It was two decades ago when Community Acquired Pneumonia (CAP) in children was more prevalent in the school age group. However, at present, a significant portion (20%) of children aged 2–5 years and (5%) in children with an age less than two years are diagnosed with CAP infection.
Mycoplasma Pneumoniae is the most common cause of community-acquired Pneumonia.
What is mycoplasma?
Mycoplasma is a bacteria with a uniqueness of being very small sized and having no cell wall. Mycoplasma can affect many organs and has a few species such as M. pneumonia, M. Hominis, urea plasma etc.
Having said this, the most common type affects mainly the respiratory tract. M. Pneumoniae affects the lining of the respiratory tract – throat, larynx, trachea and lungs.
Symptoms and signs of mycoplasma in children?
M. pneumonia manifestations are typically divided into Pulmonary and extra Pulmonary.
Pulmonary Manifestation
The infection can happen from one week to one month after exposure.
In children, 1–5 years can simply present with runny nose, sneezing, sore throat, wheezing, vomiting, fever, diarrhoea, skin rashes etc.
They are mostly interpreted as a viral infection. Furthermore, they can present with altered consciousness, irritability, and have focal neurological abnormalities.
From 5–15 years of age, children can present with a chronic cough for weeks; fever, headaches, tiredness, and sore throat.
Extra Pulmonary Manifestation
- Autoimmune Hemolytic Anaemia – IgM triggered Cold Agglutinin
- Mucocutaneous–maculopapular, vesicular, reactive infective mucocutaneous eruption RIME (looks like Steven Johnson syndrome)
- CNS – Meningoencephalitis, ADEM, GBS, Cerebellar ataxia, cranial nerve palsies, cerebellar infarcts
- Renal, Cardiac myocarditis, GI–intussusception, and rheumatological arthritis symptoms
Mode of spread
Mycoplasma spreads through close contact between people, living in the same households, accommodation, school, daycare centers etc.
Infection occurs through contact with hands, contaminated particles like tissues and air droplets; cough and sneezes. Those infected need to ensure they cover their mouth whilst coughing.
An infected person is at risk of spreading infection for up to 20 days.
NB: There is no need to exclude a child from school or daycare.
Diagnosis
Preferred tests include:
- IgM and IgG serology. These tests take one–two weeks post-infection to show positivity.
- PCR – nasopharyngeal
- Chest X-ray
- Antigen detection (for some countries)
- CSF for neurological symptoms
Having said this, diagnosis could be suspected with clinical history and symptoms that are recognised by a General Medical Practitioner. In these instances, a prophylactic treatment should be considered.
Treatment
Medical Practitioners can initiate antimicrobial therapy for pulmonary infections. The recommendations are macrolide, tetracycline (if allergic to macrolide) or fluoroquinolone. See below for detailed recommendations.
- Azithromycin or Roxithromycin is the most preferred choice.
- Erythromycin – however need to be given four times dose a day.
- Doxycycline – less risk of tooth discolouration
- Levofloxacin
I conclude that the incidents of Mycoplasma are more prevalent from infancy and they can mimic viral symptoms. Thus it is vital to consider and manage mycoplasma appropriately.