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Background: Atypical Steven-Johnson syndrome is a rare disease that can be caused by Mycoplasma pneumoniae; it is characterized by respiratory symptoms, mucosal lesions of variable severity and constitutional symptoms, in the absence of cutaneous involvement., Case Report: We present the case of a 35-old-man who developed mucositis in the conjunctiva, oral cavity and genitalia after the onset of respiratory symptoms. Mycoplasma pneumoniae infection was confirmed, and treatment with antibiotic and steroids was therefore started, whereby clinical manifestations subsided., Conclusions: Mycoplasma pneumoniae-induced atypical Steven-Johnson syndrome diagnosis can be challenging. The differential diagnosis of fever and oral, genital and conjunctival mucositis associated with respiratory symptoms should include infection with this bacteria in order to provide accurate and timely treatment.

Introduction: Mycoplasma pneumoniae may be involved in refractory asthma exacerbation., Objective: To determine the prevalence of Mycoplasma pneumoniae infection in patients with acute asthma exacerbation. Material and method. A prospective, crosssectional, observational, case-control study was carried out in patients older than 2 years old and younger than 12. Immunoglobulin M (IgM) antibodies were serologically determined for M. pneumoniae, using the NovaLisa® NovaTec kit for enzyme-linked immunosorbent assay (ELISA). Test results ≥ 11 NTU (NovaTec units) were regarded as positive. The statistical analysis was performed by means of the analysis of variance (ANOVA) and the χ² test, with a significance level of p < 0.05., Results: One hundred and eighty children were studied, of which 130 had asthma and 50 comprised the control group. Specific IgM was positive for 60 patients, that is 46.15% of the asthmatic children (p < 0.001). The severity of the exacerbation was directly related to IgM levels (p < 0.001). Hospitalization rate was 75%, and it was significantly associated to specific IgM levels (p < 0.001)., Conclusion: Our data suggest that children with acute asthma show a high prevalence (46%) of Mycoplasma pneumoniae infection and that there is a close relation between severe acute asthma exacerbation and the presence of Mycoplasma pneumoniae infection. These findings might result in therapeutic implications centered in the use of specific antibiotics to fight this atypical organism. Key words: acute asthma, exacerbation, Mycoplasma pneumoniae., (Sociedad Argentina de Pediatría.)

Introduction: Stevens-Johnson syndrome and toxic epidermal necrolysis are two serious immune diseases within the context of bullous mucocutaneous syndrome. These have varying degrees of involvement of the skin and usually at least two mucous membranes., Clinical Cases: Three clinical cases are presented, two of them with significant ophthalmological sequelae, who had received drug treatment as a possible trigger, and another milder clinical case caused by Mycoplasma pneumoniae., Discussion: The ophthalmologist plays a crucial role in the outcome and eye care of the patient in order to try to avoid the appearance of sequelae and subsequent loss of vision., (Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Benign acute childhood myositis (BACM) is a rare clinical condition that mainly affects pre-school and school age-children. It is usually preceded by a viral illness, particularly influenza virus infection., Objective: To describe a cluster of BACM cases that were seen in a paediatric unit., Patients and Methods: A retrospective series of cases that presented with a clinical picture suggestive of BACM between August and November 2012 in the paediatric emergency department of a private clinic., Results: Nine children, between 4 and 12 years, presented with a history of a recent febrile upper viral respiratory infection, followed by intense calf pain and claudication. They all recovered without complications. Laboratory results showed a marked increase in CK, with a mean of 4,066 IU/l. Three of the cases had influenza B infection and one Mycoplasma pneumonia infection. They were managed conservatively with hydration and non-steroidal anti-inflammatory drugs., Conclusions: BACM is a benign entity with a characteristic clinical presentation that can be managed most of the time in the ambulatory setting, avoiding invasive studies and unnecessary hospital admission.

