{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:41:00Z","timestamp":1790185260720,"version":"4.1.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While Mycoplasma pneumoniae (MP) infections typically present as a respiratory disease, extrapulmonary manifestations are well-documented. Historically, cardiac involvement has been considered uncommon (1%\u20132%); 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1305 MP-positive patients (mean age 33.4 years), 152 (11.6%) were found to have cardiac involvement\u201417% among adult patients and 4.9% among children (P &amp;lt; .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\u201321.66), older age (aOR per year increase: 1.03; CI: 1.01\u20131.06), and primary diagnosis other than MP (aOR 3.57; CI: 1.34\u20139.51). Pediatric cardiac involvement primarily presented as arrhythmia (42.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf453","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T11:53:51Z","timestamp":1755777231000},"page":"e269-e276","source":"Crossref","is-referenced-by-count":4,"title":["Cardiac Manifestations of\n                    <i>Mycoplasma pneumoniae<\/i>\n                    Infections: A Cohort Study 2007\u20132024"],"prefix":"10.1093","volume":"81","author":[{"given":"Tzvi","family":"Har Shefi","sequence":"first","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-1648","authenticated-orcid":false,"given":"Yonatan","family":"Oster","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]},{"name":"Faculty of Medicine, Hebrew University , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3159-8426","authenticated-orcid":false,"given":"Oren","family":"Gordon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hebrew University , Jerusalem ,","place":["Israel"]},{"name":"Pediatric Infectious Diseases Unit, Pediatric Division, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3559-1050","authenticated-orcid":false,"given":"Ronen","family":"Durst","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hebrew University , Jerusalem ,","place":["Israel"]},{"name":"Department of Cardiology, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayelet","family":"Michael-Gayego","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2221-4168","authenticated-orcid":false,"given":"Sara","family":"Hoss","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1567-2550","authenticated-orcid":false,"given":"Ran","family":"Nir-Paz","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]},{"name":"Faculty of Medicine, Hebrew University , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8315-1204","authenticated-orcid":false,"given":"Daniel","family":"Grupel","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center , Jerusalem ,","place":["Israel"]},{"name":"Faculty of Medicine, Hebrew University , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"2025122403223617000_ciaf453-B1","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.jiac.2013.09.009","article-title":"Clinical features, risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia: a review of the Japanese literature","volume":"20","author":"Izumikawa","year":"2014","journal-title":"J Infect Chemother"},{"key":"2025122403223617000_ciaf453-B2","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.cmi.2016.05.028","article-title":"Increased rates of intensive care unit admission in patients with Mycoplasma pneumoniae: a retrospective study","volume":"22","author":"Khoury","year":"2016","journal-title":"Clin Microbiol Infect"},{"key":"2025122403223617000_ciaf453-B3","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1128\/CMR.00114-16","article-title":"Mycoplasma pneumoniae from the respiratory tract and beyond","volume":"30","author":"Waites","year":"2017","journal-title":"Clin Microbiol Rev"},{"key":"2025122403223617000_ciaf453-B4","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1128\/CMR.17.4.697-728.2004","article-title":"Mycoplasma pneumoniae and its role as a human pathogen","volume":"17","author":"Waites","year":"2004","journal-title":"Clin Microbiol Rev"},{"key":"2025122403223617000_ciaf453-B5","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1111\/j.1574-6976.2008.00129.x","article-title":"Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections","volume":"32","author":"Atkinson","year":"2008","journal-title":"FEMS Microbiology Reviews"},{"key":"2025122403223617000_ciaf453-B6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3389\/fmicb.2016.00023","article-title":"Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae infection