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Mycoplasma pneumoniae
Epidemiology:
1) humans are the only known reservoir
2) spread of infection is person to person
3) infections occur in endemic & epidemic forms
4) epidemics are more common in summer & autumn
5) more common in children & young adults
6) 20% of all community-acquired pneumonia
7) outbreak affecting 83 students at a Georgia University in 2012 [5]
8) outbreak in long-term care facility in Nebraska 2014 [6]
9) common infection in closed populations [6] (residential facilities, boarding schools, military barracks ...)
Clinical manifestations:
1) incubation period is 2-3 weeks
2) fever (85%)
3) coryza
4) pharyngitis (50%)
- mucositis (image) [7]
5) bullous myringitis (20%)
6) pulmonary manifestations
a) tracheobronchitis
b) pneumonia occurs in 3-10% of infected patients
c) interstitial pneumonia
d) bronchiolitis
e) cough (> 90%)
7) hemolytic anemia
8) erythema multiforme
9) hepatitis
10) Guillain-Barre syndrome
Laboratory:
- Mycoplasma pneumoniae serology
- complement fixation serology
- 4 fold increase in titer in 50-80% of patients
- Mycoplasma pneumoniae DNA, Mycoplasma pneumoniae rRNA
- Mycoplasma pneumoniae culture
- respiratory tract secretions
- middle ear
- cerebrospinal fluid (CSF)
- cold agglutinins
- > 1:64 in 50% of patients
- appear during 2nd to 3rd week after onset of symptoms
- titer decreases to insignificant levels by 4-6 weeks
- abnormal liver function tests
- platelet count: thrombocytopenia
- see ARUP consult [4]
Radiology:
- chest X-ray
a) unilateral bronchopneumonia
b) lower lobe involvement (65%)
c) pleural effusion (5%)
Management: (antimicrobial therapy)
1) macrolide
a) erythromycin
b) clarithromycin
c) azithromycin
2) tetracycline or doxycycline
3) fluoroquinolone
4) resistance to beta-lactam antibiotics
Related
Mycoplasma DNA
General
Mycoplasma
Properties
KINGDOM: monera
DIVISION: SCHIZOMYCETES
References
- Manual of Medical Therapeutics, 28th edition, Ewald &
McKenzie (eds) Little, Brown & Co, 1995, pg 301
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 795
- Medical Knowledge Self Assessment Program (MKSAP) 15, 18.
American College of Physicians, Philadelphia 2009, 2018.
- ARUP Consult: Mycoplasma pneumoniae
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/mycoplasma-pneumoniae
- Centers for Disease Control and Prevention (CDC)
Mycoplasma pneumoniae outbreak at a university -
Georgia, 2012.
MMWR Morb Mortal Wkly Rep 2013 Aug 2; 62:603.
PMID: 23903594
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6230a2.htm
- Hastings DL et al.
Mycoplasma pneumoniae outbreak in a long-term care facility
- Nebraska, 2014.
MMWR Morb Mortal Wkly Rep 2015 Mar 27; 64:296
PMID: 25811678
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a2.htm
- Li T, Lee N.
Mycoplasma pneumoniae-Associated Mucositis.
N Engl J Med 2018; 379:1262. Sept 27, 2018
PMID: 30257151
https://www.nejm.org/doi/full/10.1056/NEJMicm1614484