Mycoplasma in the bronchi. Mycoplasma respiratory infection
One of the common causes of inflammation of the human respiratory system is mycoplasma. In large cities, seasonal outbreaks of epidemics caused by infection are observed every few years. This rather dangerous disease develops rapidly in closely contacting communities: kindergartens, schools, families.
Mycoplasma - an atypical lung infection, literally means “pneumonia caused by mycoplasma”. In the human body, scientists have discovered so far twelve types of mycoplasma... Three of them are pathogenic for humans:
- Mycoplasma urealyticum
- Mycoplasma hominis
- Mycoplasma pneumoniae
If the first two overwhelm the genitourinary system, then the latter affects the mucous membrane respiratory tract... The causative agent of mycoplasma pneumonia is this pathogenic bacterium Mycoplasma pneumoniae, which does not have walls in cells and is able to change its shape. Biologically, it is located between bacteria and viruses. Mycoplasma is not adapted to live long in the external environment and is sensitive to high temperature and disinfectants.
Mycoplasma enters the body by airborne droplets, like an acute rotavirus infection or flu, but spreads through it much more slowly. Unlike many other respiratory diseases, mycoplasma is difficult to transmit. But when it enters the body, the pathogen in most cases causes the disease.
The incubation period of the disease can last from one to four weeks (most often about two). The disease develops gradually, but a subacute or acute course occurs. In almost half of patients with mycoplasma pneumonia, the diagnosis is made only at the end of the first week of the disease; initially, they are most often mistakenly diagnosed with bronchitis, tracheitis or acute respiratory infections. This happens because mycoplasma pneumonia does not have clear physical and radiological signs of infiltration.
Symptoms in adults and children
The first symptoms in adults and children are respiratory manifestations: pharyngitis, laryngitis, tonsillitis, less often acute tracheobronchitis. Later, the symptoms of pneumonia itself appear:
- dry wheezing and hard breathing;
- prolonged dry cough without phlegm;
- redness of the throat;
- nasal congestion;
- chest pain;
- temperature rise (up to 37-37.5 ° С);
- weakness;
- headache;
- aching joints;
- rash;
- sleep disturbance;
- indigestion.
In the acute course of the disease, symptoms of intoxication occur on the first day of infection, with gradual development - only after a week. With the development of the disease, the symptoms become more serious: an increase in temperature to 39-40 ° C, painful sensations when breathing, severe attacks unproductive debilitating cough with little viscous sputum. The duration of the cough is at least ten to fifteen days. For mycoplasma pneumonia, a protracted recurrent course is quite characteristic.
IMPORTANT! There is a risk of catching the disease at any age, but children are especially susceptible to mycoplasma preschool age and the elderly. In rare cases, congenital pneumonia develops immediately after birth - it is most severe.
In children under three years of age, the disease is often mild. In infants, from the characteristic signs, there is a cough (which may also be absent) and low-grade fever, so it is difficult to recognize the disease and it is possible only by indirect symptoms, such as refusal to breast, lethargy, low muscle tone, anxiety.
In older children, symptoms are identical to those of adults. After suffering an illness, immunity is formed for up to 10 years.
Diagnostics
As previously mentioned, most often, mycoplasma pneumonia is not immediately diagnosed.
At the reception, the doctor, when listening to the lungs, will reveal the presence of wheezing during breathing, shortening of sounds when tapping, weakened vesicular breathing. Based on these symptoms, a complete diagnosis and X-ray of the lungs are prescribed.
A blood test will show that there is no increase in the level of leukocytes and a slight increase in ESR. Cultural diagnostics is protracted and laborious, but it is characterized by reliability and accuracy in identifying the pathogen. It is necessary to wait for its results from four to seven days, since it consists in growing mycoplasma bacteria in a suitable laboratory environment.
A decisive role in the diagnosis of the disease is played by laboratory data detected serologically or using PCR - polymerase chain reaction. Serotyping - detection of specific IgM and IgG antibodies to Mycoplasma pneumoniae. The current standard for serological diagnosis of mycoplasma pneumonia is the ELISA method for detecting IgM and IgG antibodies.
In addition, PCR is actively used for etiological diagnostics, which is based on the determination of the DNA pathogen. With its help, almost instant diagnosis is possible, but this method is not suitable for determining an active or persistent infection.
Thus, for the exact etiology of the disease, complex laboratory tests and examination are required, including:
- General clinical analyzes.
- X-rays of light.
- Cultural method.
- Serotyping.
