Mycoplasmosis (mycoplasmal infection) - Symptoms

The incubation period of mycoplasmosis (mycoplasma infection) lasts 1-4 weeks, on average 3 weeks. Mycoplasmas can affect various organs and systems. Respiratory mycoplasmosis occurs in two clinical forms:

• acute respiratory disease caused by M. pneumoniae.
• pneumonia caused by M. pneumoniae;

M. pneumoniae infection may be asymptomatic.

Acute respiratory disease caused by M. pneumoniae is characterized by a mild or moderate course, a combination of catarrhal-respiratory syndrome, mainly in the form of catarrhal pharyngitis or nasopharyngitis (less often with the spread of the process to the trachea and bronchi) with a mild intoxication syndrome.

The onset of mycoplasmosis (mycoplasma infection) is usually gradual, less often acute. Body temperature rises to 37.1-38 °C. Sometimes higher. The increase in temperature may be accompanied by moderate chills, a feeling of "aches" in the body, malaise, headache mainly in the frontal-temporal region. Sometimes increased sweating is noted. Fever persists for 1-8 days, subfebrile condition may persist for up to 1.5-2 weeks.

Characteristic manifestations of catarrhal inflammation of the upper respiratory tract. Patients are bothered by dryness and sore throat. From the first day of illness, an inconstant, often paroxysmal, unproductive cough appears, which gradually intensifies and in some cases becomes productive with the separation of a small amount of viscous, mucous sputum. The cough persists for 5-15 days, but can bother longer. In about half of patients, pharyngitis is combined with rhinitis (nasal congestion and moderate rhinorrhea).

In mild cases, the process is usually limited to damage to the upper respiratory tract (pharyngitis, rhinitis), while in moderate and severe cases, damage to the lower respiratory tract (rhinobronchitis, pharyngobronchitis, nasopharyngobronchitis) is added. In severe cases, the disease is characterized by bronchitis or tracheitis.

On examination, moderate hyperemia of the mucous membrane of the posterior pharyngeal wall, enlargement of the lymphatic follicles, and sometimes hyperemia of the mucous membrane of the soft palate and uvula are detected. The lymph nodes, usually the submandibular ones, are often enlarged.

In 20-25% of patients, harsh breathing is heard, in 50% of cases in combination with dry wheezing. Bronchitis in M. pneumoniae infection is characterized by a discrepancy between the severity of paroxysmal cough and the vague and inconstant physical changes in the lungs.

In some cases, diarrhea is observed, abdominal pain is possible, sometimes for several days.

Pneumonia caused byM.pneumoniae

In large cities, M. pneumoniae is the etiologic agent in 12-15% of cases of community-acquired pneumonia. In older children and young adults, up to 50% of pneumonias are caused by M. pneumoniae.

Pneumonia caused by M. pneumoniae belongs to the group of atypical pneumonias. It is usually characterized by a mild course.

The onset of the disease is usually gradual, but can also be acute. With an acute onset, symptoms of intoxication appear on the first day and reach a maximum by the third. With a gradual onset of the disease, there is a prodromal period lasting up to 6-10 days: a dry cough appears, symptoms of pharyngitis, laryngitis (hoarseness of voice) are possible, and rhinitis is uncommon; malaise, chills, moderate headache. Body temperature is normal or subfebrile, then rises to 38-40 °C, intoxication increases, reaching a maximum on the 7-12th day from the onset of the disease (moderate headache, myalgia, increased sweating, observed even after the temperature has returned to normal).

Cough is frequent, paroxysmal, debilitating, can lead to vomiting, pain behind the breastbone and in the epigastric region - an early, constant and long-term symptom of mycoplasma pneumonia. At first dry, by the end of the 2nd week of the disease it usually becomes productive, with the release of a small amount of viscous mucous or mucopurulent sputum. The cough persists for 1.5-3 weeks or more. Often from the 5th-7th day from the onset of the disease, pain in the chest when breathing on the side of the affected lung is noted.

The fever remains high for 1-5 days, then decreases. and subfebrile temperature may persist for different periods of time (in some cases up to a month). Weakness may bother the patient for several months. With mycoplasma pneumonia, a protracted and recurrent course is possible.

During physical examination, changes in the lungs are often weakly expressed: they may be absent. In some patients, a shortened percussion sound is detected. During auscultation, weakened or harsh breathing, dry and wet (mainly small and medium bubbling) wheezing may be heard. In pleurisy - pleural friction noise.

Extrapulmonary manifestations are often observed; for some of them, the etiologic role of M. pneumoniae is unambiguous, for others it is assumed.

One of the most common extrapulmonary manifestations of respiratory mycoplasmosis is gastrointestinal symptoms (nausea, vomiting, diarrhea); hepatitis and pancreatitis have been described.

Exanthema is possible - maculopapular, urticarial, nodular erythema. Multiforme exudative erythema, etc. Frequent manifestations of M. pneumoniae infection are arthralgia, arthritis. Damage to the myocardium and pericardium has been described. Hemorrhagic bullous myringitis is characteristic.

Subclinical hemolysis with weak reticulocytosis and a positive Coombs reaction is often observed, overt hemolysis with anemia is rare. Hemolytic anemia occurs on the 2nd-3rd week of the disease, which coincides with the maximum titer of Cold antibodies. Jaundice often develops, hemoglobinuria is possible. The process is usually self-limiting, lasting several weeks.

A wide range of neurological manifestations of M. pneumoniae infection is known: meningoencephalitis, encephalitis, polyradiculopathy (including Guillain-Barré syndrome), serous meningitis; less commonly, cranial nerve damage, acute psychosis, cerebellar ataxia, transverse myelitis. The pathogenesis of these manifestations is unclear; in some cases, M. pneumoniae DNA is detected in the cerebrospinal fluid using PCR. Damage to the nervous system can be fatal. Respiratory mycoplasmosis often occurs as a mixed infection with acute respiratory viral infections.

Complications of mycoplasmosis (mycoplasma infection)

Lung abscess, massive pleural effusion, acute respiratory distress syndrome. Diffuse interstitial fibrosis may develop as a result of the disease. The risk of complications is highest in immunocompromised patients and children with sickle cell anemia and other hemoglobinopathies. Bacterial superinfection is rare.

Mortality and causes of death

The mortality rate for community-acquired pneumonia caused by M. pneumoniae is 1.4%. In some cases, the cause of death is disseminated intravascular coagulation or CNS complications.

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