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Updated: Oct 27 2020

Mycoplasma pneumoniae

  • Snapshot
    • An 18-year-old college student presents to the student health clinic with a mild fever, headache, fatigue, and a dry, non-productive cough. He says that his symptoms started about 3 weeks ago and have not improved. The physician obtains a chest radiograph, which shows a pattern of diffuse interstitial infiltrates that appears worse than the patient’s physical appearance. The patient is prescribed azithromycin for his infection.
  • Introduction
    • Classification
      • Mycoplasma pneumoniae
        • pleomorphic
        • no cell wall
        • cell membrane contains cholesterol
        • causes an atypical “walking” pneumonia
    • Epidemiology
      • demographics
        • more common in patients < 30 years of age
      • risk factors
        • frequently seen among young individuals living in close contact
          • college students living in dormitories
          • military recruits
          • prisoners
    • Pathogenesis
      • transmission
        • respiratory droplets
      • Mycoplasma pneumoniae attaches to the respiratory epithelium, destroys the superficial layer of respiratory epithelial cells, and reduces the ability of the upper airways to clear themselves
    • Associated conditions
      • cold autoimmune hemolytic anemia
      • erythema multiforme
      • acute interstitial nephritis
      • bacterial myocarditis
  • Presentation
    • Symptoms
      • mild fever
      • headache
      • non-productive cough
    • Physical exam
      • non-productive cough
      • bilateral wheezing may be heard on auscultation
      • macropapular or vesicular rash
  • Imaging
    • Chest radiography
      • patchy or diffuse interstitial infiltrates
      • chest radiograph often looks more severe than the patient’s actual presentation
  • Studies
    • Labs
      • detection of high titer of cold agglutinins (IgM antibodies) on serology
        • cold agglutinin production peaks during the third week of infection
    • Microbiological studies
      • growth on Eaton agar
      • not seen on Gram stain due to lack of a cell wall
    • Making the diagnosis
      • based on clinical presentation and laboratory studies
  • Differential
    • Viral infection
      • distinguishing factor
        • would not produce high titer of cold agglutinins (IgM)
    • Chlamydophila pneumoniae infection
      • distinguishing factor
        • d3 cytoplasmic inclusions (reticulate bodies) seen on Giemsa or fluorescent antibody-stained smear
    • Legionella infection
      • distinguishing factor
        • different demographic
          • more common in smokers and patients with chronic lung disease
        • grows on charcoal yeast extract agar buffered with cysteine and iron
  • Treatment
    • Medical
      • macrolide antibiotics (especially Azithromycin)
      • doxycycline
      • fluoroquinolones
  • Complications
    • Autoimmune hemoltyic anemia
    • Acute interstitial nephritis
    • Bacterial myocarditis
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