Treatment
Given the difficulty of timely diagnosis, the features of the symptoms and the severity of the disease, attention should be paid to the importance of timely access to a doctor and compliance with the prescribed prescriptions.
Self-medication, the use of folk recipes and unauthorized replacement of drugs can cause severe complications. The acute form of the disease with respiratory symptoms is treated in a hospital.
Mycoplasma pneumonia in children and adults is successfully treated by showing sensitivity to the pathogen. The doctor prescribes them based on the test results and, if necessary, the treatment is adjusted.
IMPORTANT! Antibiotics from the groups of penicillins and cephalosporins are ineffective for the treatment of mycoplasma.
Drugs from the following groups are used:
- Macrolides are bacteriostatic antibiotics with a low level of toxicity.
- Fluoroquinolones are artificial antimicrobial agents.
- Tetracyclines are one of the first antibiotics of natural and semi-synthetic origin.
The age of a child is of great importance in treating a child. Treatment of newborns is based on antibiotics from the macrolide group: erythromycin. For exacerbations of infections, tetracycline antibiotics are prescribed, but doxycycline cannot be used to treat children under 12 years of age and with a body weight of less than 45 kg. Treatment also includes drinking plenty of fluids, detoxifying the body, physiotherapy, massage, the use of expectorants in the form of syrups or mixtures.
Treatment is also accompanied by symptomatic therapy and fortifying measures: physiotherapy, massage, drinking plenty of fluids, expectorants. Mycoplasma pneumonia in children is rarely severe and almost always ends with recovery.
For adults, antibiotics from the group of fluoroquinolones are also suitable: afenoxin, levoflox, ofloxacin. Macrolides are considered the safest; they are also suitable for pregnant women.
Most often, the doctor prescribes a stepwise intake of drugs: the first three days in the form of intravenous injections, then the same drug (or another from its class), but already orally. To prevent relapse, it is very important to continue treatment for two to three weeks.
In addition to the treatment of mycoplasma in adults, the following drugs may also be prescribed:
- expectorant syrups and potions;
- analgesics;
- antipyretic drugs;
- immunomodulators;
- antihistamines;
- bronchodilators.
A vaccine against the causative agent of mycoplasma pneumonia does not exist at the moment due to the high immunogenicity of antibodies. Infection is problematic to prevent due to the ease with which bacteria can spread.
During treatment, it is very important to observe bed rest, not burden the body, drink abundantly and often ventilate the room.
Patients who have had pneumonia are assigned dispensary observation for six months. The first examination takes place in a month, the second in three months, and the third in six months after recovery. It includes an examination by a doctor, a study of a general blood test. During the recovery period, the following activities will have a positive effect on the body:
- physiotherapy;
- breathing exercises;
- physiotherapy;
- massage;
- water procedures.
IMPORTANT! Treatment in a sanatorium will be beneficial in a warm climate without excessive humidity, especially for people who have suffered a severe form of the disease with a deterioration in lung function.
Characteristics of mycoplasmas and their reproduction
What results in mycoplasmosis?
First, due to their small size, mycoplasmas can be located exclusively inside cells, which allows them to reliably protect themselves from the effects of antibodies and cells. immune system... Simply put, mycoplasmas simply “hide” in cells human body.
Secondly, mycoplasmas are motile microorganisms, therefore, in case of death of an infected cell, they quickly and easily move to other cells in the intercellular space and infect them.
Thirdly, mycoplasmas have the ability to firmly attach themselves to the cell membranes, as a result of which mycoplasmosis occurs regardless of the number of microbes that have entered the body.
Fourth, penetrating the respiratory tract, inside the epithelial cells (that is, the cells that form the surface of the bronchi and trachea), mycoplasmas begin to multiply very quickly and instantly paralyze the functioning of the infected cells.
The most surprising and most important feature of mycoplasmas, which is the cause of the chronic course of mycoplasmosis, is that microorganisms are very similar in structure to certain components of healthy tissues of the human body. It is for this reason that the immune system of people suffering from mycoplasmosis practically does not recognize these microorganisms and does not interfere with their development and survival in infected cells and tissues.
In addition, mycoplasmas, along with chlamydia, are resistant to most antibiotics, which greatly complicates the treatment of mycoplasma infection.
Signs and symptoms of pulmonary mycoplasmosis
The emergence of pulmonary mycoplasmosis occurs as a result of infection of the body with such a pathogen as mycoplasma pneumoniae (lat.Mycoplasma pneumoniae). According to statistics, children of preschool age most often suffer from mycoplasmosis, in connection with which there is a great danger of a large number of cases in children's groups. Mycoplasma infection is transmitted by airborne droplets, through droplets of saliva and sputum secreted by a person during a cough. In addition, mycoplasmosis can be contracted by contact with various things that have sputum or saliva. So, in children's groups, the infection can be transmitted through toys, food, or, for example, common chewing gum.
