Clinical features, risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia: a review of the Japanese literature.
Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children and young adults. Although MP sometimes causes self-limiting pneumonia, severe and fulminant cases with hypoxia occur, but their clinical features have rarely been reported. This study aimed to reveal the clinical manifestations, risk factors, and treatment of fulminant MP pneumonia (MPP). Using PubMed and abstracts from the proceedings of several domestic Japanese academic societies, we reviewed the Japanese and English literature for cases of fulminant or severe MPP reported in Japan. All clinical information such as sex, age, underlying diseases, clinical symptoms, clinical course, laboratory and radiological findings, and treatment was collected and analyzed. In total, 52 fulminant MPP cases were reported between September, 1979 and February, 2010. The dominant population of fulminant MPP was young adults without severe underlying diseases. Cough (97.3%), fever (100.0%), and dyspnea (83.3%) with diffuse abnormal findings in radiological examinations were noted. Antibiotics without anti-mycoplasmal activity were used in 32 cases (61.5%) as initial treatment prior to the onset of hypoxia. Anti-mycoplasmal drugs were appropriately used in 41 cases (78.8%) after onset of respiratory failure with steroids (23 cases, 45.1%) and effective. The majority of patients improved within 3-5 days after steroid administration. There were only 2 fatal cases. Although this small retrospective study did not reveal the apparent risk factors of fulminant MPP, initial inappropriate use of antibiotics may be a risk factor, and early administration of appropriate anti-mycoplasmal drugs with steroids as a cellular immune suppressor is required.
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Nagasaki University Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan. Electronic address: koizumik@nagasaki-u.ac.jp.
Koichi
K
Izumikawa
Department of Internal Medicine, Izumikawa Hospital, Nagasaki, Japan.
Kinichi
K
Izumikawa
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Takahiro
T
Takazono
Nagasaki University Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan.
Kosuke
K
Kosai
Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Yoshitomo
Y
Morinaga
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Shigeki
S
Nakamura
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Nagasaki University Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan.
Shintaro
S
Kurihara
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Yoshifumi
Y
Imamura
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Taiga
T
Miyazaki
Nagasaki University Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan.
Misuzu
M
Tsukamoto
Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Katsunori
K
Yanagihara
Nagasaki University Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan.
Kohei
K
Hara
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Shigeru
S
Kohno
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009177:Mycoplasma pneumoniae; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids
Fulminant pneumonia; Mycoplasma pneumoniae; Steroids