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Mycoplasma Infections Follow-up

  • Author: Ken B Waites, MD; Chief Editor: Michael Stuart Bronze, MD  more...
Updated: Oct 08, 2015

Further Outpatient Care

With appropriate treatment, uncomplicated episodes of M pneumoniae infection can be expected to resolve clinically within 7-10 days after onset.

Additional laboratory tests or radiographs are not usually necessary unless the illness does not respond to therapy, which would raise questions about the accuracy of the microbiological diagnosis or the possibility of chronic infection, which sometimes occurs.

The presence of extrapulmonary manifestations may warrant further workup and follow-up, depending on their nature and severity.

Improvement of pneumonia on chest radiographs may lag behind clinical improvement.



Antimicrobial prophylaxis

As with other bacterial infections, researchers have studied the value of antimicrobial prophylaxis for those in contact with persons with M pneumoniae infection.

Klausner et al (1998) reported that the administration of oral azithromycin plus standard epidemic control measures significantly reduced secondary attack rates following an outbreak of M pneumoniae pneumonia in a long-term care facility for mentally and developmentally disabled persons.[23]

Previous studies using tetracyclines also demonstrated the efficacy of chemoprophylaxis in reducing transmission of M pneumoniae pneumonia.


Researchers have studied vaccines for many years, but they have not produced a vaccine for general use.

The fact that natural infection does not confer complete protective immunity against future infections makes this approach less promising.


Because of the endemicity of infection with M pneumoniae in susceptible populations, isolating patients is seldom practical and generally is not recommended.



Extrapulmonary complications

Extrapulmonary complications may occur simultaneously with the onset of respiratory manifestations or as long as several days later. These complications may predominate to the extent that physicians may overlook a primary respiratory tract infection. Less than 10% of cases of M pneumoniae infections are associated with nonrespiratory illnesses, with the exception of various skin rashes, nausea, vomiting, and diarrhea, which may occur more often.[15]

When extrapulmonary manifestations occur, however, they clearly can complicate the diagnosis and the recovery; they also make hospitalization more likely. Thus, a careful history and physical examination are essential, and follow-up is indicated.

Researchers believe that an autoimmune response plays a role in some extrapulmonary complications, but, because M pneumoniae has been isolated directly from cerebrospinal, pericardial, and synovial fluids and from other extrapulmonary sites, always consider direct invasion by this organism.

Extrapulmonary manifestations may include the following:

  • Meningoencephalitis
  • Ascending (ie, Guillain-Barré) paralysis
  • Transverse myelitis
  • Myopericarditis
  • Cardiac arrhythmia
  • Raynaud phenomenon
  • Hemolytic anemia
  • Disseminated intravascular coagulation
  • Renal failure
  • Arthritis
  • Erythema multiforme (ie, Stevens-Johnson syndrome)
  • Erythema nodosum
  • Urticaria
  • Ulcerative stomatitis
  • Nausea
  • Vomiting
  • Diarrhea


Most persons who are free of underlying conditions that may adversely affect the outcome of a respiratory tract infection can expect an excellent prognosis and a full return of pulmonary function.

For the minority of patients who have severe disease, diminished lung function may persist for weeks to months.

For the few persons who experience disseminated extrapulmonary symptoms, particularly neurologic manifestations, recovery can require weeks to months. While most recover fully and uneventfully, some persons with neurologic manifestations may experience long-term paralysis and reports describe cases of permanent neurologic deficits.

Contributor Information and Disclosures

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

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, Sigma Xi

Disclosure: Nothing to disclose.

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