From the Guidelines
Severe Mycoplasma infections are characterized by symptoms such as severe dyspnea and high fever, and require prompt antibiotic treatment, typically with macrolides as first-line therapy, although resistance is a growing concern, especially in Asia, as reported in a study where up to 95% of M. pneumoniae isolates from adult patients with respiratory tract infections were resistant to macrolides 1.
Characteristics of Severe Infections
Severe Mycoplasma pneumoniae infections can lead to complications such as:
- Pleural effusions
- Respiratory failure
- Extrapulmonary manifestations, including neurological symptoms, skin rashes, or hemolytic anemia These complications can be life-threatening and require immediate medical attention.
Treatment Options
The treatment of severe Mycoplasma infections typically involves antibiotics, with macrolides being the first-line therapy, although alternatives such as fluoroquinolones like levofloxacin or doxycycline may be necessary in cases of macrolide resistance or allergies, as reported in the guidelines for the treatment of pneumonia in Taiwan 1.
Supportive Care
Supportive care, including oxygen therapy, adequate hydration, and antipyretics for fever, is essential in managing severe Mycoplasma infections.
Recovery and Prevention
Recovery from severe Mycoplasma infections can take 2-4 weeks, and patients should complete the full antibiotic course even if symptoms improve earlier to prevent relapse and antibiotic resistance, highlighting the importance of adherence to treatment protocols 1.
From the Research
Characteristics of Severe Mycoplasma Infections
- Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men and is associated with cervicitis and pelvic inflammatory disease (PID) in women 2, 3
- Symptoms of M. genitalium infection include vaginal discharge, dysuria, and symptoms of PID such as abdominal pain and dyspareunia in women, and urethritis, dysuria, and discharge in men 2, 3
- Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults, and is associated with symptoms such as fever, cough, and hospitalization 4
Transmission and Diagnosis
- Transmission of M. genitalium occurs through direct mucosal contact 2, 3
- Diagnosis of M. genitalium infection is achievable only through nucleic acid amplification testing (NAAT) and must include investigation for macrolide resistance mutations 2, 3
- Diagnosis of M. pneumoniae infection can be made through molecular methods applicable directly from respiratory specimens 4
Treatment and Resistance
- Azithromycin is the preferred treatment for M. genitalium infection, with a cure rate of 85-95% in macrolide-susceptible infections 2, 3
- However, macrolide resistance is increasing, with prevalence ranging from 0 to 100% in different regions 4, 3, 5, 6
- Alternative treatments for M. genitalium infection include moxifloxacin, doxycycline, and pristinamycin, but resistance to these antibiotics is also increasing 2, 3, 5, 6
- Treatment failure rates for M. genitalium infection are substantial, with 44% of patients having a positive test of cure after azithromycin treatment 5