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Archives de pédiatrie
Volume 20, n° 4
pages 378-381 (avril 2013)
Doi : 10.1016/j.arcped.2013.01.020
Received : 30 July 2012 ;  accepted : 22 January 2013
Infections extrapulmonaires à Mycoplasma pneumoniae  : atteintes neurologique et rénale
Two uncommon extrapulmonary forms of Mycoplasma pneumoniae infection
 

M. Arca a, , A. Bellot b, C. Dupont a, N. Bach a, P. Eckart a, M.-J. Penniello-Valette a, J. Brouard a
a Service de pédiatrie, pôle femme-enfant-hématologie, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France 
b Service de néonatologie, pôle femme-enfant-hématologie, CHU de Caen, 14000 Caen, France 

Auteur correspondant.
Résumé

Mycoplasma pneumoniae (MP) est le 2e germe le plus fréquent dans les infections pulmonaires et le premier germe intracellulaire des pneumopathies atypiques. M. pneumoniae peut également causer des atteintes extrapulmonaires, associées ou non à la pneumopathie. Nous rapportons 2 cas, correspondant à une atteinte rénale et à une atteinte neurologique, rarement observées. L’atteinte rénale correspondait à un tableau de glomérulonéphrite membrano-proliférative (GNMP) avec syndrome néphrotique impur, et un taux des fractions C3 et C4 du complément abaissé chez une enfant de 6ans qui avait présenté une infection des voies aériennes hautes. L’autre enfant avait présenté un tableau de rhombencéphalite post-infectieuse, avec des explorations biologiques et radiologiques normales. Le diagnostic d’infection par M. pneumoniae avait été retenu devant la sérologie très positive. Le germe n’avait pu être directement mis en évidence. Ces 2 cas montrent la diversité des tableaux liés à l’infection à MP, dus soit au germe lui-même, soit à la réaction auto-immune dont il serait à l’origine. Compte tenu de l’augmentation de fréquence de cette infection, elle doit être évoquée rapidement. Le pronostic des atteintes extrapulmonaires est mal connu et justifie un suivi au long cours.

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Summary

Mycoplasma pneumonia is the second most frequent bacterium in pneumonia and the leading intracellular type. M. pneumoniae pulmonary infection is characterized by a slower onset profile and a lower biological inflammatory picture than pneumococcal infection. Both upper and lower respiratory tracts are often affected and sometimes a Kawasaki-like syndrome can be associated, with conjunctivitis or cheilitis. Extrapulmonary forms of the disease can occur, whether or not it is associated with pulmonary infection. We report two cases: in the first case, a renal form of M. pneumoniae disease developed in a 6-year-old girl, with membranous proliferative glomerulonephritis expressed as a picture of impure nephritic syndrome with decreased serum complement concentration, following an upper respiratory infection. Diagnosis was obtained by means of a kidney biopsy. The second case occurred in an 8-year-old girl who expressed, after a respiratory tract infection, neurological symptoms such as ocular flutter, perception disorder, and ataxia. This onset is typical of post-infectious rhombencephalitis. Biological investigations and imaging were normal. In both cases, M. pneumoniae infection was diagnosed on the basis of immunoglobulin M-positive serology. Direct exploration of the bacterium was negative, due to its fragility and delayed diagnostic hypothesis. Several forms of M. pneumoniae infection are either the direct effect of the bacterium or are secondary to a cross-immunological reaction. As its frequency is increasing, M. pneumoniae infection should be raised as a cause of atypical, less well-known extrapulmonary forms of the disease.

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