Mycoplasmas

General features

No cell wall only cell memb

Cell memb is triple layered containing cholesterol
Cannot synthesize their own cholesterol
Have both DNA & RNA so differ from virus
smallest free-living organisms
easily pass bacterial filters
reproduction binary fission & budding
usually nonmotile but some show gliding motility.
Gram negative but better stained by Giemsa

Their lack of a cell wall is associated with cellular pleomorphism and

resistance to cell wallactive antimicrobial agents, such as penicillins and
cephalosporins.
Mycoplasmas typically colonize mucosal surfaces of the respiratory and urogenital
tracts of many animal species.

Mycoplasma pneumoniae
Clinical Presentation
Chest muscle soreness may result from frequent and prolonged coughing, but true
pleuritic pain is uncommon.
Pharyngeal injection is often noted.
Cervical lymph node enlargement is unusual.

Ear pain due to bullous myringitis (blisters on the tympanic membrane) is a

unique but uncommon manifestation.
As in other "atypical" pneumonias, findings on auscultation of the lung may be
normal or nearly normal despite striking radiographic abnormalities.
Pleural effusions develop in <20% of patients.
M. pneumoniae infection may be particularly severe in patients who have sickle
cell disease and other hemoglobin Srelated hemoglobinopathies. The
functional asplenia seen in sickle cell disease may contribute to severe disease as
it does in pneumococcal infection. Severe respiratory distress and large pleural
effusions may occur.
.
Table 168-1 Extrapulmonary Manifestations of Mycoplasma pneumoniae
Infection

System
Dermatologic

Cardiovascular
Neurologic

Manifestations
Erythema multiforme
Maculopapular exanthems
Vesicular exanthems
Erythema nodosum
Urticaria
Myocarditis
Pericarditis
Encephalitis
Aseptic meningitis
Cerebellar ataxia
Guillain-Barr syndrome
Transverse myelitis
Polyradiculopathy

System
Rheumatologic

Hematologic

Manifestations
Arthralgias
Arthritis
Juvenile-onset spondyloarthropathy
Hemolytic anemia
Coagulopathies

Diagnosis
TLC is increased
Gram's staining of sputum - shows leukocytes without a predominance of
any bacterial morphologic type.
CXR- show reticulonodular or interstitial infiltration, primarily in the lower
lobes.
Culture media are 20% horse or human serum & yeast extract. Serum
provides cholesterol.
MC media is brain heart infusion media which contains 20% horse
serum & 10% yeast extract , glucose & phenol red as indicator.
Fried egg colonies are formed.
Colonies are identified by
1. Haemadsorbtion test adsorb guinea pigs RBCs at 37*c
2. Tetrazolium reduction test
3. Serological techniques

Biochem rxns- utilize glu & arginine. Non proteolytic.

Serology
1. Specific - enzyme-linked immunoassays, indirect
immunofluorescence, or complement fixation
2. Non specific- Cold agglutinins & streptococcus MG Test

Pneumonia Caused by M. pneumoniae: Treatment

Table 168-2 Oral Antimicrobial Agents for the Treatment of Ambulatory Patients
with Community-Acquired Pneumonia

Agent
Doxycycline
Erythromycin
Clarithromycin
Azithromycin
Levofloxacin
Moxifloxacin
Gemifloxacin

Dose and Schedule

100 mg bid
500 mg qid
500 mg bid
500 mg qd
500 mg qd
400 mg qd
320 mg qd

Note: Treatment of documented M. pneumoniae pneumonia is usually continued

for 1421 days.
Table 168-3 Antimicrobial Agents for the Treatment of Hospitalized Patients with
Community-Acquired Pneumonia

1. Intravenous ceftriaxone (1.0 g/d) or

Intravenous cefotaxime (1.0 g q8h) or
Intravenous ampicillin/sulbactam (1.53.0 g q6h)
plus
Intravenous or oral erythromycin (500 mg qid) or
Intravenous or oral azithromycin (500 mg qd) or
Oral clarithromycin (500 mg bid)
2. Intravenous or oral levofloxacin (500 mg qd)
3. Intravenous or oral moxifloxacin (400 mg qd)

Note: Treatment of documented M. pneumoniae pneumonia is usually continued

for 1421 days.

Genital Mycoplasmas
Epidemiology

M. hominis, U. urealyticum, and U. parvum are the most prevalent genital

mycoplasmas.
Infants may become colonized with these organisms during passage through a
colonized birth canal. Neonatal colonization tends not to persist.
M. fermentans colonizes both the respiratory and genital tracts in >20% of adults.

Association with Human Disease

A. Nongonococcal Urethritis (NGU)
Although Chlamydia trachomatis is the organism most firmly implicated in the
etiology of NGU, there is no doubt that sexually transmitted ureaplasmas and M.
genitalium also cause some cases.
B. Epididymitis and Prostatitis
C. Pelvic Inflammatory Disease (PID)
M. hominis and ureaplasmas are prominent components of the complex microbial
flora of bacterial vaginosis.
Although M. genitalium is not associated with bacterial vaginosis, preliminary
studies have linked it to cervicitis, PID, and tubal factor infertility in women
D. Disorders of Reproduction
Ureaplasmas have been considered as causes of involuntary infertility in both men
and women,
These organisms have been associated with chorioamnionitis and preterm birth.
E. Extragenital Infections
Sexually acquired reactive arthritis and Reiter's syndrome may be triggered by
ureaplasmas, although C. trachomatis is the usual triggering agent.

Genital Mycoplasmas: Treatment

Ureaplasmas, M. genitalium, and M. hominis are usually susceptible to
tetracyclines (e.g., doxycycline). Infections caused by tetracycline-resistant
ureaplasmas can be treated with erythromycin, while those due to tetracyclineresistant strains of M. hominis respond to treatment with clindamycin.