Alles wat je moet weten over Mycoplasma pneumoniae huiduitslag

Introduction

MIRM, a recently identified mucocutaneous entity, was introduced and coined in a 2015 systematic review by Canavan et al.[13] This review, comprising 202 cases of M pneumoniae-associated erythema multiforme, SJS, and mucositis without rash, delineated the distinct features of MIRM.[13] MIRM is characterized by prominent mucositis with comparatively less cutaneous involvement than other mucocutaneous syndromes associated with M pneumoniae, such as urticaria, erythema nodosum, erythema multiforme, SJS, TEN, and DRESS.[6][7][14]

M pneumoniae most frequently causes community-acquired pneumonia, particularly in children aged 5 or older, with some regions reporting it as the cause in up to 37% of pediatric cases.[1][2] Both M pneumoniae and MIRM occur mostly during the winter months.[16] A systematic review by Canavan et al, using their novel proposed definition, found that MIRM was mostly reported in children and young adolescents with a mean age of 12.[13] However, a more recent systematic review by Lofgren and Leinkeit found that MIRM cases ranged between the ages of 4 and 46, with a mean age of 16.[16] However, MIRM has also been reported in young adults.[17][18] In the systematic review by Canavan et al, 60% of the identified cases of MIRM occurred in males, with 47% of patients experiencing mucositis without significant skin involvement and 34% presenting with mucositis alone without any skin involvement.[13]

The exact incidence of MIRM is not known for various reasons. Importantly, until now, a distinct definition distinguishing it from other causes of mucocutaneous syndromes associated with M pneumoniae infection does not exist, leading to misclassification of the syndrome. Other contributing factors include potential underreporting, often due to M pneumoniae not being considered in the initial diagnosis, limited availability of resources for testing, failure to identify a definitive cause, and possible lack of reporting. Until 2015, the lack of a discreet definition for MIRM led to inconsistent naming conventions in publications describing cases of M pneumoniae infection. Examples include M pneumoniae–associated SJS, Fuchs syndrome, and SJS without skin lesions.[17][19][20]

StatPearls [Internet].

Garrett F. Frantz , Scott A. McAninch .

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Last Update: April 28, 2024 .

Identify the clinical features and characteristic manifestations of Mycoplasma pneumoniae–induced rash and mucositis to facilitate accurate diagnosis.

Implement evidence-based management strategies for Mycoplasma pneumoniae–induced rash and mucositis, including antibiotic therapy and supportive care, to optimize patient outcomes.

Select appropriate pharmacological interventions for the treatment of Mycoplasma pneumoniae–induced rash and mucositis, considering factors such as antibiotic resistance patterns and patient comorbidities.

Collaborate with interprofessional healthcare team members, including infectious disease specialists, dermatologists, and intensivists, to provide comprehensive care for patients with Mycoplasma pneumoniae–induced rash and mucositis.

Mycoplasma Pneumoniae Antibody (IgG)

Mycoplasma Pneumoniae Antibody (IgG) testing plays a pivotal role in the serological diagnosis of infections caused by the bacterium Mycoplasma pneumoniae, a common agent of atypical pneumonia and other respiratory tract infections.

This antibody is a specific type of immunoglobulin G (IgG), which the human immune system produces in response to an infection with this organism.

The detection of IgG antibodies is crucial because it indicates a past or ongoing immune response against Mycoplasma pneumoniae.

However, it's important to note that the presence of IgG antibodies alone cannot definitively confirm an active infection, as they can persist in the bloodstream for months or even years after the initial exposure, indicating immunity from past infection.

Therefore, the interpretation of Mycoplasma pneumoniae IgG tests often involves considering the patient's clinical presentation, symptoms, and, if available, comparing antibody titers from acute and convalescent phases of the illness. This comparison can help to ascertain whether the detected antibodies are from a recent infection or a past exposure. In some cases, the testing for IgM antibodies, which are produced earlier in the infection, might be conducted alongside IgG testing for a more comprehensive understanding of the infection's timeline. Mycoplasma pneumoniae IgG antibody testing is a valuable tool in the epidemiological tracking and management of respiratory infections, particularly in outbreak settings or when diagnosing atypical pneumonia cases.

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Pathophysiology

The presence of histopathological features unique to MIRM that differentiate it from erythema multiforme, SJS, and TEN remains uncertain. Erythema multiforme, SJS, and MIRM exhibit similar and overlapping histopathological characteristics, including apoptotic keratinocytes and sparse perivascular dermal infiltrates. The existence of distinct biopsy features enabling histopathological differentiation between these diseases remains controversial.

In contrast, erythema multiforme presents initially as a cutaneous acral rash with macules that evolve into papules, plaques, and typical target lesions. These target lesions spread centripetally to the trunk and face. Erythema multiforme minor has little or no mucous membrane involvement, and erythema multiforme major has a rash on one or more mucous membranes. SJS/TEN manifests as a rash characterized by macules, purpura, diffuse erythema, atypical target lesions, and numerous flaccid blisters. These lesions are extensive in number and initially more concentrated centrally and gradually coalesce, spreading to involve the face and limbs. Extensive mucous membrane involvement affecting 2 or more mucosal sites is common. The amount of skin detachment determines the extent of SJS/TEN—SJS involves less than 10% skin detachment. Skin detachment ranging from 10% to 30% overlaps between SJS and TEN, whereas skin detachment exceeding 30% meets the criteria for TEN.[27]