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Mycoplasma

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Mycoplasma pneumoniae pneumonia

Causes spectrum of disease from inapparent infection, mild afebrile URTI to severe pneumonia.

Clinical features

- not sufficiently distinctive to permit early definitive diagnosis to be made
- shares features of other non-bacterial pneumonias in that generalised symptoms (eg malaise and headache) often precede chest symptoms by 1-5 days and chest X-ray changes develop before sign become apparent

CXR

- usually only 1 lower lobe affected
- patchy opacities most usual finding
- bilateral in approx. 20%
- pleural effusions unusual

Course

- variable but often protracted
- cough, abnormal chest signs and XR changes may persist for several weeks. Organisms may persist in respiratory secretions despite antibiotics
- in children infection occasionally characterised by prolonged illness with paroxysmal cough followed by vomiting
- very severe infections are associated with immunodeficiency or sickle cell anaemia
- death rare

Extra-pulmonary manifestations

Cardiovascular

- myocarditis
- pericarditis
- <5% patients

Skin

- erythema multiforme
- Stevens-Johnson
- other rashes
- 25% patients

Gastrointestinal

- anorexia, nausea, vomiting, transient diarrhoea in 14-44%
- hepatitis
- pancreatitis

Genitourinary

- tubo-ovarian abscesses (rare)
- acute glomerulonephritis

Haematology

- cold agglutinin production in 50%
- cold AIHA (IgM)
- thrombocytopaenia
- intravascular coagulation

Musculoskeletal

- myalgia, arthralgia 14-45%
- arthritis

Neurological

- meningitis, meningoencephalitis 6-7%
- ascending paralysis
- transient myelitis
- cranial nerve palsy
- polio-like illness

Ears

- bullous myringitis

Treatment

- tetracycline or erythromycin


©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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