on the basis of possible pathogenesis","volume":"7","author":"Narita","year":"2016","journal-title":"Front Microbiol"},{"key":"2025122403223617000_ciaf453-B7","first-page":"329","article-title":"Infection with and carriage of Mycoplasma pneumoniae in children","volume":"7","author":"Sauteur","year":"2016","journal-title":"Front Microbiol"},{"key":"2025122403223617000_ciaf453-B8","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/S0140-6736(15)60733-4","article-title":"Community-acquired pneumonia","volume":"386","author":"Prina","year":"2015","journal-title":"Lancet"},{"key":"2025122403223617000_ciaf453-B9","first-page":"j2471","article-title":"Advances in the causes and management of community acquired pneumonia in adults","volume":"358","author":"Wunderink","year":"2017","journal-title":"BMJ (Online)"},{"key":"2025122403223617000_ciaf453-B10","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1056\/NEJMra1312885","article-title":"Community-acquired pneumonia","volume":"371","author":"Musher","year":"2014","journal-title":"N Engl J Med"},{"key":"2025122403223617000_ciaf453-B11","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/joim.12875","article-title":"Pathogenesis and prevention of risk of cardiovascular events in patients with pneumococcal community-acquired pneumonia","volume":"285","author":"Feldman","year":"2019","journal-title":"J Intern Med"},{"key":"2025122403223617000_ciaf453-B12","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1086\/518849","article-title":"The association between pneumococcal pneumonia and acute cardiac events","volume":"45","author":"Musher","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2025122403223617000_ciaf453-B13","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jinf.2012.09.003","article-title":"Risk stratification and prognosis of acute cardiac events in hospitalized adults with community-acquired pneumonia","volume":"66","author":"Viasus","year":"2013","journal-title":"J Infect"},{"key":"2025122403223617000_ciaf453-B14","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/S1473-3099(09)70233-6","article-title":"Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review","volume":"9","author":"Warren-Gash","year":"2009","journal-title":"Lancet Infect Dis"},{"key":"2025122403223617000_ciaf453-B15","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1056\/NEJMoa1702090","article-title":"Acute myocardial infarction after laboratory-confirmed influenza infection","volume":"378","author":"Kwong","year":"2018","journal-title":"N Engl J Med"},{"key":"2025122403223617000_ciaf453-B16","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1056\/NEJMc2010459","article-title":"Acute cor pulmonale in critically ill patients with COVID-19","volume":"382","author":"Creel-Bulos","year":"2020","journal-title":"N Engl J Med"},{"key":"2025122403223617000_ciaf453-B17","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1001\/jamacardio.2020.0950","article-title":"Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan","volume":"5","author":"Shi","year":"2020","journal-title":"China. JAMA Cardiol"},{"key":"2025122403223617000_ciaf453-B18","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jacc.2020.05.068","article-title":"Takotsubo cardiomyopathy in COVID-19","volume":"76","author":"Giustino","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025122403223617000_ciaf453-B19","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1161\/CIRCULATIONAHA.120.047971","article-title":"Spectrum of cardiac manifestations in COVID-19: a systematic echocardiographic study","volume":"142","author":"Szekely","year":"2020","journal-title":"Circulation"},{"key":"2025122403223617000_ciaf453-B20","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1136\/heartjnl-2020-317056","article-title":"Cardiovascular manifestations and treatment considerations in COVID-19","volume":"106","author":"Kang","year":"2020","journal-title":"Heart"},{"key":"2025122403223617000_ciaf453-B21","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat Med"},{"key":"2025122403223617000_ciaf453-B22","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1159\/000057677","article-title":"Mycoplasma-associated carditis case. Reports and review","volume":"97","author":"Paz","year":"2002","journal-title":"Cardiology"},{"key":"2025122403223617000_ciaf453-B23","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/j.0954-6820.1979.tb13473.x","article-title":"Carditis associated with Mycoplasma pneumoniae infection","volume":"206","author":"P\u00f6nk\u00e4","year":"1979","journal-title":"Acta