What is Mycoplasma Infections?
Mycoplasma refers to a type of bacteria that belongs to a class called Mollicutes, which includes both Mycoplasma and Ureaplasma. These bacteria are unique because they lack a cell wall, which is usually a key component of a bacterial structure. There are over 100 different types of Mycoplasma and they can cause many different symptoms and infections.
First discovered in 1898, Mycoplasma was initially recognized as a cause of infection in animals. Now, it’s known for causing a variety of infections in humans too. The most well-known subspecies is Mycoplasma pneumoniae, which is often responsible for a unique kind of pneumonia called “atypical pneumonia”. This type of pneumonia doesn’t respond to regular antibiotics, hence the name “atypical”. Mycoplasma pneumoniae has been extensively researched due to its rising occurrence.
Despite its name, M. pneumoniae is not only associated with lung infections. It can also lead to infections in other body parts like the skin, brain, blood, heart, and joints. Another species called Mycoplasma genitalium is getting more attention because it’s linked to sexually transmitted infections. Additionally, Ureaplasma species are known to cause infections related to urinary and reproductive health, which can lead to complications in men, women, and newborn babies.
This article will discuss the most common infections caused by Mycoplasma and its impact on today’s medical practices.
What Causes Mycoplasma Infections?
: Mycoplasma is a type of bacteria that’s mainly passed from person to person, although there are some rare cases where it can be passed from animals to humans. It typically impacts the lining of the respiratory tract (like your nose and lungs) and urogenital tract (like the urinary system and reproductive organs).
This bacterium, specifically known as Mycoplasma pneumoniae, attaches itself to the cells in the upper and lower parts of the respiratory tract. Any droplets containing this bacterium can spread the infection from one person to another. Although still not fully understood, the bacterium seems to infect other tissues by directly invading them. The body’s immune response and some autoimmunity-related triggers also play a part in its spread.
There are also many harmless types of Mycoplasma that naturally live in our bodies, mostly in the mouth and throat. The most common ones are Mycoplasma salivarium and Mycoplasma orale. These bacteria are not harmful unless the person’s immune system is weak, in which case the bacteria might cause infections.
Another group of bacteria related to Mycoplasma, known as Ureaplasma, are known to cause infections in the urinary tract, and in female reproductive organs. Ureaplasma species, Mycoplasma genitalium, and M. hominis are all types of bacteria found on the genital and urinary tract’s lining. They can spread through direct sexual contact.
Risk Factors and Frequency for Mycoplasma Infections
Mycoplasma infections can be found all around the world and affect both genders equally. A particular subspecies, Mycoplasma pneumoniae, is responsible for 15-20% of cases of pneumonia that people catch in the community. These infections are more likely to spread in crowded places like hospitals, military bases, and schools.
The infection primarily happens in children between the ages of 5 to 14 and young adults. Infants under 6 months old rarely get this infection, likely due to immunity passed on from their mothers. Some people can carry the bacteria without showing any symptoms, meaning the actual number of infections could be higher than officially reported.
Symptoms of a M. pneumoniae infection usually develop gradually over 2 to 3 weeks. In the United States, more cases are diagnosed in the late summer and early fall, possibly because other respiratory infections are less common at that time of the year. Outbreaks of infection often happen every 3 to 5 years.
- Up to 80% of sexually active women can have Ureaplasma species, Mycoplasma genitalium, and Mycoplasma hominis, but this doesn’t always mean they have an active infection.
- Mycoplasma genitalium can cause up to 20% of non-sexually transmitted cases of inflammation of the urethra, cervix, and pelvic organs after pregnancy.
- Carriage of these bacteria is more common in lower socioeconomic groups and those with multiple sexual partners.
Signs and Symptoms of Mycoplasma Infections
Mycoplasma pneumoniae is a bacterium that can cause different types of infections. However, it’s most commonly associated with respiratory tract infections. It’s frequently found in children aged 5 to 14 years and can result in mild to severe illness. The symptoms usually develop gradually and are not specific. Common symptoms include fever, headache, sore throat, and cough.
