Mycoplasma Yount

1. Noon Conference
Evan Yount, MD
August 1st, 2018

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Objectives
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Acute Mycoplasma Infection
• Epidemiology
• Diagnosis
• Clinical Manifestations
• Respiratory Symptoms
• Extrapulmonary Manifestations
• Treatment

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Epidemiology
• M. pneumonia
• Cause of atypical CAP
• Incidence varies depending on study
• A prospective series of 1300 patients requiring
hospitalization, M. pneumoniae accounted for 5 percent
of all cases and 9 percent in older patients
• Other studies range from 2% to 23%
• Takeaway – common!
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Epidemiology
M. genitalium
• Strong link between M. genitalium and
non-gonococcal urethritis in men;
cervicitis and PID in women
• Prevalence: 1% among young adults
• N. gonorrhoeae .4%
• C. trachomatis 2.3%
• One study found a prevalence of M. genitalium of 7.7
percent in women attending a Seattle STI clinic,
compared with a prevalence of 5.8 percent for C.
trachomatis and 2.4 percent for N. gonorrhoeae
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Epidemiology
Risk Factors:
• Young age, <20 to 22 years old
• Smoking
• Recent sexual intercourse
• Increasing number of sexual
partners
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Chronology of Untreated Infection
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The horizontal dimension depicts the estimated duration of symptoms,
signs, positive cultures of respiratory tract samples, and radiographic
abnormalities. The temporal correlations of these features are shown
vertically.

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Question
Which of the following is not a known
extrapulmonary manifestation of acute
mycoplasma infection?
1) Hemolysis
2) CHF
3) Acute Renal Failure
4) SJS
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Answer
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Which of the following is not a known
extrapulmonary manifestation of acute
mycoplasma infection?
1) Hemolysis
2) CHF
3) Acute Renal Failure
4) SJS

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Clinical Manifestations
• M. pneumonia
• Headache, malaise, low-grade fever
• Intractable, non-productive cough
• Wheezing, dyspnea
• Pharyngitis, rhinorrhea, ear pain
• M. genitalium (urethritis)
• Dysuria
• Urethral pruritis
• Urethral Discharge
• May be asymptomatic
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Extrapulmonary Manifestations
• Hematologic
• Hemolysis – Cold agglutinin disease
• Dermatologic
• “Maculopapular Rash”
• SJS
• Cardiac
• “Rhythm Disturbances”
• CHF
• Chest Pain
• Other
• Rhabdomyolysis
*Single case reports of many different manifestations
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Question
What is the diagnostic test of choice
for acute mycoplasma infection?
1) Gram Stain and Culture
2) IgM and IgG serology
3) PCR
4) Antigen detection testing
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Answer
What is the diagnostic test of choice
for acute mycoplasma infection?
1) Gram Stain and Culture
2) IgM and IgG serology
3) PCR
4) Antigen detection testing
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Diagnosis
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Diagnosis
• Culture – No cell wall  Not visible on GS.
• Fastidious, takes 2 to 3 weeks to grow
• Serologies – New EIA techniques with sensitivity 97.8
percent and specificity of 99.7 percent
• Takes longer to result
• PCR - Sensitivity of 92 percent, specificity of 98 percent
• Quick, used more frequently
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Differential Diagnosis
• Atypical Pneumonia
• Legionella
• Psitticosis
• Tularensia
• Q fever
• EBV, VZV, HIV, CMV
• Urethritis
• Gonorrhea
• Chlamydia
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Treatment
• Urethritis, cervicitis:
• 1st line – Single dose of 1g azithromycin
• If persistent/recurrent, moxifloxacin is reasonable
alternative
• Pneumonia:
• 1st line – Azithromycin 5 day course
• If doxycycline or fluoroquinolone used, 7 to 14 day course
*Increasing macrolide resistance
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Illness Script
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Mycoplasma
Infection
Acute TMP-SMX Reaction
Tenofovir
Reaction
Pathophysiology
Direct bacterial toxic
reaction
Immune reaction
Varies Varies
Epidemiology Young, male, Varies Varies
Time course
1-2 week incubation
1-3 weeks clinical illness
Acute to subacute
Half-life 10 to 12 hours
Acute to subacute
Clinical
presentation
Urethritis
Atypical Pneumonia
Rhabdomyolysis
Rash
Hemolysis
Anaphylaxis; Rash;
nausea/vomiting/diarrhea; RTA; Hepatitis;
Hypoglycemia;Hyponatremia
Hemolysis (in G6PD deficiency)
Fever, headache, anaphylaxis
Headache, fatigue,
abdominal pain,
nausea, cough
Mild increase CK
Diagnostics
Serology
PCR
Tryptase; History and Physical History and Physical
Therapeutics
Azithromycin – 1st line
Doxycycline
Discontinuation of agent
Discontinuation of
agent

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Questions?
Thanks!
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