Pediatric Mycoplasma Infections Clinical Presentation

Updated: Apr 17, 2018
  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD  more...
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Presentation

History

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, [29] and acute asthma may be the first manifestation ofinfection. [19, 20, 21, 22, 23, 30, 31, 32]

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, 33, 34, 35, 36, 37, 38, 39] Neonates may present with symptoms of cough, meningitis, or brain abscess. [40, 41]

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Physical

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. [42] Wheezing can occur, especially in patients with asthma. [21, 22, 23, 43] 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. [44, 45] Neonates, especially premature infants, may present with wheezing, retractions, and respiratory failure or signs of meningitis/brain abscess (eg, seizures, lethargy, neurologic deficits). [14, 40, 41]

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, 46, 47, 48, 49, 50, 51, 52]

  • Urticarial manifestations - Raynaud phenomenon

  • Cardiac manifestations

    • Arrhythmia and/or ECG abnormalities (conduction defects)

    • Congestive failure

    • Pericarditis

    • Myocarditis

    • Endocarditis

  • Neurologic/psychiatric manifestations [5, 7, 9, 53, 54]

    • 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 [55, 56, 57]

    • Polyarthralgias

    • Acute arthritis (monoarticular or migratory)

    • Digital necrosis

  • Hematologic manifestations

    • Immune hemolytic anemia [53, 58, 59, 60]

    • Pancytopenia

    • Splenic infarct

    • Hemophilia-like illness

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Causes

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.

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