- Fever
- Headache
- Sore throat
- Cough
Upon medical examination, patients with this condition often have a painful throat, with little to no swelling of the lymph nodes or pus. Lung sounds can vary depending on how extensive the infection is. Crackling or wheezing sounds may be heard if there’s inflammation in the windpipe or bronchi. If pneumonia develops, the lungs may produce a dull sound with crackles. Patients can take a long time to recover, usually with a persistent cough for 4 to 6 weeks. In rare cases, Mycoplasma pneumoniae can also cause skin rashes related to conditions such as erythema multiforme and Steven Johnson syndrome. Hives and a type of rash that looks like purple spots, known as anaphylactoid purpura, are less common.
Other types of Mycoplasma bacteria can cause symptoms associated with sexual organs. Infections caused by Ureaplasma species, Mycoplasma genitalium, and M. hominis, commonly show up as non-gonococcal urethritis, burning sensation during urination, urgency to urinate, and urethral discharge in men. Many infected women may not have symptoms, but if the infection leads to pelvic inflammatory disease, they may experience pelvic pain.
Testing for Mycoplasma Infections
If your doctor suspects a Mycoplasma infection, they’ll typically make a diagnosis based on your symptoms and their examination. Laboratory tests can help confirm this diagnosis, but they’re not often the first choice due to factors like cost, the time it takes to get results, and limited availability. There are a few different types of lab tests that might be used.
The culture test can identify the specific type of bacteria causing the infection. However, this test can be time-consuming and may not affect the treatment plan. Specifically, the bacteria M. genitalium, which often causes these types of infections, can take up to 8 weeks to grow enough for identification in culture.
Antibody tests (also known as serology tests) are often used in hospitals to diagnose Mycoplasma infections. These tests measure substances in your blood (IgM and IgG antibodies) that your body produces in response to the infection. The level of these antibodies increase a few weeks after you’ve become infected. However, the antibody levels can take up to a year to go back down even after the infection is gone, leading to the possibility of the test showing a false positive.
PCR testing is another type of lab test that could be used. It involves obtaining samples from the back of your throat or from vaginal or urethral swabs. This test is very specific, meaning it’s very good at accurately identifying the presence of the bacteria. However, it’s more expensive and can also take longer to get results compared to the antibody test.
Your doctor might also recommend imaging tests such as a chest X-ray if they suspect you might have atypical pneumonia, which could be caused by a Mycoplasma infection. However, the findings from these imaging tests can vary greatly. More common findings include changes around the bronchi and blood vessels, areas of lung consolidation, reticulonodular opacification (a type of shadowing), and small solid areas. Approximately one in five patients have bilateral involvement, meaning the infection is present in both lungs.
Treatment Options for Mycoplasma Infections
Mycoplasma is a type of bacteria that is different from many others because it doesn’t have a cell wall. This means it can resist many regular antibiotics and doesn’t respond to them. So, doctors don’t have many choices for treatment when you catch a Mycoplasma infection.
However, there are three types of antibiotics that have proven to be effective against this. These are: Macrolides, Tetracyclines, and newer kinds of drugs called Fluoroquinolones. It’s important to note that for children, the best treatment is usually Macrolides because certain drugs can be harmful to them.
Two examples of Macrolides that are commonly used are Azithromycin and Clarithromycin. These are especially useful for treating a specific type of lung infection (called atypical pneumonia) because they tend to be easier to handle and cause fewer unpleasant reactions compared to another drug, Erythromycin.
In cases where the infection has spread to the brain and spinal cord (the central nervous system), Tetracyclines like Doxycycline are preferred. This is also the first go-to treatment for certain species of Mycoplasma, such as M. hominis and U. urealyticum.
Fluoroquinolones, on the other hand, actually kill the bacteria and are therefore useful for those with weakened immune systems or unusual systemic infections where the infection has spread throughout the body. The duration of the treatment can vary depending on how severe the infection is and how the patient’s body responds to the treatment.
It’s also usually recommended that if the infection affects the urinary or reproductive tract, the patient’s sexual partners should also receive treatment to prevent further spreading of the infection.
What else can Mycoplasma Infections be?
Mycoplasma, due to its varied symptoms, can sometimes be mixed up with a number of other medical conditions.
