Neuropediatrics 2011; 42 - P062
DOI: 10.1055/s-0031-1274034

Neurological presentations in children with serological active mycoplasma pneumoniae infection

V Kraus 1, P Strotmann 1, 2, P Dressel 1, C Makowski 1
  • 1Kinderklinik München Schwabing – Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Schwabing, StKM GmbH und Klinikum Rechts der Isar (AÖR) der Technischen Universität München, München, Germany
  • 2KfH Nierenzentrum, München, Germany

Introduction: Mycoplasma pneumoniae infections are frequent in school age children and lead to infections of the respiratory tract. Several neurological complications of mycoplasma infections have been reported in the literature.

Case report: We describe five children, who developed neurological complaints. One of them presented with viral meningitis, one with meningitis and encephalitis, one with encephalopathy and infectious nephritis, one with facial nerve palsy and one with cerebral vasculitis. Mycoplasma pneumoniae serology was positive in all cases, other infections were excluded. Preceding symptoms of an upper respiratory tract infection were present in three of the patients, active infection in one and headaches in another patient. Three of the patients were treated with clarithromycine and two with doxicycline. As long as results for other infectious or autoimmune etiologies were pending, one patient received aciclovir, cephalosporines or cortisone treatment i.v., two patients received aciclovir. The other patients were directly started on clarithromycine or doxicycline. With the positive mycoplasma serology all patients were continued on antibiotic monotherapy for two weeks. Symptoms resolved in all of them. In those started with antibiotic monotherapy clinical response was prompt.

Discussion: In patients with neurological complaints positive mycoplasma serology is often detected. Positive serological results are complicated by the findings of bystander reaction. However, mycoplasma detection with PCR in CSF is often elusive. Post-infectious neurological complications question the use of antibiotic therapy. We treated all of our patients with antibiotics and symptoms resolved in 3/5 of the patients with monotherapy. Further studies in larger patients cohorts are needed to link serological results for mycoplasma to the neurological clinical picture and measure therapeutic effects of antibiotic therapy in different disease stages.