Cardiac Manifestations of Mycoplasma pneumoniae Infections: A Cohort Study 2007–2024

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BACKGROUND: While Mycoplasma pneumoniae (MP) infections typically present as a respiratory disease, extrapulmonary manifestations are well-documented. Historically, cardiac involvement has been considered uncommon (1%-2%); however, recent observations suggest higher rates, especially in MP ICU patients. This study aims to characterize the prevalence, clinical spectrum, and outcomes of hospitalized patients with MP and cardiac manifestations. METHODS: We conducted a cohort study at Hadassah Medical Center, Jerusalem, Israel, including all inpatients with a positive PCR for MP from 2007 to mid-2024. Cardiac involvement included congestive heart failure (CHF), arrhythmias, acute coronary syndrome (ACS), peri/myocarditis, and isolated troponin elevation. RESULTS: Of 1305 MP-positive patients (mean age 33.4 years), 152 (11.6%) were found to have cardiac involvement-17% among adult patients and 4.9% among children (P < .001). In adults, CHF and arrhythmias were most common (each 34.7%), followed by ACS (10.5%), peri/myocarditis (15.3%), and isolated troponinemia (9.7%). ICU admission occurred in 50% of adults with cardiac involvement and was significantly higher in arrhythmias and peri/myocarditis groups. In-hospital mortality among adults was high at 22.6%. Predictors of mortality included ICU admission (aOR 7.76; CI: 2.78-21.66), older age (aOR per year increase: 1.03; CI: 1.01-1.06), and primary diagnosis other than MP (aOR 3.57; CI: 1.34-9.51). Pediatric cardiac involvement primarily presented as arrhythmia (42.9%). CONCLUSIONS: Cardiac involvement in hospitalized MP-infected adults is more common than previously recognized (17%) and carries substantial morbidity and mortality risks. Early evaluation for cardiac complications is crucial in MP-infected hospitalized patients presenting with severe illness or unexplained cardiac symptoms.

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