What are the clinical presentations of Mycoplasma (Mycoplasma) infections?

From the Guidelines

Mycoplasma infections typically present with respiratory symptoms, including persistent dry cough, sore throat, low-grade fever, headache, and malaise, and can be diagnosed through a combination of clinical presentation, laboratory findings, and serological tests, with macrolide antibiotics being the first-line treatment. The clinical presentation of Mycoplasma infections can vary, but common symptoms include:

• Persistent dry cough
• Sore throat
• Low-grade fever
• Headache
• Malaise
• Extrapulmonary manifestations, such as skin rashes, neurological symptoms, hemolytic anemia, and myocarditis, can occur in severe cases 1. Laboratory findings may show mild leukocytosis or normal white blood cell counts, and chest X-rays typically demonstrate interstitial infiltrates rather than lobar consolidation 1. The diagnosis of Mycoplasma infections can be challenging, but a combination of IgM antibody detection and PCR may be the most sensitive approach, as demonstrated in several studies 1. For treatment, macrolide antibiotics, such as azithromycin or clarithromycin, are the first-line therapies, with fluoroquinolones or tetracyclines being alternatives for patients with macrolide allergies or in areas with high macrolide resistance 1. Supportive care with adequate hydration and antipyretics is also important for symptom management, and the slow-growing nature of mycoplasma organisms explains the prolonged course of illness and the need for longer antibiotic treatment compared to other respiratory infections 1.

From the Research

Clinical Presentations of Mycoplasma Infections

The clinical presentations of Mycoplasma infections vary depending on the species and the infected individual.

• Mycoplasma genitalium infections are associated with:
  • Non-chlamydial non-gonococcal urethritis in men, with symptoms including urethritis, dysuria, and discharge 2
  • Cervicitis and pelvic inflammatory disease (PID) in women, with symptoms including vaginal discharge, dysuria, abdominal pain, and dyspareunia 2
• Mycoplasma pneumoniae infections are associated with community-acquired respiratory tract infections, particularly in school-aged children and young adults, with symptoms including fever, cough, and respiratory distress 3

Transmission and Diagnosis

• Mycoplasma genitalium infections are transmitted through direct mucosal contact 2
• Diagnosis of Mycoplasma infections is achievable only through nucleic acid amplification testing, and must include investigation for macrolide resistance mutations 2
• Symptoms are the main indication for diagnostic testing, and asymptomatic infections are frequent 2

Treatment Options

• Azithromycin is the preferred treatment for Mycoplasma genitalium infections, with a cure rate of 85-95% in macrolide-susceptible infections 2, 4
• Doxycycline has a cure rate of 30-40%, but resistance is not increasing 2
• Moxifloxacin can be used as second-line therapy, but resistance is increasing 2, 4
• Pristinamycin and solithromycin may be of clinical benefit for multidrug-resistant infections 4