February 2024 Healthcare Hygiene magazine February 2024 | Page 8

By Rodney E . Rohde , PhD , MS , SM ( ASCP ) CM , SVCM , MBCM , FACSc

Since late December 2023 , there has been higher pneumonia case activity in children across China , Denmark , France , and the Netherlands . In the U . S ., there was also a surge in Ohio , especially in one county , and it these reports have raised some alarm in the public health and healthcare communities as we continue to navigate COVID-19 and other respiratory agents early in 2024 .

Currently , there is no other outbreak activity being reported in the U . S . and typically , Mycoplasma pneumoniae infections are not consistently high . Usually , there is higher activity about every three years and the U . S . has not seen significant cases occurring since before the pandemic . We may therefore see more frequent infections during the 2024 winter respiratory season .

What is Mycoplasma pneumoniae ?

The Centers for Disease Control and Prevention ( CDC ) and the National Institutes of Health share that Mycoplasma species are the smallest living organisms that can survive alone in nature . Interestingly , and sometimes frustrating to physicians and medical laboratory professionals , diagnosis and treatment can be challenging . This is because they have no cell wall which means it can easily be missed on a clinical Gram stain . Gram stains are usually reliable , accurate , easy to perform , and have a relatively short turnaround . However , the staining mechanism relies on a bacterial cell wall for the staining differential to perform . Thus , an initial stain with M . pneumoniae as a causative agent is often not detected on microscopy of a clinical gram stain . To make matters worse , it is a fastidious [ difficult to culture on normal bacteriological media ], and isolation is not usually performed in most medical and clinical laboratories . Due to these reasons , one would have to suspect it and utilize special culture media supplemented with serum while waiting for the longer incubation time to grow .

The genus is large with more than 120 species , but only 13 have been isolated from humans , and only four are known to be human pathogens . Mycoplasma pneumoniae is the pathogen most associated with disease in humans . It is a short rod and most often excreted from the respiratory

tract after many weeks of acute infection ; therefore , isolation of the organism is not specific for acute infection at that time .

Transmission , Signs , Symptoms , and Illnesses

M . pneumoniae is now considered a common cause of community-acquired pneumonia ( CAP ) and is transmitted from person to person via respiratory droplets during close contact . The incubation period ranges between two to three weeks . Like most respiratory pathogens , infection usually occurs during the winter months but can happen year-round . It is commonly referred to as walking pneumonia or atypical pneumonia . The infection can mimic the common cold and symptoms may be mild . This can often lead to one not needing to stay in bed or seek healthcare . People may not need bedrest or a hospital stay and likely will not want to stay home from work or school . Since you may feel well enough to just keep walking around , the illness was often called “ walking pneumonia .”

The CDC states Infections caused by Mycoplasma pneumoniae are generally mild but sometimes can be severe . Once someone becomes infected with the bacteria , symptoms usually appear after one to four weeks . Symptoms can last for several weeks .

Symptoms depend on the type of infection .

● Tracheobronchitis ( chest cold )

● Pneumonia ( lung infection ) can sometimes occur .

● Sore throat

● Feeling tired

● Fever and chills

● Slowly worsening cough

● Headache

● Cough

● Shortness of breath

Symptoms in young children

Children younger than 5 years old who get M . pneumoniae infection could have symptoms that are different from older children and adults . Instead , they may have the following symptoms :

● Sneezing

● Stuffy or runny nose

● Sore throat

● Watery eyes

● Wheezing

● Vomiting

● Diarrhea

Prevention , Diagnosis , and Treatment People can get infected with Mycoplasma pneumoniae more than once .

While there is no vaccine to prevent M . pneumoniae infections , there are things people can do to protect themselves and others . Some of the best preventative measures and strategy are now commonplace considering the COVID-19 pandemic – practice good hand hygiene , cough and sneeze etiquette , physical distancing , staying home when sick , and seeking testing if a severe illness develops .

As previously mentioned , a diagnosis for this pathogen is not simple . There ’ s no quick way to test for M . pneumoniae infections , unlike some other respiratory illnesses . You physician may observe the signs and symptoms described above , and if needed , a chest X-ray may be ordered to rule out pneumonia . Testing is rare . If they do choose to test , a physician or provider may collect a specimen and send it to a medical laboratory . The more common type of specimen collected will be a swab of the nose or throat and less commonly a blood specimen .

Due to the lack of a cell wall , some classes of antibiotics will not work on this infection . Mild cases may not even need treatment . However , if an illness is considered severe , then physicians can use several types of antibiotics to treat people with pneumonia caused by M . pneumoniae . Antibiotics are most effective if started early in the infection .

Typical antibiotics include macrolides , doxycycline , or fluoroquinolones . Azithromycin is the most frequently used antibiotic and is usually prescribed for 5 days ( 500 mg for the first dose , followed by 250 mg daily for four days ). Patients receiving doxycycline or fluoroquinolones should be given seven to 14 days of treatment . As with other bacteria and microbes , some M . pneumoniae are resistant to some antibiotics used for treatment . Physicians and medical laboratory professionals should be updated on current resistance and antibiotic susceptibility breakpoints .

• For more information on this infection , see Mycoplasma pneumoniae infections via CDC .

Rodney E . Rohde , PhD , MS , SM ( ASCP ) CM , SVCM , MBCM , FACSc , is the Regents ’ Professor , Texas State University System ; University Distinguished Chair & Professor , Clinical Laboratory Science ( CLS ); TEDx Speaker & Global Fellow – Global Citizenship Alliance ; Texas State Honorary Professor of International Studies ; Associate Director , Translational Health Research Initiative ; Past President , Texas Association for CLS .

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