Bacteria

Mycoplasma pneumonia

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Mycoplasma pneumonia, Mycoplasma pneumoniae, Walking Pneumonia

  • Pathophysiology
  1. Interstitial infection of lung parenchyma
  2. Organism lacks a cell wall
  3. Results in respiratory infections
    1. Atypical Pneumonia (3-10% of infected patients)
    2. Acute Tracheobronchitis
    3. Upper Respiratory Infection
  • Epidemiology
  1. Affects children (over age 3 years) and young adults
    1. May also be seen in the elderly
  • Symptoms
  1. Slow, gradual onset of prodromal symptoms
    1. Malaise
    2. Headache
    3. Fever
      1. Usually present longer than 3 days at presentation
  2. Cough
    1. Constant, harsh, dry, hacking non-productive cough
  3. Upper respiratory symptoms (50%)
    1. Pharyngitis
    2. Ear Pain
  4. Accompanying symptoms
    1. Rash
    2. Arthralgias
  • Signs
  1. Minimal signs
  2. Chest auscultation
    1. Scattered rhonchi
    2. Localized rales
  3. Serous Otitis Media
  4. Wheezing may be present
    1. Usually absent in other Bacterial Pneumonia
    2. Wheezing otherwise more common with Viral Pneumonia
  • Differential Diagnosis
  1. Fine patchy interstitial or perihilar infiltrates
  2. Lower lobe more commonly affected
  • Labs
  1. Complete Blood Count
    1. WBC Count mildly elevated (10,000 to 15,000)
  2. Cold Agglutinins
    1. Nonspecific
    2. Not sensitive (false negative in 33% of cases)
  3. Mycoplasma complement fixation titers
    1. Obtain acute and convalescent titers
  • Management
  • Antibiotic for 10 to 14 days
  1. Erythromycin
  2. Clarithromycin (Biaxin)
  3. Azithromycin (Zithromax)
  4. Doxycycline
    1. Avoid in age <8 years or pregnancy
    2. Dosing: 100 mg PO daily for 10 to 14 days
    3. Alternative dosing
      1. Dose twice daily for 1 day, once daily for 13 days
      2. Reduces gastrointestinal side effects
  • Complications
  1. Complications are uncommon
  2. Mortality rate: 1.4%
  3. Pulmonary
    1. Pleural Effusion
    2. Empyema
    3. Respiratory distress syndrome
  4. Dermatologic
    1. Erythema Multiforme
    2. Erythema Nodosum
    3. Urticaria
  5. Neurologic
    1. Aseptic Meningitis
    2. Encephalitis
    3. Guillain-Barre Syndrome
    4. Transverse Myelitis
  6. Cardiovascular
    1. Myocarditis
    2. Pancreatitis
    3. Pericarditis
  7. Miscellaneous
    1. Hemolytic Anemia
    2. Polyarthritis