From the Guidelines
Complications from Mycoplasma pneumoniae infections occur in approximately 5-10% of cases, with the most frequent complications including neurological, cardiac, and hematologic issues. The frequency of these complications can be broken down into:
- Neurological issues (such as encephalitis, meningitis, and Guillain-Barré syndrome) which occur in about 0.1% of infections 1
- Cardiac complications (myocarditis, pericarditis) in roughly 1-5% of cases
- Hematologic problems (hemolytic anemia, thrombocytopenia) in 1-3% of patients Some studies suggest that skin manifestations like Stevens-Johnson syndrome appear in approximately 1-5% of infections 1. Respiratory complications such as pleural effusions develop in about 5-20% of hospitalized patients, while progression to severe pneumonia requiring intensive care occurs in less than 5% of cases. These complications are more common in children, immunocompromised individuals, and those with delayed treatment. The pathophysiology involves both direct bacterial damage and immune-mediated responses, as Mycoplasma triggers inflammatory cascades and autoimmune reactions through molecular mimicry. Early treatment with appropriate antibiotics (macrolides like azithromycin 500mg on day 1, then 250mg daily for 4 more days; or doxycycline 100mg twice daily for 7-14 days) can significantly reduce the risk of complications 1. Key factors to consider in managing Mycoplasma pneumoniae infections include:
- Patient population: children, immunocompromised individuals, and those with underlying health conditions are at higher risk for complications
- Timely diagnosis and treatment: early initiation of appropriate antibiotics can reduce the risk of complications and improve outcomes
- Monitoring for complications: close surveillance for neurological, cardiac, and hematologic issues is crucial in patients with Mycoplasma pneumoniae infections.
From the Research
Frequency of Complications
- Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men 2
- In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID) in 10-25% 2
- M. genitalium is a frequent cause of urogenital syndromes in men and women and is associated with adverse sequelae in women 3
- The prevalence of genital mycoplasmas is 18.6% among 9956 individuals analyzed 4
Types of Complications
- Urethritis, dysuria, and discharge in men 2
- Vaginal discharge, dysuria, or symptoms of PID (abdominal pain and dyspareunia) in women 2
- Proctitis, but rarely infects the pharynx 3
- Epididymitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission 5
Antibiotic Resistance and Treatment
- Antibiotic resistance is widespread, with more than half of infections resistant to macrolides and fluoroquinolone resistance increasing 3
- Resistance-guided therapy is recommended for symptomatic patients, involving initial treatment with doxycycline followed by azithromycin for macrolide-sensitive infections or moxifloxacin for macrolide-resistant infections 3, 5
- Azithromycin 1g should not be used for the management of patients with symptomatic disease potentially caused by M. genitalium due to the risk of antibiotic resistance 6