Pulmonary or respiratory mycoplasmosis usually occurs in the form of mycoplasma pneumonia or bronchitis.
Pulmonary mycoplasmosis begins with a sore throat and sore throat, nasal congestion, and an annoying dry cough. The latter, along with a slight increase in body temperature, is often the main symptom of the disease in children. In most cases, parents are unable to distinguish mycoplasmosis from a mild cold disease and try to cure it on their own using traditional means (expectorants, cough mixtures, antibiotics), which, however, does not bring any results.
It should be noted that mycoplasma pneumonia usually develops in young people and children as a result of complications after mycoplasma bronchitis. The symptoms of mycoplasma pneumonia are similar to those of influenza, in particular, in patients, the body temperature gradually rises to 39 ° C, a dry cough appears and general weakness, weakness, it becomes difficult for them to breathe (shortness of breath develops). In some cases, coughing up sputum containing a small amount of blood or pus. X-ray of the lungs with mycoplasma pneumonia shows vague shadows - these are foci inflammatory processes.
As a rule, mycoplasma pneumonia is favorable, but sometimes people with weakened immunity may develop complications such as meningitis, nephritis or arthritis.
The symptoms of pulmonary mycoplasmosis are largely similar to those of pulmonary chlamydia, an infectious disease that affects the respiratory tract. In addition, both diseases are treated in almost the same way. At the first sign or suspicion of mycoplasma or chlamydial infection respiratory tract and with an undetected pathogen, you can undergo a trial course of treatment.
In children with mycoplasmosis, complications are possible not only in the form of pneumonia and bronchitis: the disease can develop into sinusitis (for example, sinusitis) and pharyngitis. Moreover, mycoplasmosis can affect not only the respiratory tract, but also the joints, the genitourinary system.
Diagnosis of mycoplasmosis
- PCR (polydimensional chain reaction) is the most sensitive method for determining the structure of microbial DNA. Diagnosis of pulmonary mycoplasmosis using the PRC gives the most accurate results. It should be noted that the PCR method requires rather expensive equipment, which is not available in all diagnostic centers.
- The method for detecting specific antibodies determines the traces that appear as a result of the body's immune response to the presence of mycoplasmas. In people suffering from mycoplasmosis, antibodies such as IgM and IgG are found. In people who have had this disease, only IgG antibodies are determined.
Treatment of mycoplasmosis
First, it is necessary to confirm the presence of the disease by conducting a diagnosis, since the treatment of mycoplasmosis does not coincide with the treatment of viral or bacterial bronchitis.
So, with mycoplasmosis, they are prescribed:
- A course of antibiotics from the tetracycline group, macrolides, fluoroquinolones. For example, erythromycin - 500 mg per day for adults, 50 mg per kg of body weight per day for children. Take 5-6 days.
- At the onset of the disease (1-2 days) cough medicines.
- With mycoplasma pneumonia and bronchitis (to relieve cough) - expectorants.
Mycoplasmosis (mycoplasma infection) - anthroponous infectious diseases caused by bacteria of the genera Mycoplasma and Ureaplasma, characterized by damage to various organs and systems (respiratory, urinary, nervous and other systems). Distinguish:
1. Respiratory mycoplasmosis (mycoplasma-pneumonia infection);
2. Urogenital mycoplasmosis (non-gonococcal urethritis, ureaplasmosis and other forms) - is considered in national leadership on dermatovenerology.
ICD codes -10
J15.7. Pneumonia due to Mycoplasma pneumoniae.
J20.0. Acute bronchitis due to Mycoplasma pneumoniae.
B96.0. Mycoplasma pneumoniae (M. pneumoniae) as the cause of diseases classified elsewhere.
Causes (etiology) of mycoplasmosis
Mycoplasma - bacteria of the Mollicutes class; the causative agent of respiratory mycoplasmosis is mycoplasma of the species Pneumoniae of the genus Mycoplasma.
Mycoplasma pneumoniae
The absence of a cell wall determines a number of properties of mycoplasmas, including pronounced polymorphism (round, oval, filamentous forms) and resistance to β-lactam antibiotics. Mycoplasmas reproduce by binary division or as a result of desynchronization of cell division and DNA replication, elongate with the formation of filamentous, micelle-like forms containing a multiply replicated genome and subsequently dividing into coccoid (elementary) bodies. Genome size (the smallest among prokaryotes) determines limited opportunities biosynthesis and, as a consequence, the dependence of mycoplasmas on the host cell, as well as high requirements for nutrient media for cultivation. Cultivation of mycoplasmas is possible in tissue culture.
