From the Guidelines
Mycoplasma infections typically present with a gradual onset of symptoms including persistent dry cough, low-grade fever, headache, malaise, and sore throat, often referred to as "walking pneumonia". The clinical features of mycoplasma pneumonia can be confusing and may resemble other respiratory infections, such as asthma or bacterial pneumonia 1. In older children, symptoms may include abdominal pain and chest pain, while wheezing is not a useful sign for determining severity in infants and young children, but occurs in 30% of mycoplasma pneumonias and is more common in older children 1.
Some key features of mycoplasma pneumonia include:
- Persistent dry cough
- Low-grade fever
- Headache
- Malaise
- Sore throat
- Scattered rales or rhonchi on physical examination
- Extrapulmonary manifestations such as skin rashes, hemolytic anemia, neurological complications, and cardiac issues 1.
It's worth noting that the diagnosis of mycoplasma pneumonia can be challenging, and the clinical presentation may not always be typical, especially in children 1. Therefore, a high index of suspicion and further diagnostic testing, such as chest X-rays and laboratory tests, may be necessary to confirm the diagnosis. The presence of cold agglutinins, which are present in about 50% of cases, can also aid in the diagnosis of mycoplasma pneumonia.
From the Research
Clinical Features of Mycoplasma
- Mycoplasma genitalium is a cause of non-gonococcal urethritis, cervicitis, and related upper genital tract infections 2
- It has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission 3
- The clinical features of Mycoplasma genitalium infection include urethritis, cervicitis, and proctitis 3
- In pregnant women, Mycoplasma genitalium infection has been linked to cervicitis, urethritis, and pelvic inflammatory disease (PID) 4
Diagnosis and Treatment
- Three Food and Drug Administration (FDA) approved tests are available for diagnosing Mycoplasma genitalium infection 3
- The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis, and state that testing should be considered in cases of PID 3
- Azithromycin is recommended as first-line treatment for Mycoplasma genitalium infection, but resistance to azithromycin is increasingly reported 2, 3, 5, 6
- Moxifloxacin is recommended as a second-line treatment for Mycoplasma genitalium infection, particularly in cases of azithromycin resistance 2, 3, 5
Resistance and Treatment Outcomes
- Azithromycin resistance is a significant concern in the treatment of Mycoplasma genitalium infection, with studies showing a high prevalence of resistance-associated mutations 2, 6
- The efficacy of azithromycin treatment is reduced in cases of azithromycin-resistant Mycoplasma genitalium infection 6
- Moxifloxacin has been shown to be more effective than azithromycin in eradicating Mycoplasma genitalium infections, particularly in cases of azithromycin resistance 5