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Mycoplasma-induced minimally conscious state.

Horvath T, Fischer U, Müller L, Ott S, Bassetti CL, Wiest R, Sendi P, Schefold JC - Springerplus (2016)

Bottom Line: Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited.Moreover, it can be fulminant and fatal in adults.Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.

ABSTRACT
Mycoplasma pneumoniae (M. pneumoniae) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children, M. pneumoniae is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant M. pneumoniae-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe M. pneumoniae-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe M. pneumoniae- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in M. pneumoniae disease, which is commonly self-limited.

No MeSH data available.


Related in: MedlinePlus

Resting state functional MRI (with central seed placed in the precuneus, PRE). IPL and ACC denote inferior parietal lobe and anterior cingulate cortex, respectively. Images in neurological convention; red areas indicate connectivity between PRE and IPC/ACC >0.5 (Whitfield-Gabrieli and Nieto-Castanon 2012). Left multiband EPI-sequence (TR 300 ms, TE 30 ms, 32 contiguous slices, matrix size 64 × 64, FoV 1380 mm); right diffusion weighted imaging sequence (b = 1000, TE 3500 ms, TE 89 ms, matrix size 128 × 128, FoV 230 mm)
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Fig2: Resting state functional MRI (with central seed placed in the precuneus, PRE). IPL and ACC denote inferior parietal lobe and anterior cingulate cortex, respectively. Images in neurological convention; red areas indicate connectivity between PRE and IPC/ACC >0.5 (Whitfield-Gabrieli and Nieto-Castanon 2012). Left multiband EPI-sequence (TR 300 ms, TE 30 ms, 32 contiguous slices, matrix size 64 × 64, FoV 1380 mm); right diffusion weighted imaging sequence (b = 1000, TE 3500 ms, TE 89 ms, matrix size 128 × 128, FoV 230 mm)

Mentions: At day 58, eye movements lapsed and MRIs showed extensive necrotizing encephalitis with hemorrhagic transformation and blood–brain barrier disruption within cervicospinal lesions (Fig. 1). Resting-state functional MRI to assess default mode network (DMN) connectivity was performed (Fig. 2) (Whitfield-Gabrieli and Nieto-Castanon 2012). Connectivity was preserved in the posterior DMN i.e. between the precuneus (a core structure regarding connectivity loss in comatose patients) and inferior parietal lobe, and a reduction between posterior DMN and anterior cingulate cortex. Thus, clinical and imaging findings indicated progression of locked-in syndrome to minimally conscious state (Demertzi et al. 2015). Finally, following extensive communication with next-of-kin, the patient was discharged to a nursing home on controlled mechanical ventilation. Follow-up until day 230 confirmed a persistent neurological status.Fig. 2


Mycoplasma-induced minimally conscious state.

Horvath T, Fischer U, Müller L, Ott S, Bassetti CL, Wiest R, Sendi P, Schefold JC - Springerplus (2016)

Resting state functional MRI (with central seed placed in the precuneus, PRE). IPL and ACC denote inferior parietal lobe and anterior cingulate cortex, respectively. Images in neurological convention; red areas indicate connectivity between PRE and IPC/ACC >0.5 (Whitfield-Gabrieli and Nieto-Castanon 2012). Left multiband EPI-sequence (TR 300 ms, TE 30 ms, 32 contiguous slices, matrix size 64 × 64, FoV 1380 mm); right diffusion weighted imaging sequence (b = 1000, TE 3500 ms, TE 89 ms, matrix size 128 × 128, FoV 230 mm)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764598&req=5

Fig2: Resting state functional MRI (with central seed placed in the precuneus, PRE). IPL and ACC denote inferior parietal lobe and anterior cingulate cortex, respectively. Images in neurological convention; red areas indicate connectivity between PRE and IPC/ACC >0.5 (Whitfield-Gabrieli and Nieto-Castanon 2012). Left multiband EPI-sequence (TR 300 ms, TE 30 ms, 32 contiguous slices, matrix size 64 × 64, FoV 1380 mm); right diffusion weighted imaging sequence (b = 1000, TE 3500 ms, TE 89 ms, matrix size 128 × 128, FoV 230 mm)
Mentions: At day 58, eye movements lapsed and MRIs showed extensive necrotizing encephalitis with hemorrhagic transformation and blood–brain barrier disruption within cervicospinal lesions (Fig. 1). Resting-state functional MRI to assess default mode network (DMN) connectivity was performed (Fig. 2) (Whitfield-Gabrieli and Nieto-Castanon 2012). Connectivity was preserved in the posterior DMN i.e. between the precuneus (a core structure regarding connectivity loss in comatose patients) and inferior parietal lobe, and a reduction between posterior DMN and anterior cingulate cortex. Thus, clinical and imaging findings indicated progression of locked-in syndrome to minimally conscious state (Demertzi et al. 2015). Finally, following extensive communication with next-of-kin, the patient was discharged to a nursing home on controlled mechanical ventilation. Follow-up until day 230 confirmed a persistent neurological status.Fig. 2

Bottom Line: Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited.Moreover, it can be fulminant and fatal in adults.Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.

ABSTRACT
Mycoplasma pneumoniae (M. pneumoniae) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children, M. pneumoniae is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant M. pneumoniae-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe M. pneumoniae-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe M. pneumoniae- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in M. pneumoniae disease, which is commonly self-limited.

No MeSH data available.


Related in: MedlinePlus