Hastanede Yatan Çocuklarda Mikoplazma pnömoni Enfeksiyonunun Nörolojik Belirtileri: Tek Merkezli Bir Deneyim

Öz

Amaç: Mikoplazma pnömoni, çocukluk çağında üst ve alt solunum yolu enfeksiyonlarının başlıca nedenlerinden biridir. Nörolojik hastalıklar en sık görülen ekstrapulmoner belirtiler arasındadır. Bu çalışma, M. pnömoni ile ilişkili nörolojik semptomları olan hastaların tedavi özellikleri, klinik ve radyolojik seyri ile ilgili merkezimizin deneyimlerini mevcut kanıtlar ışığında paylaşmayı amaçlamıştır.

Gereç ve Yöntemler: Hastanede yatan ve primer M. Pnömoni serolojisi pozitif çıkan pediatrik hastalar dahil edilmiştir. M. Pnömoni serolojisi akut dönemde serumda ve mümkünse konvalesan serumda M. Pnömoni spesifik IgM ve immünglobulin G (IgG) enzim immün assay yöntemi kullanılarak bakıldı. Akut dönemde ve hastalık başladıktan 7 gün-4 hafta sonra, konvalesan dönemde alınan serumlarda IgG titresinde dört kat ve üzeri artış M. Pnömoni enfeksiyonu için tanısal kabul edildi. SSS tutulumu olan hastalar demografik, klinik, labarotuvar ve görüntüleme sonuçları eşliğinde değerlendirildi.

Bulgular: Çeşitli nedenlerle Ocak 2019- Aralık 2020 tarihleri arasında hastanemizde yatan 52 hasta primer M. Pnömoni enfeksiyonu doğrulanmıştı. Mikoplazma pnömoni enfeksiyonu doğrulan 52 hastanın 13’ünde (%25) nörolojik semptom ve bulgular olduğu tespit edildi. Klinik, laboratuar ve görüntüleme sonuçları ile birlikte değerlendirildiğinde; 6 olgu (%46) Akut serebellar ataksi, 4 olgu (%30) ensefalit, bir olgu Guillain barre sendromu (GBS), bir olgu optik nörit bir olgu da Longitudinal ekstensif transvers miyelit (LETM) tanısı almıştı.

Sonuç: Mikoplazma pnömoni başlıca solunum yolu patojeni olarak bilinmesine rağmen çeşitli nörolojik rahatsızlıklara da neden olur. Nörolojik tutulumun erken tanı ve tedavisine yönelik en uygun yöntemlerin değerlendirilmesi için hastalığın uzun dönemli yükünü de göz önünde bulundurarak daha ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Mikoplazma pnömonisi
• nörolojik belirti ve semptomlar
• çocukluk çağı

Neurological Manifestations of Mycoplasma pneumoniae Infection in Hospitalized Children: A Single-Center Experience

Öz

Objective: Mycoplasma pneumoniae is one of the major causes of upper and lower respiratory tract infection in childhood. Neurological diseases are among the most common extrapulmonary manifestations.This study aimed to share our center’s experience regarding the treatment characteristics and clinical and radiological course of patients with M. pneumoniae-related neurological symptoms in light of the available evidence.

Material and Methods: The study included in hospitalized patients with positive primary M. pneumoniae serology M. pneumoniae serology was examined in serum from the acute period and, if possible, convalescent serum (1-4 weeks after disease onset) using M. pneumoniae-specific immunoglobulin M (IgM) and IgG enzyme-linked immunoassay. A 4-fold or greater increase in IgG titer between acute and convalescent serum samples was considered diagnostic for M. pneumoniae infection. The clinical, laboratory, and imaging results and demographic data of patients with CNS involvement were evaluated.

Results: Review of the patients’ charts showed that 13 (25%) of the 52 patients with confirmed M. pneumoniae infection had neurological symptoms and findings. When evaluated together with clinical, laboratory, and imaging results, 6 patients were diagnosed with acute cerebellar ataxia, 4 patients with encephalitis, and 1 patient each with GBS, optic neuritis, and longitudinally extensive transverse myelitis.

Conclusion: Although M. pneumoniae is known as mainly a respiratory pathogen, it also causes various neurological disorders. Although all of our patients had symptoms of respiratory tract infection, it has been shown that that M. pneumoniae can also cause neurological disease without respiratory symptoms. Further studies are needed to evaluate the most appropriate methods for early diagnosis and treatment of neurological involvement, considering the long-term burden of the disease.

Anahtar Kelimeler

• Mycoplasma pneumonia
• neurological signs and symptoms
• childhood

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