 2 days from onset to hospitalization), and were often in the ICU (55%). Symptoms included fever (70%), lethargy (68%), and altered consciousness (58%). Gastrointestinal (45%) and respiratory (44%) symptoms were less common. Compared with patients with other bacterial as well as viral agents, patients with M pneumoniae-associated encephalitis had fewer seizures and less-severe hospital courses.Conclusions. M pneumoniae is the most common agent implicated in the California Encephalitis Project. Patients with M pneumoniae-associated encephalitis are predominantly pediatric, and their presentations are clinically similar to enterovirus encephalitis, although they frequently require intensive care with prolonged hospitalizations. Given that M pneumoniae infection is found more than any other pathogen, increased emphasis should be placed on elucidating the role and mechanism of M pneumoniae in encephalitis.