title: Fatal outcomes in family transmission of Mycoplasma pneumoniae.
abstract: BACKGROUND
  Mycoplasma pneumoniae continues to be a significant cause of community-acquired pneumonia and, on rare occasions, manifests as fulminant disease that leads to mortality, even in healthy individuals.
  
  
  METHODS
  We conducted a retrospective study on members of a family who were quarantined by the Centers for Disease Control and Prevention in 2002 for respiratory failure and death of a 15-year-old brother (sibling 1) and a 13-year-old sister (sibling 2). Collected airway, cerebrospinal fluid (CSF), and serum samples from both deceased siblings and serum samples from both parents and the remaining 3 ill siblings (sibling 3-5) were tested using a range of diagnostic assays. Autopsy lung tissue samples from sibling 2 were also assessed using immunohistochemical and immunoelectron microscopic methods.
  
  
  RESULTS
  Autopsy evaluation of sibling 1 revealed cerebral edema consistent with hypoxic ischemic encepatholopathy and pulmonary findings of bronchiolitis obliterans with organizing pneumonia (BOOP). Postmortem lung examination of sibling 2 revealed lymphoplasmacytic bronchiolitis with intraluminal purulent exudate, BOOP, and pulmonary edema. Results of diagnostic assays implicated the household transmission of M. pneumoniae among all 5 siblings and both parents. Further analysis of lung tissue from sibling 2 demonstrated the presence of M. pneumoniae organisms and community-acquired respiratory distress syndrome toxin. M. pneumoniae was cultured directly from sibling 2 autopsy lung tissue.
  
  
  CONCLUSIONS
  Evidence is provided that M. pneumoniae was readily transmitted to all members of the household and that the resulting infections led to a spectrum of individual responses with variation in disease progression, including lymphoplasmacytic bronchiolitis, BOOP, and death.
authors: Department of Microbiology and Immunology, The University of Texas Health Science Center at San Antonio, TX 78229-3900, USA.
authors: T R
authors: TR
authors: Kannan
authors: R D
authors: RD
authors: Hardy
authors: J J
authors: JJ
authors: Coalson
authors: D C
authors: DC
authors: Cavuoti
authors: J D
authors: JD
authors: Siegel
authors: M
authors: M
authors: Cagle
authors: O
authors: O
authors: Musatovova
authors: C
authors: C
authors: Herrera
authors: J B
authors: JB
authors: Baseman
mesh_terms: D000293:Adolescent; D002648:Child; D005190:Family; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification*; D011019:Pneumonia, Mycoplasma / Q000097:blood / Q000134:cerebrospinal fluid / Q000635:transmission*; D011790:Quarantine; D012189:Retrospective Studies; D013781:Texas