What’s New in Diagnostic Testing and Treatment Approaches for Mycoplasma pneumoniae Infections in Children?

Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 719)


M. pneumoniae is a common cause of upper and lower respiratory tract infections in persons of all ages, including the very young and the very old. Extrapulmonary complications involving any organ system may accompany respiratory tract manifestations, or they may occur in persons without an obvious respiratory component to their illness. Clinical presentation is similar enough to other causes of respiratory infection that presentation alone cannot be used reliably to identify children in whom a mycoplasmal etiology is likely and coinfection with other bacterial or viral pathogens is common. Due to the many limitations of culture and serology, PCR is the preferred method for laboratory diagnosis, although it is not yet widely available in many countries. Macrolides have historically been the antibiotics of choice for children with mycoplasmal infections, but the emergence of clinically significant high-level resistance worldwide has necessitated a reevaluation of their use, particularly in locations where resistance is common. Consideration of alternatives such as tetracyclines and fluoroquinolones, even though these agents are not normally considered in younger children due to potential toxicities.


  1. 1.
    Atkinson TP, Boppana S, Theos A, CLements LS, Xiao L, Waites K. Stevens-Johnson Syndrome in a patient with macrolide-resistant Mycoplasma pneumoniae. Pediatrics 2011;127:e1605–1609.Google Scholar
  2. 2.
    Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004;17(4):697–728.PubMedCrossRefGoogle Scholar
  3. 3.
    Foy HM. Infections caused by Mycoplasma pneumoniae and possible carrier state in different populations of patients. Clin Infect Dis 1993;17 Suppl 1:S37–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Block S, Hedrick J, Hammerschlag MR, Cassell GH, Craft JC. Mycoplasma pneumoniae and Chlamydia pneumoniae in pediatric community-acquired pneumonia: comparative efficacy and safety of clarithromycin vs. erythromycin ethylsuccinate. Pediatr Infect Dis J 1995;14(6):471–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Korppi M, Heiskanen-Kosma T, Kleemola M. Incidence of community-acquired pneumonia in children caused by Mycoplasma pneumoniae: serological results of a prospective, population-based study in primary health care. Respirology 2004;9(1):109–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Layani-Milon MP, Gras I, Valette M, Luciani J, Stagnara J, Aymard M, et al. Incidence of upper respiratory tract Mycoplasma pneumoniae infections among outpatients in Rhone-Alpes, France, during five successive winter periods. J Clin Microbiol 1999;37(6):1721–6.PubMedGoogle Scholar
  7. 7.
    Esposito S, Blasi F, Bosis S, Droghetti R, Faelli N, Lastrico A, et al. Aetiology of acute pharyngitis: the role of atypical bacteria. J Med Microbiol 2004;53(Pt 7):645–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Esposito S, Bosis S, Begliatti E, Droghetti R, Tremolati E, Tagliabue C, et al. Acute tonsillopharyngitis associated with atypical bacterial infection in children: natural history and impact of macrolide therapy. Clin Infect Dis 2006;43(2):206–9.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Waites KB, Balish MF, Atkinson TP. New insights into the pathogenesis and detection of Mycoplasma pneumoniae infections. Future Microbiol 2008;3(6):635–48.PubMedCrossRefGoogle Scholar
  11. 11.
    Kannan TR, Baseman JB. ADP-ribosylating and vacuolating cytotoxin of Mycoplasma pneumoniae represents unique virulence determinant among bacterial pathogens. Proc Natl Acad Sci U S A 2006;103(17):6724–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Dallo SF, Baseman JB. Intracellular DNA replication and long-term survival of pathogenic mycoplasmas. Microb Pathog 2000;29(5):301–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Roifman CM, Rao CP, Lederman HM, Lavi S, Quinn P, Gelfand EW. Increased susceptibility to Mycoplasma infection in patients with hypogammaglobulinemia. Am J Med 1986;80(4):590–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Waites KB, Simecka JW, Talkington DF, Atkinson TP. Pathogensis of Mycoplasma pneumoniae infections: adaptive immunity, innate immuinity, cell biology and virulence factors. In: Suttorp N, Welte T, Marre R, editors. Community-acquired pneumonia. Basel, Switzerland: Burkhauser Verlag; 2007. p. 183–99.CrossRefGoogle Scholar
  15. 15.
    Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010;16(3):162–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Loens K, Goossens H, Ieven M. Acute respiratory infection due to Mycoplasma pneumoniae: current satus of diagnostic methods. Eur J Clin Microbiol Infect Dis 2010;29:1055–69.PubMedCrossRefGoogle Scholar
  17. 17.
    Beersma MF, Dirven K, van Dam AP, Templeton KE, Claas EC, Goossens H. Evaluation of 12 commercial tests and the complement fixation test for Mycoplasma pneumoniae-specific immunoglobulin G (IgG) and IgM antibodies, with PCR used as the “gold standard”. J Clin Microbiol 2005;43(5):2277–85.PubMedCrossRefGoogle Scholar
  18. 18.
    Talkington DF, Shott S, Fallon MT, Schwartz SB, Thacker WL. Analysis of eight commercial enzyme immunoassay tests for detection of antibodies to Mycoplasma pneumoniae in human serum. Clin Diagn Lab Immunol 2004;11(5):862–7.PubMedGoogle Scholar
  19. 19.
    Ozaki T, Nishimura N, Ahn J, Watanabe N, Muto T, Saito A, et al. Utility of a rapid diagnosis kit for Mycoplasma pneumoniae pneumonia in children, and the antimicrobial susceptibility of the isolates. J Infect Chemother 2007;13(4):204–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Daxboeck F, Khanakah G, Bauer C, Stadler M, Hofmann H, Stanek G. Detection of Mycoplasma pneumoniae in serum specimens from patients with mycoplasma pneumonia by PCR. Int J Med Microbiol 2005;295(4):279–85.PubMedCrossRefGoogle Scholar
  21. 21.
    Dumke R, Jacobs E. Comparison of commercial and in-house real-time PCR assays used for detection of Mycoplasma pneumoniae. J Clin Microbiol 2009;47(2):441–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Loens K, Mackay WG, Scott C, Goossens H, Wallace P, Ieven M. A multicenter pilot external quality assessment programme to assess the quality of molecular detection of Chlamydophila pneumoniae and Mycoplasma ­pneumoniae. J Microbiol Methods 2010;82(2):131–5.PubMedCrossRefGoogle Scholar
  23. 23.
    McCracken GH, Jr. Current status of antibiotic treatment for Mycoplasma pneumoniae infections. Pediatr Infect Dis 1986;5(1):167–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Harris JA, Kolokathis A, Campbell M, Cassell GH, Hammerschlag MR. Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J 1998;17(10):865–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Morozumi M, Iwata S, Hasegawa K, Chiba N, Takayanagi R, Matsubara K, et al. Increased Macrolide Resistance of Mycoplasma pneumoniae in Pediatric Patients with Community-Acquired Pneumonia. Antimicrob Agents Chemother 2008;52(1):348–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Suzuki S, Yamazaki T, Narita M, Okazaki N, Suzuki I, Andoh T, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother 2006;50(2):709–12.PubMedCrossRefGoogle Scholar
  27. 27.
    Matsuoka M, Narita M, Okazaki N, Ohya H, Yamazaki T, Ouchi K, et al. Characterization and molecular analysis of macrolide-resistant Mycoplasma pneumoniae clinical isolates obtained in Japan. Antimicrob Agents Chemother 2004;48(12):4624–30.PubMedCrossRefGoogle Scholar
  28. 28.
