Adolescent with fever and atypical presentation Galit Livnat-Levanon Carmel Medical Center פיח" ילוי פ2016
הרקמ תגצה הזנמנא ןב17םינש , אירבדב"כ ותלבק םרט םייעובש : תלחמםוח ,תלזנ , לועישלושלשו , עובש רחאל(םוח םע )הליהקב הזח םוליצ עצוב : הללצה לאמשמ, לחוה לופיטןיטנמגואב ימופ , לפוטעובש ךשמב. רואלןוימל הנפוה םימוחה ךשמה . • לש לקשמב הדירי ןייצל שי5ק"ותלחמ ךלהמב ג. •םיטוזקא תומוקמב לויט ללוש , וא הזחב םיבאכ ללוש ימד חיכ .ותביבסב םילוח אלל. Adolescent with fever and atypical presentation Galit Livnat-Levanon
ליהק הזח םוליצה 23/8/2015 Adolescent with fever and atypical presentation Galit Livnat-Levanon
הרקמ תגצה םידדמ: םוח :38.5 ,תומישנ :30הקדל ,היצרוטס : 96% ריוואברדח . ותקידבב : הלוח הארנ ,ררמצמ , אלל יוריג ינמיס ילאיגנינמ , החירפע הנידע" תיב פןטבו הזח. תואירל הנזאהב :תויצטיפירק םיסיסבבוד"צ . אלל גניבאלק . הדבעמ : סב" ד PLT=553000 WBC 10,500 ,הניקת האלמ הימיכ. , CRP=8 (76%PMN) Adolescent with fever and atypical presentation Galit Livnat-Levanon
הלבקב הזח םוליצ 30.8.2015 Adolescent with fever and atypical presentation Galit Livnat-Levanon
הרקמ רואית ךשמה תפסוהלינזא. + לופיטל רבעומןיטנמגואב • IV •ותלבק רחאל םיימוי ,םימוח םע ךישממ , עיפומ באכ הייארו שאר הלופכ ,הרכהה בצמב יוניש וא לובלב אלל. םייניב םוכיס •אירב רענ ,יצחו םייעובש תכשמנה תיטוקא הלחמ ,לקשמב הדירי , לופיט םע רופיש אלליטויביטנא • הזח םוליצב לאמשמ הללצה • םוח + שאר באכ +היפולפיד תלדבמ הנחבאב: • • MENINGITIS BRAIN ABSCESS • • ADEM ENCEPHALITIS • MS • SINUSITIS Adolescent with fever and atypical presentation Galit Livnat-Levanon
הרקמ רואית ךשמה תבחרהרוריב • םייניע ץועי- הליזפהשדח המיאתמה לש השלוחל( (Abducens שאר יבאכ לע תונולתו םוח תלחמ תוחכונב , Cranial Nerve VI ץלמומ : ו הימדה LP הקידב תיגולוריונהניקת • •קא" וקאו גבל-םיניקת MRI ח םע חמ.נ :ןיקת • MULTIPLEX VIRAL PCR ילילש חיכ. • הידימלכ- תילילש , המזלפוקימ- •היגולורס: Rickettsia, Q fever יבויח IGM PAN BACTERIAL PCR חיכ : המזלפוקימל יבויח • • תוברת םדתוילילש Adolescent with fever and atypical presentation Galit Livnat-Levanon
הרקמ רואית ךשמה רחאל5םילחמ זופשא ימי ,דרוי םוחה , הליזפה • תפלוח , אללשאר יבאכ . • ותקידבב םויבורורחש :בוטב שח ,םיניקת םידדמ , היצרוטס99%רדח ריוואב. • םייניע אפור תקידב + תיגולוריונ הקידבהניקת. •תואירה תקידבב : אלל תמשנ, הבוט ריווא תסינכ הוושווד"צ םירוחרח אלל וא םיפוצפצתויצטיפירק. • הדבעמ תרזוח :ס"ד,הימיכ-תוניקת . CRP=0.9 Adolescent with fever and atypical presentation Galit Livnat-Levanon
רורחש םרט םוליצ 3.9.2016 הנחבא :המזלפוקימהינומואינפעמ תוברועמ םע"מ Adolescent with fever and atypical presentation Galit Livnat-Levanon
MYCOPLASMA PNEUMONIA • The smallest free-living microorganisms, lack cell wall, more than 100 species (17 human pathogens) PATHOGENESIS: adherence proteins attach to the epithelial membranes (affinity for respiratory tract) → injury to epithelial cells and their cilia by hydrogen peroxide and superoxide • Cytotoxin (CARDS) direct damage to respiratory tract → influx of inflammatory cells → pro-inflammatory cytokines • Immune-mediated: antibodies against mycoplasma antigens act as autoantibodies - cross reaction with human red cells and brain cells Adolescent with fever and atypical presentation Galit Livnat-Levanon
MYCOPLASMA PNEUMONIA EPIDEMIOLOGY • Person to person by infected respiratory droplets • Incubation period ~ three weeks • Year-round, most frequently fall and winter • Can be epidemic (families 80%, children are the reservoir) • M. pneumoniae accounts for 20% of acute pneumonia in middle and high school students CLINICAL FEATURES Gradual onset with: headache, malaise, and low-grade fever • Physical examination: minimal findings Adolescent with fever and atypical presentation Galit Livnat-Levanon
