title: [Unusual presentation of a severe Mycoplasma pneumoniae infection: report of 2 cases].
abstract: Mycoplasma pneumonia is responsible for multisystemic infection. Pulmonary symptoms are most common in children. We describe herein two unusual severe forms of M. pneumoniae infection without initial pulmonary symptoms. The first case is an 8-month-old boy who was hospitalized in the pediatric intensive care unit with severe sepsis. There were no initial pulmonary symptoms, nor obvious clinical infection. Initial blood tests and x-ray did not aid the diagnosis. The blood tests came back positive for M. pneumonia. Pulmonary symptoms eventually appeared 24h later, and there was a pneumonia outbreak on the chest radiograph. The boy was given josamycin and improved quickly. The second case concerns an 8-year-old child who was hospitalized in the pediatric intensive care unit with toxic shock. No clinical infectious origin was found. A broad-spectrum antibiotic therapy was started with ceftriaxone and josamycin. The M. pneumoniae blood test came back positive, which confirmed the diagnosis of septic shock in M. pneumoniae, requiring adjustment of the antibiotic therapy. Current guidelines for the choice of probabilistic antibiotic therapy in case of severe sepsis do not include the case of M. pneumoniae. The early initiation of antibiotic therapy plays a major role in the prognosis of these patients. It seems useful to search for M. pneumoniae in cases of severe atypical infections, particularly in the absence of pulmonary symptoms.
authors: Clinique universitaire de pédiatrie du CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France; Service de réanimation pédiatrique et de surveillance continue pédiatrique du CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France. Electronic address: julienprunier2@gmail.com.
authors: J
authors: J
authors: Prunier-Duparge
authors: A
authors: A
authors: Desrumaux
authors: T
authors: T
authors: Debillon
authors: C
authors: C
authors: Bost-Bru
authors: C
authors: C
authors: Jannel
authors: A
authors: A
authors: Gayot
authors: I
authors: I
authors: Wroblewski
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D004890:Erythema / Q000382:microbiology; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D007223:Infant; D015570:Josamycin / Q000627:therapeutic use; D008297:Male; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis* / Q000188:drug therapy; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology*; D012720:Severity of Illness Index; D013610:Tachycardia / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D020097:Natriuretic Peptide, Brain; D002443:Ceftriaxone; D015570:Josamycin