Unfortunately, my son was part of the initial Mycoplasma pneumoniae outbreak that hit in the fall of 2023. We had just returned from a family cruise – bringing back more than just souvenirs. While most of my family tested positive for COVID post-cruise, my son kept testing negative. However, his cough and fever lingered just enough to keep my PA instincts and Mom Radar on high alert.
Let’s dive into reviewing a condition that has made an unwelcome comeback and caused quite a stir among our pediatric patients since 2023: Mycoplasma pneumoniae.
A Small Microbe with a Big Attitude
Mycoplasma pneumoniae is notorious for causing atypical community-acquired pneumonia, especially among school-aged children. This unique bacteria is sneaky. It latches onto a host cell, releases a toxin that is believed to cause inflammation, and then replicates inside of a cell. The kicker? Mycoplasma’s has no cell walls, making it resistant to the common antibiotics we typically use to target cell walls (looking at you, beta-lactams).
Signs & Symptoms
The Mycoplasma pneumoniae infection onset is often gradual, with an incubation period of 1-4 weeks. The symptoms are similar to upper respiratory tract infections and include:
- Fever
- Persistent dry cough (weeks to months)
- Dyspnea
- Fatigue
- Headache
- Sore throat
- Abnormal auscultation (+/- rhonchi or expiratory wheezes)
Chest X-rays may show nonspecific changes like a consolidation or patchy infiltrate that make you think, “Is that an infiltrate, a shadow, or am I just seeing things?”
Diagnosis: “Guess Who?”
Serology and PCR tests are available, but they’re not always practical or timely in the urgent care setting. So, ask yourself: would these results change my management? Most of the time, diagnosis is based on clinical suspicion. If it looks like a duck, walks like a duck, well… you know the rest!
Treatment — Azithromycin…Really?
Once you’ve deduced that your pediatric patient is likely suffering from Mycoplasma pneumoniae, it’s time to talk antibiotics. Macrolides, such as azithromycin, are the go-to choice for this pesky pathogen.
If macrolide resistance is a concern, alternatives like tetracyclines or fluoroquinolones can be considered – but these should be avoided in younger children whenever possible.
At the end of the day, knowledge is power. As urgent care clinicians, it’s important for us to be aware of the current outbreaks. Don’t forget to keep Mycoplasma pneumoniae on your radar as a differential when your next pediatric patient presents with that cough that just won’t quit.
