Mycoplasma Infections Clinical Presentation

  • Author: Ken B Waites, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 19, 2011
 

History

Typical symptoms can develop and persist over weeks to months and include flulike manifestations.

  • Symptoms
    • Generalized aches and pains
    • Fever (usually ≤ 102°F)
    • Cough - Usually nonproductive
    • Sore throat (nonexudative pharyngitis)
    • Headache/myalgias
    • Chills but not rigors
    • Nasal congestion with coryza
    • Earache
    • General malaise
  • In very young children, upper respiratory tract manifestations may predominate, whereas in older children and adults, lower respiratory tract symptoms are more likely.
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Physical

Physical findings can be quite variable. Patients typically do not appear toxic or severely ill, but some abnormalities may be apparent in a significant proportion of cases.

  • Physical findings include the following:
    • Oropharyngeal inflammation
    • Cervical adenopathy - Usually absent
    • Erythematous tympanic membranes
    • Conjunctivitis
    • Maculopapular or urticarial rash
  • Chest auscultation in patients with pneumonia may demonstrate localized rhonchi and scattered moist rales, generally involving multiple lobes of the lung and sometimes accompanied by wheezes, with no signs of consolidation, egophony, or bronchial breathing.
  • In many persons, chest auscultative and percussive abnormalities are minimal to absent.
  • Extrapulmonary manifestations may occur in a minority of persons (see Complications).[6]
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Causes

This is a bacterial infection caused by M pneumoniae.

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Contributor Information and Disclosures
Author

Ken B Waites, MD  Director, UAB Diagnostic Mycoplasma Laboratory, Professor, Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham

Ken B Waites, MD is a member of the following medical societies: American Society for Microbiology and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Maria D Mileno, MD  Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Baxter International and Johnson & Johnson Royalty Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. Oct 2004;17(4):697-728, table of contents. [Medline].

  2. Muir MT, Cohn SM, Louden C, Kannan TR, Baseman JB. Novel toxin assays implicate Mycoplasma pneumoniae in prolonged ventilator course and hypoxemia. Chest. Feb 2011;139(2):305-10. [Medline].

  3. Kannan TR, Provenzano D, Wright JR, Baseman JB. Identification and characterization of human surfactant protein A binding protein of Mycoplasma pneumoniae. Infect Immun. May 2005;73(5):2828-34. [Medline].

  4. Techasaensiri C, Tagliabue C, Cagle M, Iranpour P, Katz K, Kannan TR. Variation in colonization, ADP-ribosylating and vacuolating cytotoxin, and pulmonary disease severity among mycoplasma pneumoniae strains. Am J Respir Crit Care Med. Sep 15 2010;182(6):797-804. [Medline].

  5. Hardy RD, Coalson JJ, Peters J, Chaparro A, Techasaensiri C, Cantwell AM. Analysis of pulmonary inflammation and function in the mouse and baboon after exposure to Mycoplasma pneumoniae CARDS toxin. PLoS One. 2009;4(10):e7562. [Medline].

  6. Talkington DF, Waites KB, Schwartz S, Besser RE. Emerging from obscurity: Understanding pulmonary and extrapulmonary syndromes, pathogenesis, and epidemiology of human Mycoplasma pneumoniae infections. In: Scheld WM, Craig WA, Hughes JM, eds. Emerging Infections. Vol 5. Washington, DC: ASM Press; 2001:57-84.

  7. Waites KB, Balish MF, Atkinson TP. New insights into the pathogenesis and detection of Mycoplasma pneumoniae infections. Future Microbiol. Dec 2008;3(6):635-48. [Medline].

  8. Foy HM. Infections caused by Mycoplasma pneumoniae and possible carrier state in different populations of patients. Clin Infect Dis. Aug 1993;17 Suppl 1:S37-46. [Medline].

  9. Marston BJ, Plouffe JF, File TM Jr, et al. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. The Community-Based Pneumonia Incidence Study Group. Arch Intern Med. Aug 11-25 1997;157(15):1709-18. [Medline].

  10. Waites KB. New concepts of Mycoplasma pneumoniae infections in children. Pediatr Pulmonol. Oct 2003;36(4):267-78. [Medline].

  11. Cunha BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. May 2006;12 Suppl 3:12-24. [Medline].

  12. Cunha BA. Pneumonia Essentials. 3rd ed. Royal Oak, MI: Physicians Press; 2010.

  13. Cunha BA. Liver involvement with Mycoplasma pneumoniae community-acquired pneumonia. J Clin Microbiol. Jul/2003;41(7):3456-7. [Medline].

  14. Parchuri S, Cunha BA. Mycoplasma pneumoniae community-acquired pneumonia: Diagnostic usefulness of the agglutination-dissociation test. Infect Dis Pract. 2006;30:550-1.

  15. Talkington DF, Shott S, Fallon MT, Schwartz SB, Thacker WL. Analysis of eight commercial enzyme immunoassay tests for detection of antibodies to Mycoplasma pneumoniae in human serum. Clin Diagn Lab Immunol. Sep 2004;11(5):862-7. [Medline].

  16. Beersma MF, Dirven K, van Dam AP, Templeton KE, Claas EC, Goossens H. Evaluation of 12 commercial tests and the complement fixation test for Mycoplasma pneumoniae-specific immunoglobulin G (IgG) and IgM antibodies, with PCR used as the "gold standard". J Clin Microbiol. May 2005;43(5):2277-85. [Medline].

  17. Winchell JM, Thurman KA, Mitchell SL, Thacker WL, Fields BS. Evaluation of three real-time PCR assays for detection of Mycoplasma pneumoniae in an outbreak investigation. J Clin Microbiol. Sep 2008;46(9):3116-8. [Medline].

  18. Liu Y, Ye X, Zhang H, Xu X, Li W, Zhu D, et al. Antimicrobial susceptibility of Mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant strains from Shanghai, China. Antimicrob Agents Chemother. May 2009;53(5):2160-2. [Medline].

  19. Li X, Atkinson TP, Hagood J, Makris C, Duffy LB, Waites KB. Emerging macrolide resistance in Mycoplasma pneumoniae in children: detection and characterization of resistant isolates. Pediatr Infect Dis J. Aug 2009;28(8):693-6. [Medline].

  20. Peuchant O, Ménard A, Renaudin H, Morozumi M, Ubukata K, Bébéar CM, et al. Increased macrolide resistance of Mycoplasma pneumoniae in France directly detected in clinical specimens by real-time PCR and melting curve analysis. J Antimicrob Chemother. Jul 2009;64(1):52-8. [Medline].

  21. Wolff BJ, Thacker WL, Schwartz SB, Winchell JM. Detection of macrolide resistance in Mycoplasma pneumoniae by real-time PCR and high-resolution melt analysis. Antimicrob Agents Chemother. Oct 2008;52(10):3542-9. [Medline].

  22. Suzuki S, Yamazaki T, Narita M, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother. Feb 2006;50(2):709-12. [Medline].

  23. Klausner JD, Passaro D, Rosenberg J, et al. Enhanced control of an outbreak of Mycoplasma pneumoniae pneumonia with azithromycin prophylaxis. J Infect Dis. Jan 1998;177(1):161-6. [Medline].

 
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