Mycoplasmas are widespread in nature; they are isolated from humans, animals, birds, insects, plants, soil and water.
Mycoplasmas are characterized by a close connection with the membrane of eukaryotic cells. The terminal structures of microorganisms contain proteins p1 and p30, which probably play a role in the mobility of mycoplasmas and their attachment to the surface of cells of the macroorganism. The existence of mycoplasmas inside the cell is possible, which allows them to avoid the effects of many of the host's defense mechanisms. The mechanism of damage to the cells of the macroorganism is multifaceted (M. pneumoniae, in particular, produces hemolysin and has the ability to hemadsorption).
Mycoplasmas are unstable in the environment. As part of an aerosol under conditions of a room, mycoplasmas remain viable for up to 30 minutes, die under the influence of ultraviolet rays, disinfectants, are sensitive to changes in osmotic pressure and other factors.
Epidemiology of mycoplasmosis
Pathogen source - a sick person with an overt or asymptomatic form of M. pneumoniae infection. Mycoplasma can be secreted from the pharyngeal mucus for 8 weeks or more from the onset of the disease even in the presence of antimycoplasmic antibodies and despite effective antimicrobial therapy.
Transient carriage of M. pneumoniae is possible.
Mycoplasmosis transmission mechanism - aspiration, carried out mainly by airborne droplets. For the transmission of the pathogen, a rather close and prolonged contact is required.
Susceptibility to infection is highest in children from 5 to 14 years old, among adults the most affected age group is those under 30–35 years old.
Duration of post-infectious immunity depends on the intensity and form of the infectious process. After the transferred mycoplasma pneumonia, pronounced cellular and humoral immunity is formed with a duration of 5-10 years.
M. pneumoniae infection is widespread, but the largest number of cases is observed in cities. Respiratory mycoplasmosis is not characterized by the rapid epidemic spread that is characteristic of respiratory viral infections. For the transmission of the pathogen, a rather close and prolonged contact is required, therefore, respiratory mycoplasmosis is especially common in closed groups (military, student, etc.); in newly formed military collectives up to 20–40% of pneumonia is caused by M. pneumoniae. Against the background of sporadic morbidity, outbreaks of respiratory mycoplasmosis are periodically observed in large cities and closed groups, lasting up to 3-5 months or more.
Secondary cases of M.pneumoniae infection in family foci are typical (a school-age child is primarily ill); they develop in 75% of cases, with transmission rates reaching 84% in children and 41% in adults.
The sporadic incidence of M. pneumoniae infection is observed throughout the year with a slight increase in the autumn-winter and spring periods; outbreaks of respiratory mycoplasmosis occur more often in the fall.
M. pneumoniae infection is characterized by a periodic increase in morbidity with an interval of 3-5 years.
Pathogenesis of mycoplasmosis
One of the manifestations of damage to ciliated epithelium cells is cilia dysfunction up to ciliostasis, which leads to disruption of mucociliary transport. Pneumonia caused by M. pneumoniae is often interstitial (infiltration and thickening of the interalveolar septa, the appearance of lymphoid histiocytic and plasma cells in them, damage to the alveolar epithelium). There is an increase in the peribronchial lymph nodes.
In the pathogenesis of mycoplasmosis, great importance is attached to immunopathological reactions, which are probably responsible for many extrapulmonary manifestations of mycoplasmosis.
The formation of cold agglutinins is highly characteristic of respiratory mycoplasmosis. It is assumed that M. pneumoniae infects the erythrocyte I antigen, making it an immunogen (according to another version, their epitopic relationship is not excluded), as a result of which complement-binding cold IgM antibodies to the erythrocyte I antigen are produced.
M. pneumoniae causes polyclonal activation of B and T lymphocytes. In those infected, the level of total serum IgM increases significantly.
M. pneumoniae induces a specific immune response, accompanied by the production of secretory IgA and circulating IgG antibodies.
Symptoms (clinical picture) of mycoplasmosis
Incubation period lasts 1-4 weeks, an average of 3 weeks. Mycoplasmas are capable of infecting various organs and systems.
Respiratory mycoplasmosis occurs in two clinical forms:
Acute respiratory illness caused by M. pneumoniae.
pneumonia due to 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 rhinopharyngitis (less often with the spread of the process to the trachea and bronchi) with a mild intoxication syndrome.
