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Published on: February 24, 2023
Movement Disorders and Cerebellar Syndromes Associated with Mycoplasma pneumoniae Infection: A Systematic Review
Ravindra Kumar Garg1, Shweta Pandey2, Amita Jain3
1Department of Neurology, Era's Lucknow Medical College & Hospital, Era University, Lucknow, India.
Background:
Mycoplasma pneumoniae is a well-recognized respiratory pathogen increasingly associated with diverse neurological manifestations beyond pulmonary disease involvement.
Objectives:
To evaluate movement disorders and cerebellar syndromes linked to Mycoplasma pneumoniae, focusing on clinical relevance, diagnosis, and management challenges.
Methods:
A systematic review of published case reports and case series was conducted following PRISMA guidelines. Individual patient data were extracted for demographic characteristics, clinical features, diagnostic confirmation, cerebrospinal fluid findings, neuroimaging, treatment strategies, outcomes, and proposed pathophysiological mechanisms. The protocol was prospectively registered with PROSPERO under the identifier PROSPERO 2025 CRD420251243903.
Results:
A total of 42 published cases of Mycoplasma pneumoniae-associated movement disorders were analyzed. A preceding respiratory illness was documented in 69.0%, and neurological manifestations were mainly parainfectious (54.8%) or post-infectious (28.6%). Cerebellar ataxia/cerebellitis (38.1%) and opsoclonus-myoclonus-ataxia syndrome (26.2%) were the most frequent phenotypes. Cerebrospinal fluid pleocytosis occurred in 54.8%, while neuroimaging was normal in 50.0%; abnormalities predominantly involved the cerebellum or basal ganglia. Antibiotics alone were used in 35.7%, and 45.3% received immunotherapy with or without antibiotics. Complete or near-complete recovery occurred in 83.4%. Three pediatric cohorts confirmed the rarity of these disorders, with cerebellar ataxia as the universal phenotype and predominantly favorable outcomes.
Conclusions:
Movement disorders associated with or temporally related to Mycoplasma pneumoniae infection are uncommon and appear predominantly immune mediated, with cerebellar ataxia and opsoclonus-myoclonus-ataxia syndrome being the most frequent presentations. Most cases occur in a parainfectious or post-infectious setting and show favorable outcomes with timely antibiotic and immunomodulatory therapy, although residual deficits may persist in a minority.
Insights
Mycoplasma pneumoniae infections can cause rare neurological issues like cerebellar ataxia and opsoclonus-myoclonus-ataxia syndrome, often immune-mediated. Prompt treatment with antibiotics and immunotherapy leads to favorable outcomes in most patients.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Mycoplasma pneumoniae is a known respiratory pathogen.
- It is increasingly linked to neurological conditions beyond lung infections.
Purpose of the Study:
- To review movement disorders and cerebellar syndromes associated with Mycoplasma pneumoniae.
- Focus on clinical relevance, diagnosis, and management.
Main Methods:
- Systematic review of case reports and series following PRISMA guidelines.
- Extracted data on demographics, clinical features, diagnostics, CSF, neuroimaging, treatments, and outcomes.
- Protocol registered with PROSPERO (CRD420251243903).
Main Results:
- Analyzed 42 cases of Mycoplasma pneumoniae-associated movement disorders.
- Cerebellar ataxia/cerebellitis (38.1%) and opsoclonus-myoclonus-ataxia syndrome (26.2%) were most common.
- 83.4% achieved complete or near-complete recovery with treatment.
Conclusions:
- Mycoplasma pneumoniae-related movement disorders are uncommon and often immune-mediated.
- Cerebellar ataxia and opsoclonus-myoclonus-ataxia syndrome are frequent presentations.
- Timely antibiotic and immunomodulatory therapy improves outcomes, though some deficits may remain.
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