Mycoplasma associated stroke in a 4 year old child- A multifactorial etiology

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A BSTRACT

Mycoplasma pneumonia is a common cause of community-acquired pneumonia in India. Stroke due to infection-induced thrombosis is a rare complication of this infection and etiology can be multifactorial. We report a four-year-old girl with a mycoplasma infection associated stroke with thrombosis of the internal carotid artery and presence of lupus anticoagulant. She also had other risk factors for thrombosis like iron deficiency anemia and dehydration due to diarrhea which probably exacerbated an infection-induced procoagulant state. Lupus anticoagulants may be detected in many asymptomatic children with infections. The presence of other risk factors may precipitate a serious thrombotic event leading to significant morbidity and mortality. Recognising atypical pneumonia in the community and prompt treatment may reduce the serious extrapulmonary complications like stroke in children.

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Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis

Mitsuo Narita (2016)

The list of extrapulmonary manifestations due to Mycoplasma pneumoniae infection can be classified according to the following three possible mechanisms derived from the established biological activity of M. pneumoniae; (1) a direct type in which the bacterium is present at the site of inflammation and local inflammatory cytokines induced by the bacterium play an important role (2) an indirect type in which the bacterium is not present at the site of inflammation and immune modulations, such as autoimmunity or formation of immune complexes, play an important role, and (3) a vascular occlusion type in which obstruction of blood flow induced either directly or indirectly by the bacterium plays an important role. Recent studies concerning extrapulmonary manifestations have prompted the author to upgrade the list, including cardiac and aortic thrombi as cardiovascular manifestations; erythema nodosum, cutaneous leukocytoclastic vasculitis, and subcorneal pustular dermatosis as dermatological manifestations; acute cerebellar ataxia, opsoclonus-myoclonus syndrome, and thalamic necrosis as neurological manifestations; pulmonary embolism as a respiratory system manifestation; and renal artery embolism as a urogenital tract manifestation. Continuing nosological confusion on M. pneumoniae–induced mucositis (without skin lesions), which may be called M. pneumoniae-associated mucositis or M. pneumoniae-induced rash and mucositis separately from Stevens-Johnson syndrome, is argued in the dermatological manifestations. Serological methods are recommended for diagnosis because pneumonia or respiratory symptoms are often minimal or even absent in extrapulmonary manifestations due to M. pneumoniae infection. Concomitant use of immunomodulators, such as corticosteroids or immunoglobulins with antibiotics effective against M. pneumoniae, can be considered as treatment modalities for most severe cases, such as encephalitis. Further studies would be necessary to construct a comprehensive therapeutic strategy, covering microbiology (antibiotics), immunology (immunomodulators), and hematology (anticoagulants). The possible influence of the emergence of macrolide-resistant M. pneumoniae on extrapulmonary manifestations, which can be considered of limited clinical threat in Japan where the resistant rate has currently decreased, is discussed on the basis of unique biological characteristics of M. pneumoniae, the smallest self-replicating organism.

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Understanding Infection-Induced Thrombosis: Lessons Learned From Animal Models

Nonantzin Beristain-Covarrubias, Marisol Pérez-Toledo, Mark R Thomas … (2019)

Thrombosis is a common consequence of infection that is associated with poor patient outcome. Nevertheless, the mechanisms by which infection-associated thrombosis is induced, maintained and resolved are poorly understood, as is the contribution thrombosis makes to host control of infection and pathogen spread. The key difference between infection-associated thrombosis and thrombosis in other circumstances is a stronger inflammation-mediated component caused by the presence of the pathogen and its products. This inflammation triggers the activation of platelets, which may accompany damage to the endothelium, resulting in fibrin deposition and thrombus formation. This process is often referred to as thrombo-inflammation. Strikingly, despite its clinical importance and despite thrombi being induced to many different pathogens, it is still unclear whether the mechanisms underlying this process are conserved and how we can best understand this process. This review summarizes thrombosis in a variety of models, including single antigen models such as LPS, and infection models using viruses and bacteria. We provide a specific focus on Salmonella Typhimurium infection as a useful model to address all stages of thrombosis during infection. We highlight how this model has helped us identify how thrombosis can appear in different organs at different times and thrombi be detected for weeks after infection in one site, yet largely be resolved within 24 h in another. Furthermore, we discuss the observation that thrombi induced to Salmonella Typhimurium are largely devoid of bacteria. Finally, we discuss the value of different therapeutic approaches to target thrombosis, the potential importance of timing in their administration and the necessity to maintain normal hemostasis after treatment. Improvements in our understanding of these processes can be used to better target infection-mediated mechanisms of thrombosis.