    Morozumi M, Hasegawa K, Kobayashi R, Inoue N, Iwata S, Kuroki H, et al. Emergence of macrolide-resistant Mycoplasma pneumoniae with a 23 S rRNA gene mutation. Antimicrob Agents Chemother 2005;49(6):2302–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Xin D, Mi Z, Han X, Qin L, Li J, Wei T, et al. Molecular mechanisms of macrolide resistance in clinical isolates of Mycoplasma pneumoniae from China. Antimicrob Agents Chemother 2009;53(5):2158–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Liu Y, Ye X, Zhang H, Xu X, Li W, Zhu D, et al. Antimicrobial susceptibility of Mycoplasma pneumoniae ­isolates and molecular analysis of macrolide-resistant strains from Shanghai, China. Antimicrob Agents Chemother 2009;53(5):2160–2.PubMedCrossRefGoogle Scholar
  31. 31.
    Peuchant O, Menard A, Renaudin H, Morozumi M, Ubukata K, Bebear CM, et al. Increased macrolide resistance of Mycoplasma pneumoniae in France directly detected in clinical specimens by real-time PCR and melting curve analysis. J Antimicrob Chemother 2009;64(1):52–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Wolff BJ, Thacker WL, Schwartz SB, Winchell JM. Detection of macrolide resistance in Mycoplasma pneumoniae by real-time PCR and high-resolution melt analysis. Antimicrob Agents Chemother 2008;52(10):3542–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Miyashita N, Maruyama T, Kobayashi T, Kobayashi H, Taguchi O, Kawai Y, et al. Community-acquired macrolide-resistant Mycoplasma pneumoniae pneumonia in patients more than 18 years of age. J Infect Chemother.Google Scholar
  34. 34.
    Li X, Atkinson TP, Hagood J, Makris C, Duffy LB, Waites KB. Emerging macrolide resistance in Mycoplasma pneumoniae in children: detection and characterization of resistant isolates. Pediatr Infect Dis J 2009;28(8):693–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Dumke R, Schurwanz N, Lenz M, Schuppler M, Luck C, Jacobs E. Sensitive detection of Mycoplasma pneumoniae in human respiratory tract samples by optimized real-time PCR approach. J Clin Microbiol 2007;45(8):2726–30.PubMedCrossRefGoogle Scholar
  36. 36.
    Lopez-Boado YS, Rubin BK. Macrolides as immunomodulatory medications for the therapy of chronic lung diseases. Curr Opin Pharmacol 2008;8(3):286–91.PubMedCrossRefGoogle Scholar
  37. 37.
    Duffy LB, Crabb DM, Bing X, Waites KB. Bactericidal activity of levofloxacin against Mycoplasma pneumoniae. J Antimicrob Chemother 2003;52(3):527–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Chien S, Wells TG, Blumer JL, Kearns GL, Bradley JS, Bocchini JA, Jr., et al. Levofloxacin Pharmacokinetics in Children. J Clin Pharmacol 2005;45(2):153–60.PubMedCrossRefGoogle Scholar
  39. 39.
    Smilack JD, Burgin WW, Jr., Moore WL, Jr., Sanford JP. Mycoplasma pneumoniae pneumonia and clindamycin therapy. Failure to demonstrate efficacy. Jama 1974;228(6):729–31.PubMedCrossRefGoogle Scholar
  40. 40.
    Waites KB, Crabb DM, Duffy LB. Comparative in vitro susceptibilities of human mycoplasmas and ureaplasmas to a new investigational ketolide, CEM-101. Antimicrob Agents Chemother 2009;53(5):2139–41.PubMedCrossRefGoogle Scholar
  41. 41.
    Talkington DF, Waites KB, Schwartz SB, Besser RE. Emerging from obscurity: understanding pulmonary and exrrapulmonary syndromes, pathogenesis, and epidemiology of human Mycoplasma pneumoniae infections. In: Scheld WM, Craig WA, Hughes JM, editors. Emerging Infections 5. Washington, D.C.: American Society for Microbiology; 2001. p. 57–84.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PathologyUniversity of Alabama at BirminghamAlabamaUSA

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