Mycoplasmosis (mycoplasma infection): symptoms

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

• acute respiratory disease caused by M. Pneumoniae.
• pneumonia due to M. Pneumoniae;

M. Pneumoniae infection can be asymptomatic.

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

The onset of mycoplasmosis (mycoplasmal infection) is usually gradual, less often acute. The body temperature rises to 37.1-38 ° C. Sometimes higher. The fever may be accompanied by a moderate chill, a feeling of "aches" in the body, malaise, a headache mainly in the frontotemporal region. Sometimes there is excessive sweating. Fever persists for 1-8 days, it is possible to maintain subfebrile condition up to 1.5-2 weeks.

Characteristic manifestations of catarrh of the upper respiratory tract. Patients are concerned about dryness, perspiration in the throat. From the first day of the disease appears unstable, often paroxysmal non-productive cough, which gradually intensifies and in some cases becomes productive with the separation of a small amount of viscous, mucous sputum. Cough persists for 5-15 days, but it can also bother longer. Approximately half of patients have pharyngitis combined with rhinitis (nasal congestion and moderate rhinorrhea).

In a mild course, the process is usually limited to the upper respiratory tract (pharyngitis, rhinitis), with a moderate and severe course, the lower respiratory tract (rhinobrachitis, pharyngobronchitis, rhinopharyngobronchitis) is attached. In severe disease, bronchitis or tracheitis predominates.

When examined, a mild hyperemia of the mucous membrane of the posterior pharyngeal wall is revealed, an increase in lymphatic follicles, and sometimes hyperemia of the mucous membrane of the soft palate and tongue. Often enlarged lymph nodes, usually submandibular.

At 20-25% of patients listen to hard breathing, in 50% of cases in combination with dry rales. For bronchitis, M. Pneumoniae infection is characterized by a discrepancy between the severity of paroxysmal cough and mild and unstable physical changes in the lungs.

In some cases, diarrhea is noted, pain in the abdomen is possible, sometimes for several days.

Pneumonia caused by M , pneumoniae

In large cities, M. Pneumoniae is an etiological agent in 12-15% of cases of community-acquired pneumonia. In children of older age groups and young adults up to 50% of pneumonia is due to M. Pneumoniae.

Pneumonia caused by M. Pneumoniae belongs to the group of atypical pneumonia. Usually characterized by a mild course.

The onset of the disease is more often gradual, but can be acute. At an acute onset, symptoms of intoxication appear on the first day and reach a maximum to the third. With the gradual onset of the disease, there is a prodromal period lasting up to 6-10 days: a dry cough appears, symptoms of pharyngitis, laryngitis (hoarse voice), and rarely rhinitis are possible; malaise, cognition, mild headache. Body temperature normal or subfebrile, then rises to 38-40 ° C, intoxication intensifies, reaching a maximum on the 7-12th day from the onset of the disease (moderate headache, myalgia, increased sweating, and after normalization of temperature).

Cough is frequent, paroxysmal, debilitating, can lead to vomiting, pain behind the breastbone and in the epigastric region - an early, permanent and prolonged symptom of mycoplasmal pneumonia. Initially, dry, by the end of the second week of the disease, it usually becomes productive, with the allocation of a small amount of viscous mucosa or mucopurulent sputum. Cough persists for 1.5-3 weeks or more. Often, from the 5th-7th day after the onset of the disease, the chest is noted for pain upon breathing on the side of the affected lung.

The fever persists at a high level for 1-5 days, then decreases. And for a different time (in some cases up to a month) subfebrile condition may persist. Weakness can bother the patient for several months. With mycoplasmal pneumonia, a prolonged and recurrent course is possible.

In physical examination, changes in the lungs are often poorly expressed: they may be absent. In some patients, shortening of percussion sound is revealed. At auscultation, weakened or hard breathing, dry and wet (mostly small- and medium-vesicular) rales can be heard. With pleurisy - the noise of friction of the pleura.

Often, extrapulmonary manifestations are observed; for some of them the etiological role of M. Pneumoniae is unambiguous, for others it is assumed.

One of the most frequent extrapulmonary manifestations of respiratory mycoplasmosis is gastrointestinal symptoms (nausea, vomiting, diarrhea), hepatitis and pancreatitis are described.

Possible exanthema - spotted-papular, urticaria, erythema nodosum. Exudative erythema multiforme, etc. The frequent manifestation of M. Pneumoniae infection is arthralgia, arthritis. Defeat of the myocardium, pericardium is described. Characterized by hemorrhagic bullous myringitis.

Subclinical hemolysis with weak reticulocytosis and positive Coombs reaction is often observed, obvious hemolysis with anemia is rare. Hemolytic anemia occurs on the 2-3rd 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-Barre syndrome), serous meningitis; less often - damage to the cranial nerves, acute psychosis, cerebellar ataxia, transverse myelitis. The pathogenesis of these manifestations is not clear, in cerebrospinal fluid in a number of cases, the DNA of M. Pneumoniae is detected by PCR. The defeat of the nervous system can be the cause of death. Respiratory mycoplasmosis often occurs as a mixed infection with ARVI.

Complications of mycoplasmosis (mycoplasmal infection)

Abscess of the lung, massive pleural effusion, acute respiratory distress syndrome. In the outcome of the disease, diffuse interstitial fibrosis may develop. The risk of complications is highest in patients with immunodeficiency and in children with sickle-cell anemia and other hemoglobinopathies. Bacterial superinfection rarely develops.

Mortality and causes of death

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

[1], [2], [3]