Neuropediatrics 2013; 44 - PS18_1121
DOI: 10.1055/s-0033-1337838

Antibodies against Mycoplasma pneumoniae in three patients with meningoencephalitis-causal relationship or epiphenomenon?

M Tappauf 1, S Prager-Puntigam 1, M Müller 1, M Brunner-Krainz 1, U Gruber-Sedlmayr 1, W Zenz 1
  • 1Universitätsklinik für Kinder- und Jugendheilkunde, Graz, Austria

Background: In more than half of the cases of meningoencephalitis, the causative pathogen cannot be detected.1 In almost one-third of children and teenagers with meningoencephalitis, IgM against M.p. is positive, but the detection of M.p. DNA is rare.2

Case Reports: A 14-year-old girl was admitted with a recent history of headache, fever, somnolence, personality change, and no spontaneous speech for 2 days. The CSF showed 70 cells/µL, and the cerebral MRI (cMRI) scan diffuse white matter lesions, as can also be seen in cases of ADEM.

A 12-year-old boy was referred because of decreased vigilance and ataxia. Further, he had been coughing for 1 week and suffered from fever and neck pain for 4 days. The CSF showed 38 cells/µL, and the cMRI scan was normal.

A 16-year-old boy was referred due to fever, headache, vomiting, and neck stiffness. Two weeks before, he had had a respiratory tract infection. The CSF showed 571 cells/µL, and the cMRI scan leptomeningeal enhancement. Because of increasing somnolence, personality changes and dysarthria after 6 days, lumbar puncture was repeated and the CSF showed 62 cells/µL.

Two of our three patients had a history of respiratory tract infections before the meningoencephalitis. In all three patients, specific IgM for M.p. was found. Detection of M.p. DNA by polymerase chain reaction (PCR) was not possible in any of the patients. Further, in the case of the 16-year-old boy, Varizella-Zoster IgG and FSME IgM as well as IgG were high, but without further increase of the IgG during follow-up.

All three patients were treated with doxycycline and showed clinical improvement, and no neurological sequelae were observed.

Conclusion: Since a direct detection of M.p. was not possible in our cases, it is unclear whether infections with M.p. were the causes of the meningoencephalitis. Because of the severity of the diseases, all three patients received antibiotic treatment.

References

1 Christie LJ et al. Pediatric encephalitis: what is the role of Mycoplasma pneumoniae? 2007

2 Bitnun A et al. Acute childhood encephalitis and Mycoplasma pneumoniae. 2001