Cases reported "Pneumonia, Mycoplasma"

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1/8. A 7-year-old boy with mycoplasmal infection requiring extracorporeal membrane oxygenation.

    A 7-year-old boy with down syndrome developed severe acute respiratory distress syndrome after a respiratory infection with mycoplasma pneumoniae with an unusually high agglutination titre (1:10240). Initially, mechanical ventilation and nitric oxide inhalation were used, but these did not improve the alveolar-arterial oxygen gradient. extracorporeal membrane oxygenation for 152 h improved the lung condition. CONCLUSION: our case suggests that mycoplasma pneumoniae should be considered as an aetiological agent in acute respiratory distress syndrome. extracorporeal membrane oxygenation might have a valuable role in the management.
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2/8. Acute severe spinal cord dysfunction in a child with meningitis: streptococcus pneumoniae and mycoplasma pneumoniae co-infection.

    Tetraplegia developed abruptly in an 11-y-old with pneumococcal meningitis. magnetic resonance imaging showed multiple hyperintensities at the brainstem-spinal cord junction. Serological tests were positive for mycoplasma pneumoniae (microparticle agglutination and specific IgMs). erythromycin and dexamethasone were started promptly, and 10 d later the patient was discharged with normal neurological function. CONCLUSION: Tetraplegia during the course of pneumococcal meningitis in an 11-y-old girl disappeared after treatment with ceftriaxone, erythromycin and dexamethasone.
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3/8. Cold haemagglutinin disease complicating mycoplasma pneumoniae infection in a child under cytotoxic cancer treatment.

    Acute cold haemagglutinin disease, most commonly associated with underlying mycoplasma infection, is rare in children. A 3-year-old girl who developed this auto-immune disease under intensive cytotoxic treatment for rhabdomyosarcoma is presented. Clinically, a livedo reticularis skin pattern upon exposure to cold which was reversible at room temperature and a spontaneous red cell agglutination of blood samples in vitro led to the diagnosis. Together with bronchopneumonia the girl developed hyper-IgM, high antibody titres against mycoplasma pneumoniae, as well as high titres of cold agglutinins. Laboratory signs of mild intravascular haemolysis were found. Positive direct antiglobulin test resulted from coating of red cells with C3d and C4. Three different antibodies were identified in serum: nonspecific cold agglutinins without complement activation, anti-I specific cold agglutinins with complement activation, as well as a weak biphasic Donath-Landsteiner haemolysin. Under antibiotic treatment and a short course of predisolone the clinical course was mild.
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4/8. Autoimmune hemolytic anemia. 3. Cold antibody type.

    In cold autoimmune hemolytic anemia, the causative autoantibodies (cold agglutinins) are most reactive at low temperatures. The anti-I type of cold agglutinin is found in cold hemagglutination disease and in hemolytic anemia secondary to malignant lymphoma, leukemia, or atypical pneumonia. The anti-I type of cold agglutinin is found in many patients with infectious mononucleosis and in an occasional patient with other lymphoproliferative disorders. Paroxysmal cold hemoglobinuria, a disorder in which exposure to cold temperatures triggers massive hemolysis, is characterized by a unique biphasic cold autoantibody called the Donath-Landsteiner antibody. By way of summary and review of this and the two previous articles in this series, table 4 presents a practical approach to diagnosis of the autoimmune hemolytic anemias.
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5/8. Sporadic legionnaires' disease: clinical observations on 87 nosocomial and community-acquired cases.

    To add information about sporadic legionnaires' disease, 87 cases of L. pneumophila pneumonia were reviewed. Twenty cases were nosocomial infections and 67 cases were community-acquired. Most cases (64%) occurred between July and October. The mean age of patients was 51.4 years and males outnumbered females 2.5:1.0. Thirty-one percent of patients were receiving corticosteroid, immunosuppressive, or antineoplastic chemotherapy when illness began. immunosuppression at onset of illness was more common in nosocomial infections (90%) than in community-acquired infections (14%). Seventy percent of patients had underlying diseases. Malignancies, renal failure, and transplantation were the most common conditions underlying nosocomial infections. Chronic lung disease and malignancies were the most common diseases underlying community-acquired infections. The case-fatality rate in nosocomial infection (70%) was greater than that in community-acquired disease (22%). Clinical, laboratory, and radiologic features of the cases were examined. Illness ranged from mild to severe. Extrapulmonary findings of encephalopathy and renal failure were more common in fatal than in non-fatal cases. Indirect immunofluorescent and microagglutination antibody responses plateaued by the fourth week of illness. Twenty-nine patients died. The case-fatality rate of patients receiving erythromycin (6%) was less than that of patients receiving penicillin (36%), ampicillin (28%), cephalosporin (32%), or aminoglycosides (41%). Despite erythromycin therapy, the case fatality rate for nosocomial L. pneumophilia pneumonia was unacceptably high (25%).
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6/8. mycoplasma pneumoniae pneumonia associated with IgA nephropathy.

    An 18-yr-old male developed mycoplasma pneumoniae pneumonia associated with IgA nephropathy. In the biopsied renal tissue, immunofluorescence showed striking deposits of IgA, C3 and C3 activator in the mesangium, and electron microscopic examination showed electron-dense deposits in the mesangial region. When the patient's serum was preincubated with rabbit antiserum to human IgA, the passive hemagglutination titer for M. pneumoniae was much decreased. We suggest that in some cases, IgA nephropathy may follow infection by an organism which stimulates in IgA antibody response, leading to the formation of IgA antigen antibody immune complex deposits in the glomerular mesangium.
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7/8. Serological diagnosis of mycoplasma pneumoniae infections: a critical review of current procedures.

    Respiratory diseases due to mycoplasma pneumoniae are still confirmed with serological methods, although during the acute phase of M. pneumoniae disease indicative parameters are frequently negative. This result is true not only for serodiagnosis based on tests for the presence of cold hemagglutinin (the first but unspecific acute-phase parameter; these are positive in only about 50% of cases) but also for serodiagnosis based on CF tests, particle agglutination tests, or even enzyme-linked immunoassays that test for "early" IgM antibodies. Whereas the sensitivity of the different tests is difficult to improve, advances in specificity were obtained with use of more defined protein antigen preparations of M. pneumoniae cells. Even more problematic than negative titers in the first serum samples and delayed positive titers in the convalescent-phase sera are false-negative results with sera from immunocompromised patients, which limit the value of serological approaches for diagnosis of M. pneumoniae infections in particular risk groups. This review summarizes the use and the limitations of various serological approaches but also refers to alternative methods that are suitable for diagnosis of acute-phase M. pneumoniae disease or cases in which seroconversion has not occurred.
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8/8. Hopkins syndrome associated with Mycoplasma infection.

    A 3-year-old boy who presented with flaccid weakness of the right lower limb 1 week after treatment for an acute attack of asthma is described. sensation was normal. electromyography suggested anterior horn cell damage and persisting weakness. These features suggested a diagnosis of Hopkins syndrome. Complement fixation test titer and agglutination test titer to mycoplasma pneumoniae were significantly increased, suggesting a previously unreported association with this syndrome. We review possible infectious agents detected in previous reports.
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