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Determining the Clinical Characteristics, Treatment Strategy and Prognostic Factors of Mycoplasma Pneumoniae Encephalitis in Children: A Multicenter Study from China


 Background Most of the knowledge on Mycoplasma pneumoniae encephalitis (MPE) in children is based on case reports or small case series.This study aimed to describe the clinical features, the efficacy of azithromycin with or without immunomodulatory therapy ,and prognostic factors of MPE .Methods The Medical data of eighty-seven MPE patients from three medical centers in southwestern China over a 7-years period were reviewed.Results MPE was noted in children of all ages except for neonates.The most common neurological manifestations include consciousness disturbance(90%) and headache(87.4%),the most common extra-neurological presentations include fever (96.5%)and respiratory system involvement(94.3%) ,multi-system involvement(98.2%) and elevated C-reactive protein(CRP) (90.8%)were also prominent.M. pneumoniae detection in CSF was less than in blood and respiratory tract secretions.Azithromycin with intravenous immunoglobulin (IVIG) or/and corticosteroids treatment can shorten the hospitalization duration and length of clinical improvement. Multivariate analysis revealed that onset during teenage years and high lactate dehydrogenase (LDH) and CSF protein levels were identified as independent prognostic factors for poor outcome.Conclusions In children having acute encephalitis with multi-system involvement, especially in those with respiratory tract manifestations, accompanied with prominently elevated CRP,M. pneumoniae should be given preference.Higher age,marked CSF protein and blood LDH were correlated with unfavorable outcomes. Multiplicity mechanisms ,especially immune-mediated inflammation involved in the pathogenesis. Immunomodulating therapies should be recommended regardless of the duration of prodromal period.