title: Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications.
abstract: Mycoplasma pneumoniae (Mp) is a leading cause of community acquired pneumonia. Knowledge regarding Mp pneumonia obtained from animal models or human subjects has been discussed in many different reports. Accumulated expertise concerning this critical issue has been hard to apply clinically, and potential problems may remain undiscovered. Therefore, our multidisciplinary team extensively reviewed the literature regarding Mp pneumonia, and compared findings from animal models with those from human subjects. In human beings, the characteristic pathological features of Mp pneumonia have been reported as alveolar infiltration with neutrophils and lymphocytes and lymphocyte/plasma cell infiltrates in the peri-bronchovascular area. Herein, we demonstrated the novel aspects of Mp pneumonia that the severity of the Mp pneumonia seemed to depend on the host innate immunity to the Mp, which might be accelerated by antecedent Mp exposure (re-exposure or latent respiratory infection) through up-regulation of Toll-like receptor 2 expression on bronchial epithelial cells and alveolar macrophages. The macrolides therapy might be beneficial for the patients with macrolide-resistant Mp pneumonia via not bacteriological but immunomodulative effects. This exhaustive review focuses on pathogenesis and extends to some therapeutic implications such as clarithromycin, and discusses the various diverse aspects of Mp pneumonia. It is our hope that this might lead to new insights into this common respiratory disease.
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saraya
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kurai
authors.affiliation: Department of Virology and Immunology, College of Veterinary Medicine, Nippon Veterinary and Animal Science University Mitaka, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Nakagaki
authors.affiliation: Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Sasaki
authors.affiliation: Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Niwa
authors.affiliation: Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsukagoshi
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nunokawa
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Ohkuma
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tsujimoto
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Hirao
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Bioscience Medical Research Center, Niigata University Medical and Dental Hospital Niigata, Japan.
authors.forename: Koh
authors.initials: K
authors.lastname: Nakata
authors.affiliation: Infectious Disease Surveillance Center, National Institute of Infectious Diseases Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan.
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Kozawa
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Takizawa
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Goto
keywords: Mycoplasma pneumoniae pneumonia; animal models; epidemiology; pathogenesis; pathology