Med Scand"},{"key":"2025122403223617000_ciaf453-B24","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/S1473-3099(24)00805-3","article-title":"Mycoplasma pneumoniae infection in adult inpatients during the 2023\u201324 outbreak in France (MYCADO): a national, retrospective, observational study","volume":"25","author":"Gavaud","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"2025122403223617000_ciaf453-B25","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/INF.0000000000002291","article-title":"The clinical presentation of pediatric Mycoplasma pneumoniae infections\u2014a single center cohort","volume":"38","author":"Gordon","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"2025122403223617000_ciaf453-B26","doi-asserted-by":"crossref","first-page":"2300724","DOI":"10.2807\/1560-7917.ES.2024.29.4.2300724","article-title":"Increased incidence of Mycoplasma pneumoniae infections and hospital admissions in The Netherlands, November to December 2023","volume":"29","author":"Bolluyt","year":"2024","journal-title":"Eurosurveillance"},{"key":"2025122403223617000_ciaf453-B27","doi-asserted-by":"crossref","first-page":"149","DOI":"10.15585\/mmwr.mm7307a3","article-title":"Notes from the field: reemergence of Mycoplasma pneumoniae infections in children and adolescents after the COVID-19 pandemic, United States, 2018\u20132024","volume":"73","author":"Edens","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025122403223617000_ciaf453-B28","doi-asserted-by":"crossref","first-page":"e514","DOI":"10.1016\/S2666-5247(23)00406-8","article-title":"Pneumonia outbreaks due to re-emergence of Mycoplasma pneumoniae","volume":"5","author":"Sauteur","year":"2024","journal-title":"Lancet Microbe"},{"key":"2025122403223617000_ciaf453-B29","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.3201\/eid1706.101558","article-title":"Macrolide resistance in Mycoplasma pneumoniae","volume":"17","author":"Averbuch","year":"2011","journal-title":"Emerg Infect Dis"},{"key":"2025122403223617000_ciaf453-B30","doi-asserted-by":"crossref","first-page":"4078","DOI":"10.1128\/JCM.02048-14","article-title":"Evaluation of five real-time PCR assays for detection of Mycoplasma pneumoniae","volume":"52","author":"Dumke","year":"2020","journal-title":"J Clin Microbiol"},{"key":"2025122403223617000_ciaf453-B31","doi-asserted-by":"crossref","first-page":"101019","DOI":"10.1016\/j.lanmic.2024.101019","article-title":"Global spatiotemporal dynamics of Mycoplasma pneumoniae re-emergence after COVID-19 pandemic restrictions: an epidemiological and transmission modelling study","volume":"6","author":"Sauteur","year":"2025","journal-title":"Lancet Microbe"},{"key":"2025122403223617000_ciaf453-B32","first-page":"2100746","article-title":"Mycoplasma pneumoniae detections before and during the COVID-19 pandemic: results of a global survey, 2017 to 2021","volume":"27","author":"Sauteur","year":"2022","journal-title":"Eurosurveillance"},{"key":"2025122403223617000_ciaf453-B33","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1093\/cid\/cix164","article-title":"Cardiovascular complications and short-term mortality risk in community-acquired pneumonia","volume":"64","author":"Violi","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2025122403223617000_ciaf453-B34","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1016\/j.amjcard.2019.01.014","article-title":"Mycoplasma pneumoniae pericarditis","volume":"123","author":"Vijay","year":"2019","journal-title":"Am J Cardiol"},{"key":"2025122403223617000_ciaf453-B35","author":"Pneumonia-Induced Inflammation"},{"key":"2025122403223617000_ciaf453-B36","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/1348-0421.12267","article-title":"Pathogenesis and association of Mycoplasma pneumoniae infection with cardiac and hepatic damage","volume":"59","author":"Fan","year":"2015","journal-title":"Microbiol Immunol"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaf453\/64169938\/ciaf453.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/81\/5\/e269\/64169938\/ciaf453.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/81\/5\/e269\/64169938\/ciaf453.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T08:22:49Z","timestamp":1766564569000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/81\/5\/e269\/8244960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,9,1]]},"published-print":{"date-parts":[[2025,12,24]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaf453","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11,15]]},"published":{"date-parts":[[2025,9,1]]}}}