Introduction: The gold standard for the diagnosis of pneumonia secondary to Mycoplasma pneumoniae is the serial measurement of IgM, since an isolated test for IgM has a poor sensitivity of 31.8%. A pneumonia due to Mycoplasma pneumoniae could be of clinically different origins, thus it is possible to perform a clinical score for its early diagnosis., Objective: To develop a clinical score in order to rule out a pneumoniae secondary to Mycoplasma pneumoniae., Methodology: A total of 302 patients from 0 to 18 years-old, with a diagnosis of pneumonia were evaluated and divided into two groups: Mycoplasma positive and Mycoplasma negative. Using different variables in the medical records a clinical score was calculated., Results: Of the 302 cases studied, 34 were classified as Mycoplasma positive and 268 as Mycoplasma negative. The variables relevant to the calculation of the score were age, days with fever, and days with cough, thus providing the CAF (Cough, Age, Fever) score. Ranges were assigned for each variable and points were given for each range. A value greater than or equal to 5 meant a positive score. The CAF score was applied to the 302 cases, resulting in 164 cases of Mycoplasma positive and 138 cases of Mycoplasma negative. The CAF score had a sensitivity of 85% and specificity of 49%., Conclusion: The CAF score had better sensitivity than other clinical diagnostic tools. With a negative predictive value of 96% it is possible to rule out a pneumonia secondary to M. pneumoniae. The study requires a prospective study to verify the usefulness of our score., (Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Mycoplasma infections have extrapulmonary manifestations that may be associated with respiratory symptoms and may have skin, heart, gastrointestinal, rheumatologic, neurologic, hematologic involvement. Cold agglutinin mediated autoimmune hemolytic anemia is the most common hematological manifestation. We report a 27-year-old woman infected with Mycoplasma pneumoniae, who presented respiratory involvement with pneumonia, exanthema, serositis and acute hemolytic anemia that required transfusion. The key for the diagnosis were the extrapulmonary manifestations associated with respiratory involvement after five days of hospitalization.

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis represent different manifestations of the same spectrum of severe idiosyncratic cutaneous reactions to drugs and to a lesser extent are associated with infectous agents. Among these, Mycoplasma pneumoniae is one of the most frequent. We report the case of a female patient aged 5 years, with a toxic epidermal necrolysis associated with Mycoplasma pneumoniae infection, which begins with a fever accompanied by a generalized rash with involvement of the mucous membranes. IgM serology for Mycoplasma pneumoniae was positive and initial biopsy was compatible with erythema multiforme major. The patient was treated with corticosteroids, intravenous immunoglobulin, plasmapheresis and strict care to prevent superinfection and sequels. After 31 days of hospitalization the patient was discharged from hospital.

Human metapneumovirus is a newly discovered pathogen associated with respiratory disease and occurring mainly in children. It produces an acute viral respiratory disease picture that varies from mild disease to severe, and which can require strict surveillance in intensive care units. Currently, reverse transcriptase polymerase chain reaction and cell culture are the most common methods for its diagnosis. The first six cases of human metapneumovirus in Colombia are presented from Medellín.

Introduction: Studies on Mycoplasma pneumoniae infection are scarce in Chile., Objective: To describe clinical characteristics associated with M. pneumoniae in children requiring hospitalization., Material and Methods: All children with a respiratory infection requiring hospitalizations between 2000-2005, whom had a M. pneumoniae specific IgM > or = 1:32, were analyzed., Results: Fifty children meeting study criteria were identified with an average length of hospitalization of 4 days (range: 1-10); mean age was 5.4 years (46% were younger than 5 years). Common clinical features were cough (92%), fever (82%), malaise (74%) and respiratory distress (72%). At admission 40/45 children had hypoxemia. Chest-X ray showed interstitial pattern (69.3%), consolidation (51%) and hyperinsuflation (28.5%). Six patients had pleural effusion. Eighty four percent of patients had a favorable clinical outcome; eight children required admission to the PICU all of whom recovered., Conclusion: Respiratory infections associated with M. pneumoniae in our series of children had a highly variable and non-specific clinical spectrum. Chest-X rays showed different pattern in concordance with previous publications.

Introduction: Acute cerebellitis is an uncommon complication following Mycoplasma pneumoniae infection. A benign and self-limited course has been described in the few reports found of this association., Case Reports: We report two patients with an apparently M. pneumoniae-induced acute cerebellitis that resulted in cerebellar atrophy. Patients presented with a cerebellar syndrome including ataxia, hypotonia, dysarthric speech and dysmetria, which were preceded by signs of respiratory infection. Initial brain magnetic resonance imaging (MRI) in case 1 was normal but in case 2 it displayed striking cerebellar swelling, small fourth ventricle and supratentorial ventriculomegaly which was self-limited and did not require neurosurgical intervention. Serological studies confirmed a recent M. pneumoniae infection. Case 1 has followed an unfavourable clinical course, with incomplete resolution of cerebellar dysfunction, while case 2 has remained asymptomatic. Follow-up brain MRI have demonstrated prominent cerebellar atrophy in both patients., Conclusions: M. pneumoniae infection should be considered in those patients with acute cerebellitis showing an incomplete resolution of cerebellar dysfunction or those who develop early cerebellar atrophy. The presenting MRI findings do not seem to predict final neurological outcome.

