Symptoms and Treatment of Mycoplasma Pneumonia
Mycoplasma pneumonia typically presents with fever, arthralgia, headache, cough and crackles, especially in school-aged children, and requires macrolide antibiotics as first-line treatment. 1
Clinical Presentation
Common Symptoms
- Fever (typically >38.5°C) 1
- Headache 1
- Arthralgia (joint pain) 1
- Cough (may develop later in the illness) 1, 2
- Malaise 2
- Chest pain in older children 1
- Abdominal pain (reflecting referred pain from the diaphragmatic pleura) in older children 1
Physical Examination Findings
- Crackles on auscultation 1
- Wheeze in approximately 30% of cases, more common in older children 1
- Normal or slightly elevated white blood cell count 2
- Signs of bronchial breathing and pleural effusion are typically not present at onset 1
Age-Related Considerations
- Most commonly affects school-aged children 3
- Can be confused with asthma in clinical presentation, especially when wheeze is present 1
- In older children, a history of difficulty in breathing is more helpful than clinical signs 1
Diagnostic Approach
Clinical Diagnosis
- Suspect Mycoplasma pneumonia in school-aged children with fever, arthralgia, headache, cough and crackles 1
- The presentation can resemble pneumococcal and staphylococcal pneumonias as well as adenoviral illness if wheezing is prominent 1
- Normal or only slightly elevated white blood cell count is typical 2
Radiographic Findings
- Chest radiograph may show segmental or subsegmental pulmonary infiltrates 2
- No pathognomonic radiographic presentation exists, but careful consideration of clinical and radiographic data usually suggests the diagnosis 2
Treatment
Antibiotic Therapy
- Macrolide antibiotics (erythromycin, clarithromycin, azithromycin) are the first-line treatment for Mycoplasma pneumonia 1, 4
- Azithromycin is FDA-approved for treatment of community-acquired pneumonia due to Mycoplasma pneumoniae 4
- Tetracycline derivatives (like doxycycline) are effective alternatives, especially in cases of macrolide resistance 5, 6
- Doxycycline is indicated for respiratory tract infections caused by Mycoplasma pneumoniae 5
Treatment Duration and Response
- The disease in previously healthy hosts is usually benign and self-limiting 2
- Treatment course is shortened with appropriate antibiotics 2
- If a child remains pyrexial or unwell 48 hours after starting treatment, re-evaluation is necessary 1
Management of Resistant or Refractory Cases
- Macrolide-resistant Mycoplasma pneumonia is increasingly common, especially in East Asia 6
- Alternative second-line agents such as tetracyclines (doxycycline or minocycline) or fluoroquinolones may be needed after macrolide treatment failure 6
- Immunomodulators such as corticosteroids may be beneficial in refractory cases with excessive immune response 6
Special Considerations
Severe Cases
- While typically mild, Mycoplasma pneumonia can occasionally lead to severe disease 7
- Patients with humoral immunodeficiency often develop severe infections with joint involvement 3
- Extrapulmonary complications can include dermatologic, neurological, cardiac, renal, and pulmonary manifestations 3, 8
Supportive Care
- Antipyretics and analgesics can be used to keep the child comfortable and to help with coughing 1
- Ensure adequate hydration 1
- Oxygen therapy should be provided if oxygen saturation is 92% or less 1
Follow-up
- Children cared for at home should be reviewed if deteriorating or not improving after 48 hours on treatment 1
- Families need information on managing fever, preventing dehydration, and identifying signs of deterioration 1
Prevention
- No specific vaccine is available for Mycoplasma pneumonia
- Standard respiratory hygiene practices are recommended to prevent spread