Onset of the disease usually gradual, less often acute. Body temperature rises to 37.1–38 ° C, sometimes higher. An increase in temperature may be accompanied by moderate chills, a feeling of "aches" in the body, malaise, headache, mainly in the frontotemporal region. Excessive sweating is sometimes noted. Fever persists for 1-8 days, subfebrile condition may persist for up to 1.5-2 weeks.
Characterized by manifestations of catarrhal inflammation of the upper respiratory tract. Patients are worried about dry, sore throat. From the first day of the disease, a fickle, often paroxysmal, unproductive cough appears, which gradually increases 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 it may bother you longer. In about half of patients, pharyngitis is combined with rhinitis (nasal congestion and moderate rhinorrhea).
With a mild course, the process is usually limited to the defeat of the upper respiratory tract (pharyngitis, rhinitis), with a moderate and severe course, the defeat of the lower respiratory tract (rhinobronchitis, pharyngobronchitis, rhinopharyngobronchitis) joins. With a severe course of the disease, the picture of bronchitis or tracheitis prevails.
On examination, moderate hyperemia of the mucous membrane of the posterior pharyngeal wall, an increase in lymphatic follicles, and sometimes hyperemia of the mucous membrane of the soft palate and uvula are revealed. Often increase the lymph nodes, usually submandibular.
In 20–25% of patients, hard 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 faint and inconsistent physical changes in the lungs.
In some cases, diarrhea is noted, abdominal pain is possible, sometimes for several days.
M. pneumoniae pneumonia
In large cities, M. pneumoniae is the cause in 12-15% of cases of community-acquired pneumonia. In children of older age groups and young adults, up to 50% of pneumonia is caused by M. pneumoniae. Pneumonia caused by M. pneumoniae belongs to the atypical pneumonia group. Usually characterized by a mild course.
The onset of the disease is often gradual, but it 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) are possible, rarely - rhinitis; 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, excessive sweating, which is also observed after normalization of temperature).
The cough is frequent, paroxysmal, debilitating, can lead to vomiting, pain in the chest and in the epigastric region - an early, constant and long-term symptom of mycoplasma pneumonia. Initially dry, by the end of the 2nd week of illness, 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 5-7th day from the onset of the disease, chest pain is noted when breathing on the side of the affected lung.
Fever remains at a high level for 1–5 days, then decreases, and for different times (in some cases up to a month) subfebrile condition may persist. Weakness can bother the patient for several months.
With mycoplasma pneumonia, a protracted and recurrent course is possible.
On physical examination, changes in the lungs are often mild; may be absent. In some patients, a shortening of the percussion sound is revealed.
On auscultation, weakened or hard breathing, dry and moist (mostly fine and medium bubbly) wheezing can be heard. With pleurisy - pleural friction noise.
Extrapulmonary manifestations are often observed; for some of them the etiological 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.
Possible exanthema - maculopapular, urticarial, erythema nodosum, exudative erythema multiforme, etc. A common manifestation of M. pneumoniae infection is arthralgia, arthritis. The damage to the myocardium, pericardium is described.
Hemorrhagic bullosa myringitis is characteristic.
Subclinical hemolysis with mild reticulocytosis and a positive Coombs' test is common, overt hemolysis with anemia is rare. Hemolytic anemia occurs at 2-3 weeks of illness, 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 often - defeat cranial nerves, acute psychosis, cerebellar ataxia, transverse myelitis. The pathogenesis of these manifestations is not clear; in some cases, the DNA of M. pneumoniae is detected in the cerebrospinal fluid by PCR. Defeat nervous system can be fatal. Respiratory mycoplasmosis often occurs as a mixed infection with ARVI.
Complications of mycoplasmosis
Lung abscess, massive pleural effusion, acute RDS. In the outcome of the disease, the development of diffuse interstitial fibrosis is possible. 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
Mortality in 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 central nervous system.
Diagnosis of mycoplasmosis
Clinical diagnosis of M. pneumoniae infection suggests acute respiratory infections or pneumonia, in some cases, and its possible cause. The final etiological diagnosis is possible using specific laboratory methods.
Clinical signs of pneumonia of mycoplasma etiology:
Subacute onset of the respiratory syndrome (tracheobronchitis, nasopharyngitis, laryngitis);
Subfebrile body temperature;
Unproductive, painful cough;
Non-purulent sputum;
· Poor auscultatory data;
Extrapulmonary manifestations: cutaneous, articular (arthralgia), hematological, gastroenterological (diarrhea), neurological (headache) and others.
