Mycoplasma pneumonia in Cerebrospinal Fluids of Febrile Children With Neurologic Manifestations: A Cross Sectional Study: Tehran, Iran

Abstract

Background: The clinical spectrum of Mycoplasma pneumoniae CNS diseases had a wide range. Encephalitis and meningoencephalitis are the most frequent neurological manifestations, but cases of optic neuritis, transverse myelitis, Guillain-Barre syndrome (GBS), etc. have been reported Objectives: To determine the role of M. pneumonia (using PCR and serologically test) in Cerebro Spinal Fluid (CSF) in febrile children with neurologic manifestations (in comparison with normal CSF). Materials and Methods: This cross sectional study was done in pediatric wards of Rasoul hospital in Tehran between 2008 - 2010 upon 55 febrile cases with neurological signs and 10 controls with normal CSF (simple febrile seizure). The CSF samples tested for M. pneumonia DNA (PCR); and Immune Globulin G (IgG) level. Chi square values < 0.05 were considered statistically significant. Results: Positive PCR found in 1 case with Guillan Barre syndrome (1/53; 2%) and none of controls; IgG-CSF level (Cut off 0.0025) had significant difference between cases and controls (Kappa = 0.27, P Value = 0.000). The lowest and highest IgG level observed in aseptic meningitis, and convulsive cases respectively. 73% sensitivity; 90% specificity; 100% Variance (PPV); 28.8% Net Present Value (NPV) determined for IgG-CSF test. Conclusions: Even, very low amount of CSF-IgG with good specificity (90%); could differentiate cases and controls (P = 0.000). The CSF-IgG test (sensitivity 70%, NPV 28.8%) was weak for ruling out the M. pneumonia in cases. positive PCR was rare (2%) in CSF of cases and controls but is more reliable for diagnosing the recent M. pneumonia infection. We prefer to assay the CSF for both serology and PCR in highly suspicious cases. Anti-microbial or immune modulating therapies had possible benefits.