Which is more common to cause adenitis, Mycoplasma or Enterovirus?

Mycoplasma vs Enterovirus as Causes of Adenitis

Enterovirus is more commonly associated with adenitis than Mycoplasma pneumoniae, particularly in cases of mesenteric adenitis. 1

Epidemiology and Causative Agents

According to national guidelines on viral infections, enteroviruses are among the most commonly identified causes of viral infections that can lead to adenitis, while Mycoplasma is generally considered in specific clinical scenarios such as atypical pneumonia 1.

The diagnostic algorithm for adenitis should consider:

1. Common viral causes:

   • Enteroviruses (frequently identified in mesenteric adenitis) 2
   • Adenovirus (particularly type 7 has been linked to mesenteric adenitis) 2
   • Other respiratory viruses (depending on adenitis location)

2. Less common causes:

   • Mycoplasma pneumoniae (primarily associated with respiratory symptoms)
   • Other atypical pathogens

Clinical Presentation Differences

When differentiating between the two causes:

• Enterovirus-associated adenitis:

  • Often presents with gastrointestinal symptoms
  • May have concurrent hand-foot-mouth disease in children 1
  • Frequently causes mesenteric adenitis that can mimic appendicitis 2
  • May be associated with viral exanthems

• Mycoplasma-associated adenitis:

  • Typically presents with concurrent respiratory symptoms
  • Associated with atypical pneumonia
  • Less commonly identified in isolated adenitis cases

Diagnostic Approach

For accurate diagnosis of the causative agent in adenitis:

1. Specimen collection:

   • Throat swabs and rectal swabs for enterovirus PCR 1
   • Throat swabs for Mycoplasma PCR when respiratory symptoms are present 1

2. Testing methods:

   • PCR testing is more sensitive than culture for both pathogens 1
   • For enterovirus: PCR of throat swab, rectal swab, and feces 1
   • For Mycoplasma: PCR of throat swab and serology 1

Clinical Pearls and Pitfalls

• Important caveat: The clinical context is crucial for determining the likely pathogen. Adenitis with respiratory symptoms suggests Mycoplasma, while adenitis with gastrointestinal symptoms suggests enterovirus.

• Diagnostic pitfall: Relying solely on serology may miss acute infections. PCR testing of appropriate specimens is recommended for both pathogens 1.

• Treatment consideration: While the question focuses on etiology rather than treatment, it's worth noting that the identification of the causative agent has implications for management, as Mycoplasma infections may respond to macrolide antibiotics, while enterovirus infections are typically managed supportively.

The evidence clearly indicates that enterovirus is more commonly associated with adenitis, particularly mesenteric adenitis, compared to Mycoplasma pneumoniae 1, 2.