Pediatric Mycoplasma Infections Workup

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 28, 2010
 

Laboratory Studies

Diagnostic tests for M pneumoniae are most useful in hospitalized children who may be at risk for fulminant pulmonary disease and complications of extrapulmonary illness. Otherwise, clinical and epidemiologic data can guide the care of the ambulatory patient.

  • Tests for M pneumoniae[52]
    • Bacterial culture is of little practical value because of fastidious growth requirements and slow growth.
    • Serologic diagnosis has been the mainstay of laboratory testing.
      • The cold agglutinin test may be performed at the bedside or in the laboratory. Serum from spun patient blood is combined with type O erythrocytes and incubated at 4°C for several minutes. The degree of agglutination is noted at this temperature and again after rewarming to 37°C to confirm resolution of the agglutination. The serum is diluted serially, and the test is repeated. The highest dilution resulting in agglutination at 4°C is reported as the cold agglutinin titer. The sensitivity of this test is 50-90%, and the specificity is approximately 75%.[1, 8]
      • Paired acute and convalescent sera are best for complement-fixation serology. A positive result requires a more than 4-fold rise in titer between acute and convalescent sera and more than 1:32 titer in a single serum specimen (86-90% sensitive and 87-94% specific). The test is not helpful in guiding diagnostic and therapeutic decisions because elevations in antibody titer may take as long as 3-4 weeks after the onset of disease. Additionally, the antibody response can be diminished or absent in immunosuppressed hosts and infants.[1, 8]
      • Enzyme-linked immunoassay is used to detect immunoglobulin M (IgM) and immunoglobulin G (IgG) directed against M pneumoniae. Specificity is greater than 99%, and sensitivity is 98% when both findings are obtained. The IgM result may be negative early (at 7-10 d) and may not be helpful in guiding initial therapy.[53]
    • Direct antigen detection in sputum specimens is performed using antigen-capture indirect enzyme immunoassay. Relatively high specificity and sensitivity (91%) are achieved.
    • Detection of nucleotide sequences with a commercially available kit is based on radioiodine-labeled DNA complementary to M pneumoniae ribosomal RNA. Sensitivity and specificity were 89% in 1 study.
    • Seminested polymerase chain reaction (PCR) assay using 16S ribosomal DNA (rDNA) as a target and real-time PCR assays targeting the gene for P1 adhesion protein are available.[54, 55, 56] They do not rely on an immunologic response; therefore, relatively early detection is possible. Both techniques have high sensitivity and high specificity. Real-time PCR assays have the advantage of speed and the ability to analyze numerous samples.
  • Tests for genital mycoplasmal organisms
    • These organisms are usually detected by means of cultures in special media (beef-heart infusion broth with fresh yeast extract and horse serum), followed by subcultures on agar media. Ureaplasma species usually grow within 1-2 days, and M hominis grows within 1 week, but Mycoplasma genitalium may require 1-2 months to grow.
    • Antibody studies, organ cultures, and animal inoculation have all been used, but they have little practical application in routine diagnostic laboratories. PCR techniques using clinical specimens from the upper genital tract obtained during laparoscopy may be of value in the future.
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Imaging Studies

Chest radiographs demonstrate characteristic features of M pneumoniae infection: bilateral pulmonary involvement, multifocal or diffuse disease, and reticular infiltrates.[32] In rare cases, pleural effusions may be superimposed on parenchymal disease; however, one study reported a 23% incidence rate.[32] Late in the course, pleural effusions may be the only remaining feature. Hilar lymphadenopathy can be present in 7-22% of pediatric patients.

High-resolution CT may reveal the lobular distribution, centrilobular involvement, and interstitial abnormalities in M pneumoniae pneumonia better than chest radiography.[10] However, high-resolution CT is more expensive, and radiation exposure is increased. High-resolution CT is usually not indicated in the routine workup of all patients.

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Procedures

Because most infections tend to be mild, few diagnostic procedures need to be performed. In severe lower respiratory infection caused by M pneumoniae, bronchoalveolar lavage with appropriate testing of the lavage fluid may be needed; antigen detection, PCR, and culturing are used.[52, 53, 54, 55, 56] In the presence of neurological disease of unknown etiology, investigating Mycoplasma serologically and using cerebrospinal fluid (CSF) analysis is prudent.[43]

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Histologic Findings

The histopathology of M pneumoniae infection is limited to the ciliated respiratory epithelium extending from the trachea to the respiratory bronchiole. The airways are surrounded by mononuclear cell infiltrates. Intraluminal infiltrates may include polymorphonuclear cells and mononuclear cells.[3]

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Contributor Information and Disclosures
Author

Archana Chatterjee, MD, PhD  Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

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

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine O'Keefe, DNP, APRN  Assistant Professor of Nursing and Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O'Keefe, DNP, APRN is a member of the following medical societies: American Academy of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, and Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

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 and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

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