eMedicine Specialties > Infectious Diseases > Bacterial Infections

Mycoplasma Infections: Follow-up

Author: Ken B Waites, MD, Director of Clinical Microbiology, Professor, Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham
Contributor Information and Disclosures

Updated: Nov 17, 2009

Follow-up

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.
  • 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.

Deterrence/Prevention

  • 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.14
    • Previous studies using tetracyclines also demonstrated the efficacy of chemoprophylaxis in reducing transmission of M pneumoniae pneumonia.
  • Vaccines
    • 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.

Complications

  • 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.8
    • 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

Prognosis

  • 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.

Miscellaneous

Medicolegal Pitfalls

  • No medicolegal pitfalls are described.
 


More on Mycoplasma Infections

Overview: Mycoplasma Infections
Differential Diagnoses & Workup: Mycoplasma Infections
Treatment & Medication: Mycoplasma Infections
Follow-up: Mycoplasma Infections
References
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References

  1. 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].

  2. 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].

  3. 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.

  4. 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].

  5. 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].

  6. 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].

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

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

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

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

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

  19. Waites KB, Rikihisa Y, Taylor-Robinson D. Mycoplasma and Ureaplasma. In: Murray PR, Baron EJ, eds. Manual of Clinical Microbiology. 8th ed. Washington, DC: ASM Press; 2003:972-90.

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Further Reading

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Keywords

mycoplasmata, mycoplasmal infection, walking pneumonia, atypical pneumonia, tracheobronchitis, bronchiolitis, upper respiratory tract infection, community-acquired pneumonia, CAP, bacterial pneumonia

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Contributor Information and Disclosures

Author

Ken B Waites, MD, Director of Clinical Microbiology, 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.

Medical Editor

Maria D Mileno, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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: Nothing to disclose.

CME Editor

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.

 
 
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