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Association between iron-deficiency anemia and stroke in young children.

Patricia C. Parkin, Gabrielle deVeber, Jonathon L. Maguire (2007)

Iron-deficiency anemia occurs with a peak prevalence of 4% to 8% in children between 1 and 3 years of age. Case reports have suggested an association between iron-deficiency anemia in healthy children and ischemic stroke. Our objective was to investigate whether iron-deficiency anemia is associated with stroke in young children. A case-control study was conducted of case patients who were selected from the stroke registry at the Hospital for Sick Children (Toronto, Ontario, Canada) and control subjects selected from a database of healthy children who were prospectively enrolled in an outpatient setting. Children were aged 12 to 38 months and were previously healthy with no identifiable risk factors for stroke. Age, gender, mean corpuscular volume, platelet count, and hemoglobin and ferritin levels were collected. Iron-deficiency anemia was defined as a hemoglobin level of <110 g/L, mean corpuscular volume <73 fL, and serum ferritin level <12 microg/L. Stroke was defined according to clinical and radiologic criteria. Case (n = 15) and control (n = 143) subjects were similar with respect to median age and percentage of boys. Case patients had a lower median hemoglobin level and mean corpuscular volume and a higher median platelet count. Iron-deficiency anemia was significantly more common among case patients (8 [53%] of 15) than control subjects (13 [9%] of 143). Previously healthy children with stroke were 10 times more likely to have iron-deficiency anemia than healthy children without stroke. Furthermore, children with iron-deficiency anemia accounted for more than half of all stroke cases in children without an underlying medical illness, which suggests that iron-deficiency anemia is a significant risk factor for stroke in otherwise healthy young children. Primary prevention and early identification of iron-deficiency anemia must remain a priority.

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Author and article information

Journal

Journal ID (nlm-ta): J Family Med Prim Care

Journal ID (iso-abbrev): J Family Med Prim Care

Journal ID (publisher-id): JFMPC

Journal ID (publisher-id): J Family Med Prim Care

Title: Journal of Family Medicine and Primary Care

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 2249-4863

ISSN (Electronic): 2278-7135

Publication date (Print): June 2022

Publication date (Electronic): 30 June 2022

Volume: 11

Issue: 6

Pages: 3346-3348

Affiliations

[1 ] Department of Paediatrics, Banglore Baptist Hospital, Bellary Rd, Hebbal, Bengaluru, Karnataka, India

[2 ] Department of Hematology and Bone Marrow Transplant, Banglore Baptist Hospital, Bellary Rd, Hebbal, Bengaluru, Karnataka, India

Author notes

Address for correspondence: Dr. Rachel R. Peterson, Department of Paediatrics, Banglore Baptist Hospital, Bellary Rd, Hebbal Bengaluru, Karnataka- 560 024, India. E-mail: drrachelranitha@ 123456gmail.com

Article

Publisher ID: JFMPC-11-3346

DOI: 10.4103/jfmpc.jfmpc_2056_21

PMC ID: 9480644

SO-VID: e362d531-af0a-4fad-beeb-0babd3979155

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

History

Date received : 13 October 2021

Date revision received : 17 December 2021

Date accepted : 29 December 2021

Mycoplasma associated stroke in a 4 year old child- A multifactorial etiology

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Most cited references 9

Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis

Understanding Infection-Induced Thrombosis: Lessons Learned From Animal Models

Association between iron-deficiency anemia and stroke in young children.

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