Mycoplasmal Pneumonia Treatment & Management

Updated: Aug 11, 2016
  • Author: Michael Joseph Bono, MD, FACEP; Chief Editor: Ryland P Byrd, Jr, MD  more...
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Treatment

Approach Considerations

Mycoplasmal pneumonia should be considered as a possible etiology in any patient who presents with three weeks or more of a steadily progressive cough. Patients are usually not critically ill but seek relief from the persistent, worsening cough. Occasionally, various pulmonary and extrapulmonary complications may occur and may require emergent attention.

Antibiotic prophylaxis for exposed contacts is not routinely recommended. However, macrolide or doxycycline prophylaxis should be used in households in which patients with underlying conditions may be predisposed to severe mycoplasmal infection, such as those with sickle cell disease or antibody deficiencies.

If patients with pneumonia due to M pneumoniae require admission, use of standard and droplet precautions are recommended for the duration of the illness. Supportive therapy and antimicrobial administration are the mainstays of treatment (See Medication).

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Complications

The following are complications of mycoplasmal pneumonia:

Although most cases of pneumonia cause by Mycoplasma pneumonia are mild and self-limited, fulminant disease can occur and result in the following:

Extrapulmonary complications may occur as a result of M pneumoniae infection, although the incidence is less than 10% when compared to respiratory problems. In many of the suspected extrapulmonary problems, it is unclear if the disease entity is caused by the organism itself, or by an immune response triggered by the M pneumoniae infection.

Cardiac problems

Cardiac involvement in M pneumoniae infection manifests as conduction abnormalities, either rhythm disturbances or heart blocks, seen on the ECG. Chest pain from pericarditis or myocarditis can be a clinical symptom, and these entities have been linked to anti-cardiolipin antibodies. [31] Congestive heart failure is another extrapulmonary complication of M pneumoniae infection. Myocardial damage has been reported in children with M pneumoniae pneumonia. [32]

Central nervous system problems

Central nervous system involvement is rare in most M pneumoniae infections, but hospitalized children are at particular risk of developing encephalitis, aseptic meningitis, transverse myelitis, peripheral neuropathy, or cerebellar ataxia. These complications can be seen in adults, although less frequently. [33, 34] Some of the CNS sequelae may be permanent. [35] How M pneumoniae causes neurologic damage is unclear, but may be linked to an immunologic reaction to antigens produced by the infection. [35]

Hematologic problems

Hemolytic anemia may develop if the IgM antibodies to M pneumoniae antigens cross react to antigens on human erythrocytes, causing destruction. Hemolysis in sickle cell patients with an M pneumoniae infection is concerning, but rarely fatal. [36]

Skin problems

M pneumoniae infection has been associated with erythema multiforme, macular exanthems, vesicular exanthems, urticaria, erythema nodosum, and Stevens-Johnson syndrome. [12] Cutaneous disease can develop in up to 25-33% of all M pneumoniae infections. [37]

Musculoskeletal problems

M pneumoniae has been associated with arthralgia and myalgias, although arthritis is rare. Rhabdomyolysis has been linked with M pneumoniae infections, with very high CPK and myoglobin levels reported. [38, 39] Dermatomyositis has been associated with M pneumoniae infection. [40]

Gastrointestinal problems

Gastrointestinal symptoms are nonspecific, include hepatitis and pancreatitis, and are thought to be related to circulating antibodies to the M pneumoniae organisms.

Ophthalmologic problems

The ophthalmologic manifestation of M pneumoniae infection is most commonly conjunctivitis, but cranial neuropathies, optic papillitis, and anterior uveitis can occur. [41]

Renal problems

Glomerulonephritis is a rare complication of M pneumoniae infection, and is likely caused by immune complex deposits in the glomerulus.

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