Mycoplasma pneumoniae, the bacterium most often associated with community-acquired pneumonia, can commonly be confused with:
- Typical bacterial pneumonia
- Viral pneumonia
- Tuberculosis
- Pulmonary embolism
- Empyema, a collection of pus in the chest cavity
- Lung abscess, a pus-filled cavity in the lung
Also, there are other manifestations within the Mycoplasma family, like Ureaplasma species, M. genitalium, and M. hominis, that are mainly linked with infections in the reproductive and urinary systems. These infections can often be confused with:
- N. gonorrhea, a sexually transmitted disease
- C. trachomatis, another sexually transmitted disease
What to expect with Mycoplasma Infections
Most mycoplasma infections typically affect only one organ and cause few symptoms throughout the rest of the body, making for a generally positive outlook. People tend to fully recover after treatment, though it’s possible for the infection to reoccur soon after therapy has ended.
However, in rare situations, there can be severe cases of Mycoplasma pneumoniae, which is a type of bacterial infection that primarily affects the lungs. These cases can result in complications or severe overall disease, potentially causing multiple organs to fail. Severe cases of M. pneumoniae are quite uncommon, making up only 0.2% to 0.5% of all cases.
Possible Complications When Diagnosed with Mycoplasma Infections
While it is rare, there have been cases of death due to M. pneumoniae infection. About 25% of people who develop respiratory infections from M. pneumoniae may also experience complications that affect other parts of the body. These issues are thought to arise from our body’s immune response to the infection and the bacteria’s direct invasion of our tissue. Specifically, the nervous system is often affected, with signs like nervous system diseases appearing one to two weeks after respiratory symptoms. Interestingly, up to 20% of these patients may not show any signs of respiratory illness.
These complications can manifest in a variety of ways including nervous system inflammation (more common in children), a type of meningitis, nerve root inflammation, cranial nerve malfunctions, an inflammatory condition of the brain and spinal cord, optic nerve inflammation, confusion, sudden psychosis, and several other neurological disorders.
Up to 25% of patients may also encounter skin related complications such as Steven-Johnson syndrome, mouth ulcers, blistering skin rashes, and red skin rashes.
Common complications:
- Nervous system diseases
- A type of meningitis
- Nerve root inflammation
- Cranial nerve malfunctions
- An inflammatory condition of the brain and spinal cord
- Optic nerve inflammation
- Confusion
- Sudden psychosis
- Steven-Johnson syndrome (skin disorder)
- Mouth ulcers
- Blistering skin rashes
- Red skin rashes
Joint fluid complications can lead to bacterial arthritis, joint pain, bone infection, and multiple joint diseases. About 14% of patients with M. pneumoniae infection experience these symptoms. In rare cases – between 1 and 8.5% – individuals with serological evidence of infection might suffer from heart complications. These heart issues are more commonly known to affect adults.
Anemia is more common in children than adults infected with Mycoplasma pneumoniae. This occurs when the body generates cross-reacting cold proteins, thought to be a response mechanism to the infection. There have also been cases of platelet disorders causing purple spots on the skin and scattered blood clotting problems. These blood related disorders might affect 50% of patients when considering less severe and undiagnosed (subclinical) cases.
Other complications related to M. pneumoniae infection can affect the digestive system (nausea, vomiting, liver inflammation, pancreas inflammation), kidneys (acute inflammation of the kidney, kidney failure), ears (ear infections, inflammation of the tympanic membrane), and eyes (pink eye, iris inflammation, optic disk swelling, and inflammation of the back of the eye).
Two species – Ureaplasma and M. genitalium – are associated with complications during pregnancy and increased risks for newborns. Recent studies have linked Ureaplasma parvum infection to an increased risk of premature birth, low birth weight infants, and lung disease in premature babies. M. hominis is connected with mid-term abortions and early miscarriages. As a sexually transmitted infection, M. genitalium, has associations with a disease causing inflammation and infection of organs in the female reproductive system and a bacterial infection of the membranes surrounding the fetus.
Preventing Mycoplasma Infections
People frequently get exposed to mycoplasmal infections in closely-packed places such as military bases, schools, and hospitals. Washing your hands often is very important in preventing the spread of these infections. Mycoplasmal infections can be spread through the air via tiny water droplets, so it’s necessary to take precautions against this, especially in the case of patients staying in a hospital.
As for individuals infected by Ureaplasma species, M. genitalium, and M. hominis, it’s suggested that they use condoms to stop the spread of the sexually transmitted infection (STI). It’s also recommended that their sexual partners get treatment as well, to avoid getting reinfected.