It has been suggested that a previous viral or bacterial pharyngitis may predispose to Lemierre's syndrome, an uncommon entity nowadays. A case of Lemierre's syndrome and co-infection with Mycoplasma pneumoniae is described, association published before in only 2 other cases. A 16-year-old girl with trombophlebitis of the left jugular vein, Fusobacterium necrophorum bacteremia and septic emboli in the lung requiring mechanical ventilation due to severe respiratory insufficiency. Despite early treatment with penicillin G and clindamycin, fever and part of pulmonary affectation persisted until that an antibiotic agent active against M. pneumoniae was instaurated, after its serological confirmation. The physicians should be easily recognized this disease because of its characteristic clinical findings, and co-infection with other organisms including M. pneumoniae, should be considered.

Context: Mycoplasma pneumonia has been related to several conditions. With this study we have tried to establish the condition more frequently associated and their physiopathological mechanism., Method: One-hundred and five patients admitted to Puerta de Hierro Hospital between March 1996 and July 2001, with IgM positive serology to Mycoplasma were evaluated. Thirty four cases were selected upon the basis of two criteria: patients which positivity was confirmed by seroconversion, elevation of the antibody titer, or confirmation by complement fixation were included, and patients with some intercurrent condition or with other diagnoses were ruled out., Results: 26 patients (77%) showed a respiratory infection, and 20 of them showed a pneumonia. Two types of complications were observed. The first type were the complications due to an invasion of the tissue by Mycoplasma, with 5 cases of pleuropericarditis and three cases of pleuritis; in 5 of these there was simultaneously a respiratory process. The second type were the complications mediated by an autoimmune mechanism, with two cases of reactive arthritis, one case of vasculitis with cutaneous predominance, one case of urticaria a frigore, three cases of lymphocytic meningitis, one case of disseminated encephalitis, one patient with Guillain-Barré syndrome and one case of Adie's tonic pupil. Six of these patients showed a respiratory infection on the previous days with an average delay of 10 days between the beginning of the respiratory symptomatology and the appearance of one of these diseases., Conclusions: Mycoplasma pneumoniae can give rise to disease through a mechanism of direct invasion and through autoimmunity mechanisms. The second group of complications is seen by more frequency in young women.

Opsoclonus is characterized by sudden onset of arrhythmic, multidirectional chaotic eye movements, generally associated with a parainfectious or paraneoplasic condition. Opsoclonus is a rare manifestation with no known link with infection by Mycoplasma pneumoniae. We present a case of a 23 year old male patient who presented fever, myalgia, vomiting, respiratory failure, opsoclonus and symmetric flaccid tetraparesis with important lower limb muscle atrophy. Serology and seroreversion for M. pneumoniae were both positive. This case illustrates the possibility that M. pneumoniae may produce a predominantly neurological disease and the need to include this infection in the differential diagnosis of opsoclonus, or polyradiculoneuritis.

Stevens-Johnson syndrome is characterized by generalized exanthema associated with high fever, catarrhal symptoms and mucositis. Various etiologies have been implicated, particularly numerous medications and certain agents of atypical pneumonia. Stevens-Johnson syndrome leads to death in up to 5% of cases. We describe the case of a 30-year-old woman with bilateral atypical pneumonia accompanied by severe generalized exanthema that required hospitalization in the serious burns unit of our hospital. She was diagnosed with Stevens-Johnson syndrome following atypical pneumonia caused by Mycoplasma pneumoniae with microbiological and pathological confirmation.

Case Report: We report a patient with Miller Fisher syndrome in the course of an acute pneumonia by Mycoplasma pneumoniae., Conclusion: Miller Fisher syndrome as a neurologic complication of mycoplasmal respiratory disease occurring at infection onset is very rare and has not been described previously.

