Stroke Associated With Recent Mycoplasma Pneumoniae Infection: A Systematic Review of Clinical Features and Presumed Pathophysiological Mechanisms.

Guillaume Turc,Nicolas Mélé

doi:10.3389/fneur.2018.01109

Abstract

Introduction: An association between Mycoplasma pneumoniae (MP) infection and stroke has been described, especially in children. However, current knowledge on this rare potential cause of stroke is scant. The purpose of this systematic review of all published cases was to help better understand the relationships between recent MP infection and ischemic stroke on a clinical, radiological and pathophysiological perspective.Material and Methods: A PubMed and Embase search was performed in September 2018 to identify all published cases of stroke occurring within 4 weeks after MP infection.Results: Twenty-eight patients with ischemic stroke associated with MP infection were identified. Median age was 8 years (range: neonate to 57). The middle cerebral artery territory was involved in 25 (89%) patients. Fifteen (54%) patients had at least one arterial occlusion. Elevated D-dimer and/or fibrinogen was reported in 8 (29%) patients. Four patients had transient anticardiolipin IgM antibodies. Cerebrospinal fluid analysis showed pleocytosis in 7/20 (35%) patients (median: 19 leucocytes/μL, range: 10 to 63) and MP PCR was positive in 3/8 (38%) patients. The etiological work-up was considered inconclusive in 25 (89%) patients. Three (11%) patients died during follow-up, all of early respiratory deterioration. Neurological functional outcome was good in 22/27 (81%) patients.Conclusion: The association between MP infection and ischemic stroke in children and young adults is rare. Underlying pathogenesis might include hypercoagulability and vasculitis. Most patients achieve a favorable recovery. Whether MP infection could be a long-term risk factor for stroke by promoting atherosclerosis is uncertain and deserves further investigation.

Highlights

An association between Mycoplasma pneumoniae (MP) infection and stroke has been described, especially in children
Studies or case reports were eligible for the present review if they: [1] included patient with ischemic or hemorrhagic stroke proven by computerized tomography (CT-scan) or magnetic resonance imaging (MRI), regardless of vascular territory or presumed cause; [2] with recent MP infection proven by serology, culture or polymerase chain reaction (PCR); [3] and featured data on age, sex, neurological symptoms and follow-up
Among 223 studies and records identified through database searching, studies met the inclusion criteria (Figure 1), reporting a total of patients who had an ischemic stroke within 4 weeks of MP infection [7, 13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]

Summary

Introduction

An association between Mycoplasma pneumoniae (MP) infection and stroke has been described, especially in children. CNS manifestation typically include meningo-encephalitis, optic neuritis or transverse myelitis, and cases of stroke occurring shortly after MP infection have been reported, mainly in young patients [6, 7]. Our current knowledge of the underlying pathogenesis, clinical features, paraclinical findings, and outcome of stroke occurring after MP infection remains poor. A large prospective study suggested that patients with recent MP infection had a higher risk of subsequent ischemic stroke than comorbidity-matched controls over a 5years follow-up period [8]. Those findings suggest that MP infection could increase the risk of ischemic stroke even over a long-term period, which might be due to different mechanisms [9, 10]

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Conclusion