In acute respiratory illness caused by M. pneumoniae, the blood picture is not informative. With pneumonia, most patients have a normal level of leukocytes, in 10-25% of cases leukocytosis up to 10-20 thousand, leukopenia is possible. IN leukocyte formula the number of lymphocytes is increased, stab shift is rarely observed.
Of great importance for diagnosis is x-ray examination organs of the chest.
With M. pneumoniae-pneumonia, both typical pneumonic infiltrations and interstitial changes are possible. The radiographic picture can be highly variable. Often there is bilateral lung damage with increased pulmonary pattern and peribronchial infiltration. The expansion of the shadows of large vascular trunks and the enrichment of the pulmonary pattern with small linear and looped details are characteristic. Strengthening of the lung pattern may be limited or widespread.
Infiltrative changes are varied: spotty, heterogeneous and inhomogeneous, without clear boundaries. They are usually localized in one of the lower lobes, involving one or more segments in the process; possible focal-confluent infiltration in the projection of several segments or lobe of the lung.
With infiltration that captures the lobe of the lung, differentiation with pneumococcal pneumonia is difficult. Possible bilateral lesion, infiltration in the upper lobe, atelectasis, involvement of the pleura in the process both in the form of dry pleurisy and with the appearance of a small effusion, interlobitis.
Mycoplasma pneumonia has a tendency to protracted reverse development of inflammatory infiltrates. In about 20% of patients, radiographic changes persist for about a month.
In a sputum smear of patients with pneumonia, a large number of mononuclear cells and a certain amount of granulocytes are found. Some patients have purulent sputum with a large number of polymorphonuclear leukocytes. Mycoplasmas are not detected by microscopy of a Gram-stained sputum smear.
For specific laboratory diagnosis of M. pneumoniae infection, it is preferable to use several methods. When interpreting the results, it should be borne in mind that M. pneumoniae is capable of persistence and its isolation is an ambiguous confirmation. acute infection... It should also be remembered that the antigenic relationship of M. pneumoniae with human tissues can both provoke autoimmune reactions and cause false positive results in various serological studies.
The culture method is of little use for the diagnosis of M. pneumoniae infection, since for isolating the pathogen (from sputum, pleural fluid, lung tissue, swabs from the posterior pharyngeal wall) special media are required and colonies need 7-14 days or more to grow.
Methods based on the detection of M. pneumoniae antigens or specific antibodies to them are more significant for diagnostics. RIF allows detecting mycoplasma antigens in nasopharyngeal smears, sputum and other clinical material. M. pneumoniae antigen can also be detected in serum by ELISA. Determination of specific antibodies using RSK, NRIF, ELISA, RNGA.
The most commonly used ELISA and / or NRIF to detect IgM-, IgA-, IgG-antibodies. An increase in the titers of IgA and IgG antibodies fourfold or more when tested in paired sera and high titers of IgM antibodies are of diagnostic value. It should be remembered that some tests do not distinguish between M. pneumoniae and M. genitalium.
The determination of the genetic material of the pathogen by PCR is currently one of the most common methods for diagnosing mycoplasma infection.
The diagnostic minimum of the examination corresponds to the procedure for examining patients with community-acquired pneumonia, which is carried out on an outpatient basis and / or in stationary conditions... Specific laboratory diagnostics M. pneumoniae infection is not included in the mandatory list, but it is advisable to carry it out if SARS is suspected and appropriate diagnostic capabilities. In case of acute respiratory infections, it is not required, it is carried out according to clinical and / or epidemiological indications.
Differential diagnosis
There were no pathognomonic clinical symptoms that could distinguish acute respiratory disease of mycoplasma etiology from other acute respiratory infections. The etiology can be clarified when carrying out specific laboratory research; it is important for epidemiological investigation, but it is not decisive for treatment.
Differential diagnosis between acute respiratory infections and mycoplasma pneumonia is relevant. Up to 30-40% of mycoplasma pneumoniae during the first week of the disease are assessed as acute respiratory infections or bronchitis.
The clinical and radiological picture of community-acquired pneumonia in many cases does not allow one to speak with certainty in favor of the "typical" or "atypical" nature of the process. At the time of the choice of antibiotic therapy, data from specific laboratory studies that allow establishing the etiology of pneumonia are in the overwhelming majority of cases not available. At the same time, given the differences in the choice of antimicrobial therapy for "typical" and "atypical" community-acquired pneumonia, it is necessary to evaluate the available clinical, epidemiological, laboratory and instrumental data to determine the possible nature of the process.
Primary atypical pneumonia, other than M. pneumoniae, is pneumonia associated with psittacosis, C. pneumoniae infection, Q fever, legionellosis, tularemia, whooping cough, adenovirus infection, influenza, parainfluenza, respiratory syncytial viral infection. Epidemiological anamnesis is often informative to exclude psittacosis, Q fever, tularemia.
In sporadic cases of legionellosis, radiographic and clinical picture may be identical to M. pneumoniae pneumonia, and differential diagnosis can only be done with laboratory data.
Infiltration in the upper lobe of the lung in association with blood-streaked sputum makes it possible to exclude tuberculosis.
Indications for consulting other specialists
The indication for consultation with other specialists is the occurrence of extrapulmonary manifestations of M. pneumoniae infection.
An example of a diagnosis formulation
B96.0. Right-sided lower lobe polysegmental pneumonia caused by Mycoplasma pneumoniae.
Indications for hospitalization
Hospitalization for respiratory mycoplasmosis is not always required. Indications for hospitalization:
Clinical (severe course of the disease, aggravated premorbid background, ineffectiveness of starting antibiotic therapy);
Social (impossibility of adequate care and fulfillment of medical prescriptions at home, the desire of the patient and / or his family members);
· Epidemiological (people from organized groups, such as barracks).
Treatment for mycoplasmosis
Drug-free treatment
In the acute period of the disease, the half-bed regimen is not required.
Drug treatment
ARI caused by M. pneumoniae does not require etiotropic therapy. The drugs of choice in outpatients with suspected primary atypical pneumonia (M. pneumoniae, C. pneumoniae) are macrolides. Preference is given to macrolides with improved pharmacokinetic properties (clarithromycin, roxithromycin, azithromycin, spiramycin).
Alternative drugs - respiratory fluoroquinolones (levofloxacin, moxifloxacin); the use of doxycycline is possible.
The duration of treatment is 14 days. The drugs are taken orally.
Doses of drugs:
Azithromycin 0.25 g once a day (on the first day 0.5 g);
Clarithromycin 0.5 g twice a day;
Roxithromycin 0.15 g twice a day;
Spiramycin 3 million IU twice a day;
Erythromycin 0.5 g four times a day;
Levofloxacin 0.5 g once a day;
Moxifloxacin 0.4 g once a day;
· Doxycycline 0.1 g 1-2 times a day (on the first day 0.2 g).
In patients hospitalized for various reasons with a mild course of the disease, the treatment regimen usually does not differ.
The severe course of M. pneumoniae pneumonia is relatively rare.
The clinical assumption of an "atypical" etiology of the process is risky and unlikely. The choice of antimicrobial therapy regimen is carried out according to the principles generally accepted for severe pneumonia.
Pathogenetic therapy of acute respiratory disease and pneumonia caused by M. pneumoniae is carried out according to the principles of pathogenetic therapy of acute respiratory infections and pneumonia of a different etiology.
During the recovery period, physiotherapy and exercise therapy (breathing exercises) are indicated.
Reconvalescents of pneumonia caused by M. pneumoniae may need sanatorium-resort treatment due to the propensity of the disease to a protracted course and often prolonged asthenovegetative syndrome.
Forecast
The prognosis is favorable in most cases. Death is rare. The outcome of M. pneumoniae-pneumonia in diffuse interstitial pulmonary fibrosis is described.
The approximate terms of disability are determined by the severity of respiratory mycoplasmosis and the presence of complications.
Dispensary observation of a patient who has been ill is not regulated.
Patient memo
In the acute period of the disease, half-bed rest, during the period of convalescence, a gradual expansion of activity.
The diet in the acute period usually corresponds to table number 13 according to Pevzner, with a gradual transition in the period of convalescence to the usual diet.
During the period of convalescence, it is necessary to follow the recommendations of the attending physician, regularly undergo the prescribed examination.
In the period of convalescence, long-term manifestations of asthenovegetative syndrome are possible, in connection with which it is necessary to observe the mode of work and rest, temporarily limit the usual loads.
Prevention of mycoplasmosis
Specific prophylaxis of mycoplasmosis has not been developed.
Nonspecific prevention of respiratory mycoplasmosis is similar to the prevention of other acute respiratory infections (separation, wet cleaning, ventilation of premises).
Respiratory mycoplasmosis refers to infectious diseases, accompanied by the development of inflammatory processes in the organs of the respiratory system. Infection with pathogenic microorganisms Mycoplasma pneumoniae is possible at any age. People who stay for a long time in a large group and in a closed room are especially susceptible to infection.
