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Pediatric Mycoplasma Infections Clinical Presentation

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD  more...
Updated: Jul 23, 2015


Symptoms of Mycoplasma pneumoniae infection are often nonspecific. The onset is usually insidious, with fever, malaise, headache, and cough. Cough is a hallmark of M. pneumoniae infection.[4, 12, 15, 16] The frequency and severity of cough may increase over the few days after onset and may become debilitating. In patients in whom the infection progresses to lower respiratory tract disease, the original symptoms persist, with a worsening and relatively nonproductive cough. On occasion, white or blood-flecked sputum and parasternal chest pain may be present as a result of muscle strain. Otitis media and sinusitis are uncommon. Postinfectious bronchitis may persist for weeks. M. pneumoniae infection may complicate asthma and exacerbate chronic obstructive pulmonary disease,[28] and acute asthma may be the first manifestation ofinfection.[19, 20, 21, 22, 23, 29, 30, 31]

Infection by genital mycoplasmal organisms may have diverse manifestations, including burning micturition (nongonococcal urethritis); prostatic pain, fever, and chills (suggestive of pyelonephritis); vaginal discharge; symptoms of pelvic inflammatory disease; postpartum fever; and postabortal fever.[1, 32, 33, 34, 35, 36, 37, 38] Neonates may present with symptoms of cough, meningitis, or brain abscess.[39, 40]



Patients with M. pneumoniae infection usually do not appear ill, and the illness often has been termed "walking pneumonia".[1, 3, 4, 15, 16] The pharynx may be erythematous without cervical adenopathy. Bullous myringitis is a classic but rare complication. Examination of the chest and lungs may yield little abnormality. A hallmark of M. pneumoniae infection is the disparity between physical findings (relatively few) and radiographic evidence of pneumonia.[41] Wheezing can occur, especially in patients with asthma.[21, 22, 23, 42] Rarely, fulminant pneumonia with respiratory failure can occur.[19, 20, 21, 22, 23]

Physical findings of genital Mycoplasma infection vary depending on the type of infection.[43, 44] Neonates, especially premature infants, may present with wheezing, retractions, and respiratory failure or signs of meningitis/brain abscess (eg, seizures, lethargy, neurologic deficits).[14, 39, 40]

Extrapulmonary manifestations of M. pneumoniae infection may or may not involve respiratory symptoms and include the following:

  • Dermatologic manifestations (most common)[4, 5, 6, 8, 45, 46, 47, 48, 49, 50, 51]
  • Urticarial manifestations - Raynaud phenomenon
  • Cardiac manifestations
    • Arrhythmia and/or ECG abnormalities (conduction defects)
    • Congestive failure
    • Pericarditis
    • Myocarditis
    • Endocarditis
  • Neurologic/psychiatric manifestations[5, 7, 9, 52, 53]
    • Encephalitis and meningoencephalitis
    • Transverse myelitis
    • Aseptic meningitis
    • Peripheral neuropathies and radiculopathies
    • Brainstem dysfunction
    • Dysfunction of the pyramidal or extrapyramidal tract
    • Cerebellar dysfunction
    • Cerebral infarction
    • Guillain-Barré syndrome
  • Musculoskeletal manifestations[54, 55, 56]
    • Polyarthralgias
    • Acute arthritis (monoarticular or migratory)
    • Digital necrosis
  • Hematologic manifestations
    • Immune hemolytic anemia[52, 57, 58, 59]
    • Pancytopenia
    • Splenic infarct
    • Hemophilia-like illness


M. pneumoniae causes infections leading to clinically apparent disease involving the upper respiratory tract. In 5-10% of patients, depending on age, the infection progresses to tracheobronchitis or pneumonia. M. hominis causes genital mycoplasmal infections, which may result in diverse manifestations.

Contributor Information and Disclosures

Archana Chatterjee, MD, PhD Professor and Chair, Department of Pediatrics, Senior Associate Dean for Faculty Development, Sanford School of Medicine, The University of South Dakota

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.


Catherine O’Keefe, DNP, APRN-NP Associate Professor of Nursing, Clinician-Educator Track Graduate Curriculum Coordinator, Nurse Practitioner Programs, Creighton University, School of Nursing; Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O’Keefe, DNP, APRN-NP is a member of the following medical societies: American Association of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.


Rosemary Johann-Liang, MD Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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General characteristics of Mycoplasma species.
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