From the Guidelines
Mycoplasma pneumonia in children typically presents with a gradual onset of symptoms, including a persistent dry cough, low-grade fever, and general malaise, with minimal respiratory distress despite significant radiographic findings. The clinical features of mycoplasma pneumonia in children can be summarized as follows:
- Gradual onset of symptoms over several days
- Persistent, dry, hacking cough that may last for weeks
- Low-grade fever (usually less than 101.5°F or 38.6°C)
- General malaise or fatigue
- Headache, sore throat, and chest pain that worsens with deep breathing or coughing
- Minimal respiratory distress despite significant radiographic findings, a phenomenon sometimes called "walking pneumonia"
- Auscultation may reveal scattered rales or crackles, though lung findings can be surprisingly minimal compared to the severity of cough
- Extrapulmonary manifestations can occur, including skin rashes (particularly erythema multiforme), hemolytic anemia, and neurological symptoms in rare cases
- School-aged children and adolescents (5-15 years) are most commonly affected, with symptoms typically lasting 3-4 weeks if untreated
- Diagnosis is often clinical, supported by chest radiographs showing patchy or interstitial infiltrates
- Treatment with macrolide antibiotics like azithromycin is effective in most cases, though many mild infections resolve without specific treatment 1. Some key points to consider when diagnosing and treating mycoplasma pneumonia in children include:
- The use of macrolide antibiotics as first-line empirical treatment in children aged 5 and above 2
- The importance of considering extrapulmonary manifestations, such as skin rashes and hemolytic anemia, in the diagnosis and management of mycoplasma pneumonia 3
- The need for careful clinical evaluation and radiographic assessment to distinguish mycoplasma pneumonia from other causes of lower respiratory tract infection, such as bacterial pneumonia or asthma 4.
From the Research
Clinical Features of Mycoplasma Pneumonia in Children
- Mycoplasma pneumoniae is a common cause of community-acquired respiratory tract infections, particularly in school-aged children and young adults 5.
- The clinical presentation of Mycoplasma pneumoniae infection in children includes cough, asthma-like symptoms, and low-grade fever 6.
- Extra-pulmonary symptoms are common and can present as nausea/vomiting and skin manifestations 6.
- Radiological findings are often positive, with 94% of children having abnormal chest x-rays 6.
- The infection can affect infants and young children, with symptoms similar to those caused by respiratory viruses, but severe lower respiratory tract infections (LRTI) can also occur 6.
Age-Specific Characteristics
- Children over 5 years old are more likely to be infected with Mycoplasma pneumoniae, accounting for up to 40% of cases of pneumonia in this age group 7.
- Children under 2 years old are less likely to be infected, with only 4% of cases occurring in this age group 6.
- School-aged children (7 years and older) are more likely to test positive for Mycoplasma pneumoniae, with 65% of cases occurring in this age group 6.
Treatment and Resistance
- Macrolides, such as azithromycin and clarithromycin, are commonly used to treat Mycoplasma pneumoniae infections, but resistance is increasing worldwide 5, 8, 9.
- Tetracyclines, such as minocycline and doxycycline, may be effective alternative treatments for macrolide-resistant Mycoplasma pneumoniae infections 8, 9.
- The clinical efficacy of tetracycline treatment has been shown to be superior to that of macrolide treatment in children with macrolide-resistant Mycoplasma pneumoniae pneumonia 9.