Mycoplasma pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion: report of two pediatric cases and a comprehensive literature review. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Ueda, Norishi; Minami, Satoshi; Akimoto, Manabu
• Is Part Of: BMC infectious diseases. Volume 16:Issue 1(2016)
• Page Start: 1
• Page End: 10
• Publication Date: 2016-12
• Subjects: Encephalitis -- MERS -- Neuroimaging -- Mycoplasma pneumoniae -- Splenium of the corpus callosum; Communicable diseases -- Periodicals; Sexually Transmitted Diseases -- Periodicals; 616.905
• DOI: 10.1186/s12879-016-1985-1
• Languages: English
• ISSNs: 1471-2334

Abstract

Abstract Background No literature review exists onMycoplasma pneumoniae -associated mild encephalitis/encepharopathy with a reversible splenial lesion (MERS). Methods M.pneumoniae -associated MERS cases were searched till August 2016 using PubMed/Google for English/other-language publications and Ichushi (http://www.jamas.or.jp/ ) for Japanese-language publications. Inclusion criteria were children fulfilling definition for encephalitis, M.pneumoniae infection, and neuroimaging showing hyperintensity in the splenium of the corpus callosum (SCC) alone (type I) or SCC/other brain areas (type II). Results We described two children with type I and IIM.pneumoniae -associated MERS. Thirteen cases found by the search and our 2 cases were reviewed. Mean age, male/female ratio, duration of prodromal illness was 8.3 years, 1.5 and 3.5 days. The most common neurological symptom was drowsiness, followed by abnormal speech/behavior, ataxia, seizure, delirium, confusion, tremor, hallucination, irritability, muscle weakness, and facial nerve paralysis. Fever was the most common non-neurological symptom, followed by cough, headache, gastrointestinal symptoms, headache, lethargy and dizziness. Seizure and respiratory symptoms were less common. All were diagnosed forM.pneumoniae by serology. Cerebrospinal fluid (CSF)M.pneumoniae was undetectable by PCR in the 3 patients. Three patients were clarithromycin-resistant. Leukocytosis, positive C-reactive protein, hyponatremia, CSF pleocytosis and slow wave on electroencephalography frequently occurred. All except 2 were type I MERS. Neuroimaging abnormalities disappeared within 18 days in the majority of patients. All type I patients completely recovered within 19 days. Two type II patients developed neurological sequelae, which recovered 2 and 6 months after onset. Conclusions Prognosis ofM.pneumoniae -associated MERS is excellent. Type II MERS may increase a risk of neurological sequelae.