MYCOPLASMA PNEUMONIAE

Mycoplasmas are the smallest self-replicating biologic system; they depend on

attachment to the host cells for obtaining nutrition. They are double-stranded
DNA & are fastidious in growth.
Epid. M. pneumoniae infection occur worldwide and year-round. The peak age of
illness is school-aged children & adolescents. Re-infection can occur but usually
mild or subclinical. Transmission of infection occurs through the respiratory route
by large droplet spread.
M. pneumoniae may persist for years in the respiratory tract of patients with
hypogammaglobulinemia (despite Rx) & it is a common infection in acute chest
syndrome of SCA, but it not prevalent in patients with AIDS!.
Path. M. pneumonia most commonly causes LRTI e.g. tracheobronchitis &
broncho-pneumonia, although it can cause URTI e.g. pharyngitis, sinusitis, AOM,
& croup.
C.M. The I.P. is 2-3 wk. The onset is gradual as headache, malaise, fever, and sore
throat; followed by hoarseness and cough, whereas coryza is unusual & may
suggest viral etiology. The cough initially is nonproductive, but older children and
adolescents may produce frothy, white sputum. The cough may followed by
dyspnea if the infection is untreated.
The severity of symptoms are usually greater than that suggested by physical
signs, which appear later e.g. fine crackles or wheezes that are fine and resemble
those of asthma and bronchiolitis.
Note: M. pneumoniae may be a common trigger of wheezing in asthmatic children
& may cause chronic colonization in them.
Inv.
CXR usually show interstitial pneumonia or bronchopneumonia, but more
commonly it show unilateral, centrally dense infiltrates in the lower lobes +/_
hilar LAP.
 CBP; WBC count is usually normal, but ESR is usually elevated.
Serology; indirect fluorescence or enzyme-linked immune assay (EIA) can detect
IgM which may remain +ve for 6–12 mo after infection. 4-fold ↑ in IgG titer, by
complement fixation or EIA, between acute and convalescent sera is diagnostic;
whereas Cold Agglutinin is not specific & +ve in only half of cases. - 453 -
Cultures of throat or sputum on specific media is also diagnostic.
PCR of nasopharyngeal or throat swab.
Cx. Bacterial superinfection is unusual in M. pneumonia infection, but non-
respiratory Cxs may be due to direct invasion of M. pneumoniae to other organs
or due to autoimmune mechanism, including:-
Dermatologic; maculopapular rashes, erythema multiforme, and Stevens-
Johnson syndrome.
Hematologic; hemolysis may be associated with cold hemagglutinins with +ve
Coombs test after 2–3 wk of the respiratory illness; thrombocytopenia and
coagulation defects are rarely occur.
Neurologic; meningoencephalitis, transverse myelitis, aseptic meningitis,
cerebellar ataxia, Bell's palsy, deafness, brainstem syndrome, acute demyelinating
encephalitis, & Guillain-Barre syndrome. They usually occur 2–3 wk after
respiratory illness but may occur without it.
Note: Early onset of encephalitis may be due to direct invasion, whereas delayed
onset may be due to autoimmune mechanism. Concomitant viral infection may
also occur.
After Mycoplasma encephalitis, 20–30% of patients may have neurologic
sequelae.
Other rare Cxs include: myocarditis, pericarditis, rheumatic fever–like
syndrome, transient monoarticular arthritis, hepatitis, pancreatitis, and protein-
losing hypertrophic gastropathy.
Rx. M. pneumonia is resistant to β-lactam antibiotics which act on the cell wall of
bacteria (because these organisms have no cell wall); however they sensitive to
Tetracyclines & Macrolides e.g. Azithromycin, 10 mg/kg on day 1 then 5 mg/kg
for the following 4 days once daily; or Clarithromycin, 15 mg/kg/day ÷ 2 for 10
days orally.
These antibiotics can also given as Px during outbreak of Mycoplasma infection.
Corticosteroids +/_ IVIG has been used for Rx of most Cxs of Mycoplasma
infection, especially the Neurologic