Objectives: To investigate the presence Mycoplasma pneumoniae and Chlamydia pneumoniae and to determine their importance as the cause of community-acquired pneumonia in childhood., Material and Methods: We performed a retrospective descriptive study of all the patients aged less than 15 years old diagnosed with community-acquired pneumonia due to M. pneumoniae in the pediatric emergency department of our hospital between May 1998 and May 2000. Patients in whom C. pneumoniae was also identified as a cause of pneumonia were investigated., Results: Of 242 cases of community-acquired pneumonia, 82 were due to M. pneumoniae (34.7 %) and 32 were due to C. pneumoniae (13.22 %) Of these, eight cases were coinfections with C. pneumoniae and M. pneumoniae. Most infections occurred in boys (5/8). The mean age at diagnosis was 7.7 years. No seasonal predominance was found., Conclusions: Both C. pneumoniae and M. pneumoniae play a substantial role in community-acquired pneumonia in children aged more than 5 years old. Although coinfection with both species usually worsens the course of the disease, outcome in all the patients studied was satisfactory.

Clinical features and outcome of 15 children with Guillain-Barré syndrome were retrospectively analyzed. In 53% of the patients there was an infectious illness previous to the neurologic symptoms and in five children the etiologic agent was demonstrated. Motor deficit affecting limbs was the most common clinical presentation and facilal paralysis was the most frequent accompanying sign. One of these children developed the Fisher syndrome variant. The outcome was excellent except in one case. We want to remark from this serie high percentage of agents identified in the infectious process previous to Guillain-Barré syndrome and the good outcome of these patients, due to the supportive treatment in the pediatric intensive care unit where they were admitted.

Pneumonia due to Mycoplasma pneumoniae may present at any age after age five. The clinical picture varies from an acute febrile illness to a prolonged disease with affected general state and little pulmonary involvement. The radiological picture is varied but the alveolar pattern predominates, making the differential diagnosis with the bacterial pneumonias difficult. However, in the presence of an interstitial or mixed pattern, especially if generalized, pneumonia due to Mycoplasma pneumoniae must be suspected. This radiological picture is particularly frequent in elderly patients, often affected by other diseases able to induce immunodepression. In such patients the radiology and the unspecific clinical picture frequently cause diagnostic delays. The presence of a pneumonia with multisystem involvement (blood, nervous system, joints, etc.) should suggest the possibility of Mycoplasma pneumoniae infection.

"Mycoplasma pneumoniae" respiratory infection was diagnosed by completed fixation assay in 81 ages 8 months to 14 years. Seventy had pneumonia and ten had bronchitis. The "Mycoplasma pneumoniae" represented the 25% of all pneumonia of any aetiology. Seventy per cent of cases occurred during spring and summer months. Rashes developed in 13 (16%) patients (maculo-papular, 6; Stevents-Johnson, 2; purpuric-acular, 2; petechial, 1; urticarial, 1; erythema nodosa, 1). Other nonrespiratory complications were: hemolytic anemia, 2 cases; hepatitis, 5 cases; aseptic meningitis, 2 cases, and Guillain-Barré syndrome, 1 case. The white blood cell counts and ESR were normal or slightly raised in most of patients. Serum samples from 46 children were tested for cold agglutinins and positive titers were found in 19 (41%). The roentgenographic pattern of "Mycoplasma pneumoniae" was alveolar and/or mixed in 57 patients, and interstitial in the remainder. The lower lobes were more frequently involved. Twenty one per cent of patients with pneumonia had mediastinal lymphadenopathy. The outcome was favorable in all children except in one who developed irreversible pulmonary damage.

Three patients with Mycoplasma pneumoniae infection, documented by CF antibody titers greater than 128, developed severe extrapulmonary manifestations. Two of them had a Stevens-Johnson syndrome seven and two days after the beginning of respiratory symptoms and the third a demyelinating polyradicyloneuropathy three weeks later. One of the patients with Stevens-Johnson syndrome and serious respiratory involvement also had hemolytic anemia associated with a cold agglutinins titer of 128. Authors determined lymphocytes subpopulations in one of the cases of Stevens-Johnson syndrome and in the patient with polyradiculoneuropathy. In both of them they found a reduced number of T-helper lymphocytes, and in the patient with Guillain-Barré syndrome an increase in suppressor T cells was also demonstrated.