Zusammenfassung
Ein Fall von Pneumonie durch Mycoplasma pneumoniae mit tödlichem Ausgang bei einer vorher gesunden 18-jährigen Frau wird dargestellt. Der Antikörpertiter gegen M. pneumoniae wurde am Tag 9 des Spitalsaufenthalts mit 1:512 (Komplementbindungsreaktion) bzw. 1:5120 (Mikropartikel-Agglutinationstest) gemessen. Nach 5-wöchiger Behandlung an der Intensivstation verstarb die Patientin an nekrotisierender hämorrhagischer Pneumonie mit Multiorganversagen. Während der Dauer der Intensivpflichtigkeit traten keine relevanten zusätzlichen Infektionen auf. Korticosteroide (ab dem 8. Tag der stationären Behandlung) konnten den Krankheitsverlauf nicht positiv beeinflussen. Bemerkenswert ist, dass wie auch in einigen früheren Fallberichten trotz adäquater antimikrobieller Therapie gegen M. pneumoniae (in diesem Fall seit 2 Tage vor der stationären Aufnahme) zu einer Verschlechterung des klinischen Zustands kam, trotz der Eradikation des Erregers aus dem Respirationstrakt (mittels PCR konnte am Tag 22 nach Aufnahme M. pneumoniae nicht aus der bronchoalveolären Lavage nachgewiesen werden). Es ist jedoch festzuhalten, dass die Erkrankung bereits einige Tage vor der stationären Aufnahme begonnen hat, sodass über den möglicherweise positiven Effekt einer adäquaten antimikrobiellen Therapie in einem sehr frühen Stadium der Erkrankung keine Aussage getroffen werden kann. Aufgrund des Fehlens anderer therapeutischer Optionen im Fall von schweren Verläufen scheint die frühzeitige Diagnose und Therapie der Mykoplasmenpneumonie wesentlich. Dies ist der dritte Fall von tödlicher Pneumonie durch M. pneumoniae, welcher während der letzten Jahre in Österreich veröffentlicht wurde, was die Bedeutung der potentiell schweren Verläufe der Mykoplasmenpneumonie unterstreicht.
Summary
A case of fatal Mycoplasma pneumoniae pneumonia in a previously healthy 18-year-old girl is reported. On hospital day 9, the antibody titer to M. pneumoniae was 1:512 in the complement fixation test and 1:5120 in the microparticle agglutination assay. After five weeks in the intensive care unit, the patient died from necrotizing hemorrhagic pneumonia with multi-organ failure. No significant superinfections occurred during ICU treatment. Corticosteroids (hospital day 8 onward) did not influence the course of the disease. It is noteworthy that, as in some previously reported cases, the clinical state deteriorated during presumably adequate antibiotic treatment (2 days before admission onward), and despite documented eradication of the pathogen from the respiratory tract (PCR from bronchoalveolar fluid on hospital day 22 was negative). However, the illness had lasted for several days before admission to the hospital, therefore the potentially beneficial effect of antibiotic treatment at an early stage of the disease cannot be assessed. Clearly, in default of other treatment options, correct diagnosis and early treatment of mycoplasma community-acquired pneumonia seems mandatory. This is the third case of fatal mycoplasma pneumonia reported from Austria in recent years, making this topic worthy of further scientific attention.
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Daxboeck, F., Eisl, B., Burghuber, C. et al. Fatal Mycoplasma pneumoniae pneumonia in a previously healthy 18-year-old girl. Wien Klin Wochenschr 119, 379–384 (2007). https://doi.org/10.1007/s00508-007-0810-7
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DOI: https://doi.org/10.1007/s00508-007-0810-7