Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications
Takeshi Saraya1, Daisuke Kurai1, Kazuhide Nakagaki2, Yoshiko Sasaki3, Shoichi Niwa3, Hiroyuki Tsukagoshi3, Hiroki Nunokawa1,
Kosuke Ohkuma1, Naoki Tsujimoto1, Susumu Hirao1, Hiroo Wada1, Haruyuki Ishii1, Koh Nakata4, Hirokazu Kimura5, Kunihisa Kozawa3,
Hajime Takizawa1 and Hajime Goto1*
Front. Microbiol., 11 August 2014 | doi: 10.3389/fmicb.2014.00410
1Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Japan
2Department of Virology and Immunology, College of Veterinary Medicine, Nippon Veterinary and Animal Science University, Mitaka, Japan
3Gunma Prefectural Institute of Public Health and Environmental Sciences, Maebashi, Japan
4Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan
5Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
Mycoplasma pneumoniae (Mp) is a leading cause of community acquired pneumonia. Knowledge regarding Mp pneumonia obtained from animal models or
human subjects has been discussed in many different reports. Accumulated expertise concerning this critical issue has been hard to apply clinically,
and potential problems may remain undiscovered. Therefore, our multidisciplinary team extensively reviewed the literature regarding Mp pneumonia,
and compared findings from animal models with those from human subjects. In human beings, the characteristic pathological features of Mp pneumonia
have been reported as alveolar infiltration with neutrophils and lymphocytes and lymphocyte/plasma cell infiltrates in the peri-bronchovascular area.
Herein, we demonstrated the novel aspects of Mp pneumonia that the severity of the Mp pneumonia seemed to depend on the host innate immunity to the Mp,
which might be accelerated by antecedent Mp exposure (re-exposure or latent respiratory infection) through up-regulation of Toll-like receptor 2 expression
on bronchial epithelial cells and alveolar macrophages. The macrolides therapy might be beneficial for the patients with macrolide-resistant Mp pneumonia
via not bacteriological but immunomodulative effects. This exhaustive review focuses on pathogenesis and extends to some therapeutic implications
such as clarithromycin, and discusses the various diverse aspects of Mp pneumonia.
It is our hope that this might lead to new insights into this common respiratory disease.