Respiratory tract disease • Cough: 75-100% intractable, nonproductive only 3-10% develop pneumonia • Pharyngitis (6-59 %), rhinorrhea (2-40%), and ear pain (2-35%). Possible relation to asthma: • *M. pneumoniae implicated in the exacerbation of asthma # Isolated the bacteria in higher prevalence among asthmatics • • M. pneumoniae infection may worsen asthma symptoms and can produce wheezing in children who do not have asthma. • The mechanism behind development of the disease is still unknown *Biscardi,S., etal. Mycoplasma pneumoniae and asthma in children. Clin. Infect.Dis 2004 # Smith-Norowitz,T.A. etal.. Asthmatic children have increased specific anti- Mycoplasma pneumoniae IgM but not I Gg or IgE-values independent of history of respiratory tract infection. Pediatr.Infect.Dis. 2013 Adolescent with fever and atypical presentation Galit Livnat-Levanon
Mycoplasma and asthma Chlamydia pneumoniae, and mycoplasma pneumoniae: Are they related to severe asthma in childhood? Objective: To determine the frequency of these triggers and their relationship to severe asthma. Methods: 82 children , three study groups: Group 1 : severe asthma , Group 2 : stable asthma and Group 3 : control group . Serological tests ( IgG and IgM) for both C. pneumoniae and M. pneumoniae . Results: M. pneumoniae IgM was observed in 6/27 ( 22.2% ) in Group 1, 2/29 ( 6.9% ) in Group 2 and 0/26 in the Control Group (p = 0.01). M. pneumoniae IgG was observed in 7/27 ( 25.9% ) in Group 1, 4/29 ( 13.7% ) in Group 2 and 0/26 in the Control Group (p < 0.05). Conclusions: M. pneumoniae and C. pneumoniae may play a role in the development of severe asthma Adolescent with fever and atypical presentation Galit Livnat-Levanon Iramain R et al. J Asthma. 2016 Aug
Mycoplasma pneumoniae in children with acute and refractory asthma OBJECTIVES: To identify the frequency of M pneumoniae in respiratory secretions of children with and without asthma METHODS: 143 (53 patients with acute asthma , 26 patients with refractory asthma , and 64 healthy controls ; age range 5-17 years) Detection of M pneumoniae using CARDS toxin antigen capture and PCR. Immune responses were determined by IgG and IgM RESULTS: M pneumoniae in 64% of patients with acute asthma, 65% with refractory asthma, and 56% of healthy controls. Children with asthma had lower antibody levels compared with healthy controls CONCLUSION: M pneumoniae is common in children, detection is associated with worsening asthma, and children with asthma may have poor humoral immune responses to M pneumoniae. Wood PR et al. Ann Allergy Asthma Immunol. 2013 May Adolescent with fever and atypical presentation Galit Livnat-Levanon
Extra pulmonary disease • Hemolysis, skin rash, joint involvement, GIT, CNS and heart disease. • CNS involvement — 0.1% of all patients, most frequently in children, significant morbidity and mortality: aseptic meningitis meningoencephalitis (postencephalitic epilepsy) peripheral neuropathy transverse myelitis cerebellar ataxia cranial nerve palsies pathogenesis uncertain: Direct infection + immune- mediated Adolescent with fever and atypical presentation Galit Livnat-Levanon
Neurological Complications of PCR-Proven M. pneumoniae Infections in Children: Prodromal Illness Duration May Reflect pathogenetic Mechanism Objective: to characterize the neurologic complications of M. pneumoniae in children Methods: All children admitted to hospital over a 16- year period with acute neurologic manifestations and PCR – confirmed M. pneumoniae Results: 365 children had M. pneumoniae in the CSF or respiratory tract by PCR, 42 (11.5%) had neurologic disease: encephalitis (52%), acute disseminated encephalomyelitis (12%), transverse myelitis (12%), and cerebellar ataxia (10%). Samiah A. Al-Zaidy et al. Clinical Infectious Diseases , June 2015 Adolescent with fever and atypical presentation Galit Livnat-Levanon
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