Mycoplasma pneumoniae % loop-mediated isothermal amplification LAMP DNA

Transcription

1 ,2 1, MERS Bickerstaff MERS 1 1 loop-mediated isothermal amplification DNA Mycoplasma pneumoniae % tmzn1005@ksh.biglobe.ne.jp PA loop-mediated isothermal amplification LAMP DNA 24 5/ l 5/ l

2 MERS MERS ADEM Bickerstaff / 2 8/8 7/ /8 GCS 13 GCS 14 GCS 9 GCS 14 JCS 100 GCS 14 8/8 PA 2, , /10,240 3/4 5, /5,120 17/4 LAMP 3/4 X 5/8 5,120 8/8 / l mg/dl DNA LAMP 0/4 GluR- IgM/IgG Gal-C IgG GQ1b 6/8 MRI DWI T2/FLAIR T2 4/ /8 IVIG 3/8 CAM AZM AZM MINO CAM MINO 3/8 AZM CAM MINO MINO AZM CLDM MINO 6/8 2/8 MERS clinically mild encephalitis/encephalopathy with a reversible splenial lesion ADEM acute demyelinating encephalomyelitis PA particle agglutination LAMP loop-mediated isothermal amplification GCS Glasgow coma scale JCS Japan coma scale GluR glutamate receptor Gal-C galactocerebroside FLAIR fluid attenuated inversion recovery IVIG intravenous immunoglobulin CAM clarithromycin AZM azithromycin MINO minocycline 51

3 a b a b 1 1 MRI a b ADC PA 320 LAMP DNA X / l 1-854/ l mg/dl mg/dl DNA 4 LAMP 6 MRI MERS 2 3 ADEM 1 Bickerstaff MERS / l methylprednisolone mpsl X PA 2,560 LAMP DNA MRI 1 MERS mpsl MRI 9 a T2 b FLAIR azithromycin AZM 1 34/ l X PA 2,560 9 MRI T2 FLAIR 2 mpsl 1 16 mpsl X PA 320 AZM minocycline 3 LAMP DNA PA 10, / l MRI mpsl WISC- IQ Cell-based assay NMDA LGI1 Caspr2 AMPAR1 AMPAR2 GABAB 52

4 % % Daxboeck Daxboeck DNA MERS 2 1 DNA ADEM Bickerstaff % X , DNA DNA LAMP DNA Daxboeck 9% 34% 4 CT MRI 53% MERS ADEM

5 LAMP Guleria R, Nisar N, Chawla TC, Biswas NR. Mycoplasma pneumoniae and central system complications a review. J Lab Clin Med Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplama peumoniae infections. J Infect Daxboeck F, Blacky A, Seidl R, Krause R, Assadian O. Diagnosis, treatment, and prognosis of Mycoplasma pneumonia chilhood encephalitis systematic review of 58 cases. J Child Neurol Al-Zaidy SA, MacGregor D, Mahant S, Richardson SE, Bitnun A. Neurological complications of PCR-proven M. pneumoniae infections on children prodromal illness duraiton may reflect pathogenetic mechanism. Clin Infect Dis Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections summary of cases at the University of Helsinki and review. Clin Infect Dis suppl 1 S Bitnun A, Ford-Jones EL, Petiric M, et al. Acute childhood encephalitis and Mycoplasma pneumoniae. Clin Infect Dis Narita M, Itakura O, Matsuzono Y, Togashi T. Analysis of mycoplasmal central nervous system involvement by polymerase chain reaction. Pediatr Infect Dis J Narita M. Pathogenesis of neurologic manifestations of Mycoplasma pneumoniae infection. Pediatr Neurol Christie LJ, Honarmand S, Talkington DF, et al. Pediatric encephalisis what is the role of Mycoplasma pneumoniae? Pediatrics Carpenter TC. Corticosteroids in the treatment of severe mycoplasma encephalitis in children. Crit Care Med Candler PM, Dale RC. Three cases of central nervous system complications associated with Mycoplasma pneumoniae. Pediatr Neurol Lehtokoski-Lehtiniemi E, Koskiniemi ML. Mycoplasma pneumoniae encephalitis a severe entity in children. Pediatr Infect Dis J Chambert-Loir C, Ouachee M, Collins K, Evrard P, Servais L. Immediate relief of Mycoplasma pneumoniae encephalitis symptoms after intravenous immunoglobulin. Pediatr Neurol Sakoulas G. Brainstem and striatal encephalitis complicating Mycoplasma pneumoniae pneumonia possible benefit of intravenous immunoglobulin. Pediatr Infect Dis J Clinical features of eight pediatric patients with Mycoplasma pneumoniae-associated encephalitis/encephalopathy Toru Kanamori, Tomoko Mizuno, Masayuki Nagasawa, Saori Amano, Miho Ashiarai, Mari Okada, Keiko Onda, Masako Imai, Natsuko Suzuki, Akihiro Oshiba Department of Pediatrics, Musashino Red Cross Hospital, Tokyo TK, TM, MN, SA, MA, MO, KO, MI, NS, AO Department of Pediatrics, Tokyo Medical and Dental University, Tokyo TK, TM Objective We examined the clinical features of pediatric patients with Mycoplasma pneumoniae-associated encephalitis/encephalopathy. Methods We retrospectively evaluated 0-15-year-old patients hospitalized for M. pneumoniae-associated encephalitis/encephalopathy to our hospital or to an affiliated hospital between 2010 and Results There were six males and two females aged 2-14 years. They were categorized into two groups early-onset type nin which neurological sympoms developed within 3 days of fever or cough onset and late-onset type n 6 in which neurological symptoms developed 10 days after their onset. The early-onset group included two patients with mild encephalitis with a reversible splenial lesion MERS. The late-onset group included three patients with autoimmune limbic encephalitis, one with acute disseminated encephalomyelitis, one with Bickerstaff s brainstem encephalitis, and one with unclassified encephalopathy. Although these six patients completely recovered without sequela, dysarthria persisted in one patient with MERS and cerebellar lesions. Mild intellectual impairment persisted in one patient with limbic encephalitis. Conclusion As prodromal respiratory symptoms were not outstanding in some studied patients, M. pneumoniae infection should be considered in patients with encephalitis/encephalopathy of unknown etiology. Although there are few clinical reports from Japan, further clinical investigations are expected given the recent development of sensitive diagnostic procedures such as loop-mediated isothermal amplification assay. No To Hattatsu 2018;50: