Mycoplasma pneumoniae

Diagnosis
Background
Lab Tests
References
Related Topics

Indications for Testing

Viral pneumonia presentation with persistent cough

Laboratory Testing

PCR – rapid test to identify M. pneumoniae
- Increased sensitivity if sputum is tested and infection is in early stage (first 21 days after onset)
- Probably most sensitive test to use, especially in adults who may not mount significant IgM levels early in infection
IgG, IgM by ELISA, EIA, complement fixation – usually requires acute and convalescent samples
- Not effective in early diagnosis
Culture – inadequate for acute diagnosis
- Not recommended; bacteria are relatively fastidious and require a long incubation (up to 4 weeks)
Consider concurrent serology for C. pneumoniae, urinary antigen detection for Legionella, viral studies (eg, DFA panel for respiratory viruses)

Imaging Studies

Chest radiography – patchy, unilateral infiltrates or diffuse, bilateral interstitial process

Differential Diagnosis

Mycoplasmas, the smallest self-replicating organisms, include M. pneumoniae (pneumonia), M. genitalium, and Ureaplasma urealyticum (urethritis). M. pneumoniae is a common cause of community-acquired pneumonia.

Epidemiology

Prevalence
- Responsible for 15-20% of all community-acquired pneumonia; higher rates among school children and people in closed populations (military recruits)
  - 2-5% of patients require hospitalization as compared with 15-20% hospitalization rates for other causes of pneumonia
Transmission – respiratory droplet
- Most common in U.S. during late summer to early fall

Organism

M. pneumoniae
- Flask-shaped bacteria with no true cell wall and a very small genome (816 kilobase pairs)
- Facultative intracellular parasite
- Cultivation in vitro is difficult
  - Fastidious nature
  - Heavily dependent on externally supplied growth factors (by host organism or in culture medium)
  - Limited metabolic capacity inherent in small genome

Clinical Presentation

Most infections are mild and often indistinguishable from other viral and atypical bacterial pathogens
Initial symptoms – malaise, myalgias, sore throat, headache (retro-orbital), ear pain, and fever
- Patients who progress to pneumonia may have additional symptoms, including chills, chest pain, shortness of breath, nausea, vomiting, diarrhea
Pulmonary infection
- Dry, nonproductive cough occurs 3-5 days after onset of initial nonspecific symptoms
  - Cough may produce mucopurulent sputum later in illness
- Patients usually seek medical attention after 5-7 days
  - Cough may become paroxysmal and nocturnal
- Cough may persist several weeks following resolution of constitutional symptoms
- Pleural effusions more common in severe disease
Extrapulmonary manifestations of M. pneumoniae infections
- Syndromes caused by spread of organism
  - Bullous hemorrhagic otitis
  - Arthritis
  - Acute respiratory distress syndrome
  - Myocarditis
  - Encephalitis/meningitis
  - Sinusitis
- Immunologically mediated syndromes
  - Skin rashes
  - Erythema nodosum or erythema multiforme
  - Anemia
  - Thrombocytopenia
  - Guillain-Barré syndrome

Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Mycoplasma pneumoniae by PCR 0060256
Method: Qualitative Polymerase Chain Reaction

Recommended Use

Diagnose M. pneumoniae infection

Distinguish M. pneumoniae from other viruses and atypical pathogens (Chlamydia pneumoniae, Bordetella pertussis, Legionella)

Limitations

Throat swab specimens are preferred

Mycoplasma pneumoniae Antibodies, IgG & IgM 0050399
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Recommended Use

Diagnose M. pneumoniae infection; requires both acute and convalescent samples (2-4 weeks apart)

Respiratory Viruses DFA with Reflex to Respiratory Virus Mini Panel by PCR 2002565
Method: Direct Fluorescent Antibody Stain/Qualitative Polymerase Chain Reaction

Recommended Use

Screen for respiratory viruses

If DFA is negative or inadequate for influenza, Respiratory Virus Mini Panel by RT-PCR will be added

General References

Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev. 2008; 32(6): 956-73. PubMed

Loens K, Goossens H, Ieven M. Acute respiratory infection due to Mycoplasma pneumoniae: current status of diagnostic methods. Eur J Clin Microbiol Infect Dis. 2010; 29(9): 1055-69. PubMed

Thurman KA, Walter ND, Schwartz SB, Mitchell SL, Dillon MT, Baughman AL, Deutscher M, Fulton JP, Tongren JE, Hicks LA, Winchell JM. Comparison of laboratory diagnostic procedures for detection of Mycoplasma pneumoniae in community outbreaks. Clin Infect Dis. 2009; 48(9): 1244-9. PubMed

Waites KB. What's new in diagnostic testing and treatment approaches for Mycoplasma pneumoniae infections in children? Adv Exp Med Biol. 2011; 719: 47-57. PubMed

Zhang L, Zong Z, Bin Liu Y, Ye H, Lv X. PCR versus serology for diagnosing Mycoplasma pneumoniae infection: a systematic review & meta-analysis. Indian J Med Res. 2011; 134: 270-80. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology®

Diaz MH, Benitez AJ, Cross KE, Hicks LA, Kutty P, Bramley AM, Chappell JD, Hymas W, Patel A, Qi C, Williams DJ, Arnold SR, Ampofo K, Self WH, Grijalva CG, Anderson EJ, McCullers JA, Pavia AT, Wunderink RG, Edwards KM, Jain S, Winchell JM. Molecular Detection and Characterization of Mycoplasma pneumoniae Among Patients Hospitalized With Community-Acquired Pneumonia in the United States Open Forum Infect Dis. 2015; 2(3): ofv106. PubMed

Dunn JJ, Malan AK, Evans J, Litwin CM. Rapid detection of Mycoplasma pneumoniae IgM antibodies in pediatric patients using ImmunoCard Mycoplasma compared to conventional enzyme immunoassays. Eur J Clin Microbiol Infect Dis. 2004; 23(5): 412-4. PubMed