Mykoplasma-pneumoniae-assoziierte Meningoenzephalitis

Zusammenfassung

Infekt-assoziierte Erkrankungen des ZNS stellen seltene, aber in der Regel schwer verlaufende Erkrankungen im klinischen Alltag dar. Wir berichten über den Fall eines 22-jährigen Patienten, der nach einem respiratorischen Infekt bei bekanntem Asthma bronchiale ausgeprägte neurologische Defizite entwickelte, die unter einer empirischen Therapie mit Vancomycin, Ampicillin und Ceftriaxon progredient waren. Im Liquor und in der kranialen Magnetresonanztomografie fanden sich Hinweise auf eine Meningoenzephalitis. Mikrobiologische Untersuchungen konnten im Verlauf eine akute Infektion mit Mykoplasma pneumoniae nachweisen, so dass eine Therapie mit Minozyklin und Prednisolon erfolgte, die zu einer nahezu kompletten Remission der Erkrankung führte. Die Pathomechanismen und Behandlungsstrategien der Erkrankung werden im Folgenden dargestellt.

Abstract

In clinical practice, secondary infections of the central nervous system (CNS) represent rare yet severe complications of their respective primary infections. In this case report, we describe a 22-year-old patient with a medical history of Asthma bronchiale, who developed significant neurological deficits after a respiratory infection. The neurological symptoms progressed despite antibiotic therapy with vancomycin, ampicillin and ceftriaxone. The patient’s cerebrospinal fluid and a cranial magnetic resonance imaging (MRI) furnished evidence of acute meningoencephalitis. Microbiological assessment confirmed an acute mycoplasma pneumonia infection. Changing the patient’s antibiotic regimen to minocycline and prednisolone led to significant clinical improvement. Pathomechanisms and therapeutic options to treat meningoencephalitis will be discussed in the following.

Schlüsselwörter

Meningitis - Enzephalitis - Meningoenzephalitis - Mykoplasma pneumoniae

Key words

meningitis - encephalitis - meningoencephalitis - mycoplasma pneumoniae

• Literatur

• 1 Tunkel AR, Hartman BJ, Kaplan SL et al. Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases 2004; 39: 1267-1284
• 2 Whitney CG, Farley MM, Hadler J et al. Increasing prevalence of multidrugresistant Streptococcus pneumoniae in the United States. New England Journal of Medicine 2000; 343: 1917-1924
• 3 Van de Beek D, de Gans J, Tunkel AR et al. Community-Acquired Bacterial Meningitis in Adults. New England Journal of Medicine 354: 44-53
• 4 Sparing R, Spitzer C, Häfner H et al. Fulminante Mycoplasma pneumoniae-assoziierte Meningoenzephalitis des Erwachsenen. Aggressive Therapie ermöglicht gutes Outcome. Nervenarzt 2004; 75: 1016-1021
• 5 Abramovitz P, Schvartzman P, Harel D et al. Direct invasion of the central nervous system by Mycoplasma pneumoniae: a report of two cases. The Journal of Infectious Diseases 1987; 155: 482-487
• 6 Stamm B, Moschopulos M, Hungerbuehler H et al. Neuroinvasion by Mycoplasma pneumoniae in acute disseminated encephalomyelitis. Emerg Infect Dis 2008; 14 (04) 641-643
• 7 Christie L, Honarmand S, Talkington D et al. Pediatric Encephalitis: What Is the Role of Mycoplasma pneumoniae?. Pediatrics 2007; 120: 305
• 8 Saito Y, Kure-Kageyama H, Saito-Sakurai Y et al. Late-onset, unusual neurological symptoms in children with mycoplasma infection. Pediatr Int 2009; 51 (04) 579-582
• 9 Gorman MP, Rincon SP, Pierce VM. Case records of the Massachusetts General Hospital. Case 19-2014. A 19-year-old woman with headache, fever, stiff neck, and mental-status changes. N Eng J Med 2014; 25: 2427-2438
• 10 Lanczik O, Lecei O, Schwarz S et al. Atypische Enzephalitis eines 20-jährigen Wehrpflichtigen. Nervenarzt 2004; 75: 145-148
• 11 Witmer CM, Steenhoff AP, Shah SS et al. Mycoplasma pneumoniae, Splenic Infarct, and Transient Antiphospholipid Antibodies: A New Association?. Pediatrics 2007; 119: e292-e295
• 12 Francis DA, Brown A, Miller AH et al. MRI appearances of the CNS manifestations of Mycoplasma pneumoniae: a report of two cases. J Neurol 1988; 235: 441-443
• 13 Hasselbring BM, Jordan JL, Krause RW et al. Terminal organelle development in the cell wall-less bacterium Mycoplasma pneumoniae. Proceedings of the National Academy of Sciences 2006; 103: 16478-16483
• 14 Bebear C, Pereyre S, Peuchant O. Mycoplasma pneumoniae: susceptibility and resistance to antibiotics. Future Microbiology 2011; 6: 423-431
• 15 Daxboeck F, Blacky A, Seidl R et al. Diagnosis, Treatment, and Prognosis of Mycoplasma pneumoniae Childhood Encephalitis: Systematic Review of 58 Cases. Journal of Child Neurology 2004; 19: 865-871
• 16 Adamo MA, Deshaies EM. Emergency decompressive craniectomy for fulminating infectious encephalitis. Report of two cases. Journal of Neurosurgery 2008; 108: 174-176
• 17 Riedel K, Kempf VA, Bechtold A et al. Acute disseminated encephalomyelitis (ADEM) due to Mycoplasma pneumoniae infection in an adolescent. Infection 2001; 29: 240-242
• 18 Yiş U, Kurul SH, Cakmakçi H et al. Mycoplasma pneumoniae: nervous system complications in childhood and review of the literature. Eur J Pediatr 2008; 167: 973-978
• 19 Mishra MK, Basu A. Minocycline neuroprotects, reduces microglial activation, inhibits caspase 3 induction, and viral replication following Japanese encephalitis. J Neurochem 2008; 105: 1582-1595