Psychiatric Manifestations Caused by Mycoplasma pneumoniae Encephalitis Mimicking Autoimmune Encephalitis

Abstract

A significant etiological factor for upper respiratory tract infections and community-acquired pneumonia is Mycoplasma pneumoniae. The incidence of extrapulmonary neurological problems in infected patients has been shown to range from 0.1 to 7%, often manifesting within a timeframe of 2 to 14 days following the onset of respiratory symptoms. Acute disseminated encephalomyelitis, Guillain–Barré syndrome, and transverse myelitis are among the immune-mediated illnesses encompassed under the syndrome. A 3-year-old male child exhibited symptoms of acute encephalopathy and behavioral disruption subsequent to an infection caused by M. pneumoniae. He presented with irritability, sleep disturbance, slurred speech, increased appetite, episodes of unresponsiveness, moving in circles, staring, and laughing episodes lasting for up to 15 to 30 minutes over a week. He lost his previous toilet training. Abnormal jerks were noted while awake and asleep. Symptoms were preceded by exposure to vague febrile illness 3 weeks prior to presentation. The patient's brain magnetic resonance imaging was normal. Electroencephalography showed a slow background with no epileptiform discharges. Cerebrospinal fluid analysis and polymerase chain reaction for viruses were negative. The workup for autoimmune encephalitis was negative. Mycoplasma serology IgM was detected. Marked improvement was noted after methylprednisolone pulse therapy, intravenous immunoglobulin, valproic acid, and azithromycin. In conclusion, our report serves as a reminder that M. pneumoniae infection is a possible cause of encephalopathy and behavioral disturbance in children. Early recognition and promotion of immunomodulatory and antimicrobial treatment can prevent the affected child from experiencing different levels of long-lasting impairments in cognitive, physical, or visual abilities.

Keywords

Mycoplasma pneumoniae - encephalopathy - behavioral changes - children

Ethics Approval and Consent to Participate

Written informed consent for publishing clinical details and images was obtained from the patient. Ethical approval to report this case was not required.

Publication History

Received: 05 March 2024

Accepted: 02 July 2024

Article published online:
22 July 2024

• References

• 1 Sánchez-Vargas FM, Gómez-Duarte OG. Mycoplasma pneumoniae-an emerging extra-pulmonary pathogen. Clin Microbiol Infect 2008; 14 (02) 105-117
• 2 Guleria R, Nisar N, Chawla TC, Biswas NR. Mycoplasma pneumoniae and central nervous system complications: a review. J Lab Clin Med 2005; 146 (02) 55-63
• 3 Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005; 51 (05) 343-354
• 4 Candler PM, Dale RC. Three cases of central nervous system complications associated with Mycoplasma pneumoniae . Pediatr Neurol 2004; 31 (02) 133-138
• 5 Bitnun A, Ford-Jones E, Blaser S, Richardson S. Mycoplasma pneumoniae encephalitis. Semin Pediatr Infect Dis 2003; 14 (02) 96-107
• 6 Kolski H, Ford-Jones EL, Richardson S. et al. Etiology of acute childhood encephalitis at The Hospital for Sick Children, Toronto, 1994-1995. Clin Infect Dis 1998; 26 (02) 398-409
• 7 Thompson C, Kneen R, Riordan A, Kelly D, Pollard AJ. Encephalitis in children. Arch Dis Child 2012; 97 (02) 150-161
• 8 Lim YXJ, Kwek SY, How CH, Chan WSD. A clinical approach to encephalopathy in children. Singapore Med J 2020; 61 (12) 626-632
• 9 Willoughby RE. Encephalitis, meningoencephalitis, and postinfectious encephalomyelitis. In: Long SS, Pickering LK, Prober CG. eds. Principles and Practice of Pediatric Infectious Diseases. Philadelphia: Elsevier Science; 2003: 291-292
• 10 Piras C, Pintus R, Pruna D, Dessì A, Atzori L, Fanos V. Pediatric acute-onset neuropsychiatric syndrome and Mycoplasma pneumoniae infection: a case report analysis with a metabolomics approach. Curr Pediatr Rev 2020; 16 (03) 183-193
• 11 Al-Zaidy SA, MacGregor D, Mahant S, Richardson SE, Bitnun A. Neurological complications of PCR-proven M. pneumoniae infections in children: prodromal illness duration may reflect pathogenetic mechanism. Clin Infect Dis 2015; 61 (07) 1092-1098
• 12 D'Alonzo R, Mencaroni E, Di Genova L, Laino D, Principi N, Esposito S. pathogenesis and treatment of neurologic diseases associated with Mycoplasma pneumoniae infection. Front Microbiol 2018; 9: 2751
• 13 Ruuskanen O, Nohynek H, Ziegler T. et al. Pneumonia in childhood: etiology and response to antimicrobial therapy. Eur J Clin Microbiol Infect Dis 1992; 11 (03) 217-223
• 14 Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004; 17 (04) 697-728
• 15 Christie LJ, Honarmand S, Talkington DF. et al. Pediatric encephalitis: what is the role of Mycoplasma pneumoniae?. Pediatrics 2007; 120 (02) 305-313
• 16 Ramsey BW, Marcuse EK, Foy HM. et al. Use of bacterial antigen detection in the diagnosis of pediatric lower respiratory tract infections. Pediatrics 1986; 78 (01) 1-9
• 17 Parrott GL, Kinjo T, Fujita J. A compendium for Mycoplasma pneumoniae . Front Microbiol 2016; 7: 513
• 18 Fan G, Guo Y, Tang F, Chen M, Liao S, Wang J. Determining the clinical characteristics, treatment strategies, and prognostic factors for Mycoplasma pneumoniae encephalitis in children: a multicenter study in China. J Clin Neurol 2023; 19 (04) 402-409
• 19 Pereyre S, Goret J, Bébéar C. Mycoplasma pneumoniae: current knowledge on macrolide resistance and treatment. Front Microbiol 2016; 7: 974
• 20 Daba M, Kang PB, Sladky J, Bidari SS, Lawrence RM, Ghosh S. Intravenous immunoglobulin as a therapeutic option for Mycoplasma pneumoniae encephalitis. J Child Neurol 2019; 34 (11) 687-691