The causative agent of respiratory mycoplasmosis
Microbiology revealed that Mycoplasma pneumoniae does not contain a cell membrane and is small in size. Bacteria can take many forms. This facultative anaerobic microorganism differs from others in a complex cell membrane that serves as a membrane. The cytoplasm does not have the ability to produce sterols, which are part of it in other bacteria. To compensate for the lack of this important substance, mycoplasmas receive it from the body of an infected person. Due to these structural features, microorganisms have a low survival rate in the environment.
More than 10% of respiratory infections are associated with mycoplasma exposure.
During the massive incidence of acute respiratory viral infections and acute respiratory infections, observed in early spring and autumn, the rate increases to 50%.
Causes of pathology
Respiratory mycoplasmosis is transmitted by airborne droplets from infected people to healthy people. The most dangerous period during which infection is possible are the manifest and subclinical stages of development. Not all researchers admit that a person can only be a carrier, since there is not enough data to date.
Despite the fact that mycoplasma is transmitted by airborne droplets, it is possible to become infected with it only during close contacts, which is due to its poor resistance to survival in the environment. The risk of infection increases in schools, boarding schools, barracks. There are known cases of respiratory mycoplasmosis in hospitals.
Infection rates are high in temperate regions. An increase in the number of infected is observed every 6-7 years, among the sick - most of children and adolescents. This category of the population has a manifest form of the disease. Children under the age of 5 are less likely to suffer from this pathology, after 6 years - cases of infection are much more common.
The incubation period is 7-28 days. Infection with respiratory mycoplasmosis from a sick person is possible as early as 5-6 days. Pathogenic bacteria enter the body through the mucous membranes of the nose, oral cavity... Due to the special structure of the antigens located on the outer part, the pathogen easily binds to the cells of the surface tissues of the respiratory tract. Microorganisms produce certain substances that damage the epithelium.
Most often, mycoplasmosis affects precisely the upper parts of the respiratory tract, but inflammatory processes can develop in the parenchymal tissues of the lungs, which leads to pneumonia.
The disease affects frequently ill children with weakened immune systems.
Pulmonary mycoplasmosis causes the appearance of dystrophic signs of the epithelium, thickening of the interalveolar septa.
Signs and symptoms of the disease
The mycoplasma pathogen, penetrating into the mucous membranes of the respiratory tract, is capable of causing various symptoms:
- cough;
- sore throat;
- trouble swallowing;
- nasal discharge;
- rashes;
- sneezing.
The manifest form of an infectious disease is accompanied by signs of acute inflammatory processes of the respiratory tract. The main symptom is a red throat (pharyngitis). Cases of sinusitis and laryngitis are more rare.
In addition to the fact that the respiratory tract becomes inflamed, the temperature rises sharply in infected people, the intoxication phenomenon increases, manifested by malaise, dizziness, weakness, fatigue, and joint pain. The onset of cough is observed 2-3 days after the development of the first signs of the disease. It is paroxysmal, with poorly separated sputum. This symptom in most infected people persists for a half month after recovery. X-ray studies can show the presence of a focus of infiltration in the lung.
Although many patients develop bronchitis as a result of mycoplasmosis infection, some are diagnosed with pneumonia. The difference between this disease and other types of lung damage lies in the presence of minor symptoms of intoxication.
Rashes, inflammation of the mucous membranes of the eyes, pain in the ears are observed in patients much less often. Such signs are accompanied by fever, which decreases by 5 days of illness. Then, for another 7 days, subfebrile condition is observed. The catarrhal symptom regresses by day 11, while the multiplication of pathogenic microorganisms continues for some time.
Respiratory mycoplasmosis is characterized by a typical form of the course: without consequences, smooth, not heavy. With reduced immunity, children sometimes develop respiratory failure.
Treatment of respiratory mycoplasmosis in adults
Etiological therapy of respiratory mycoplasmosis is carried out if patients have signs of pneumonia, bronchitis. When choosing an antibacterial drug, the doctor should take into account that the pathogenic pathogen is characterized by increased resistance to semi-synthetic penicillin, cephalosporin, co-trimoxazole. When mycoplasmosis is detected, the above drugs are not prescribed.
- The patient has tachycardia with abnormal heart rhythm.
- There are complaints of insomnia, anxiety, nausea, muscle tremors, convulsive phenomena.
- In some patients, hypotension may develop, which is accompanied by weakness, dizziness, and decreased appetite.
When prescribing antibiotics, the doctor must calculate the correct dosage if the patient has signs of renal or hepatic dysfunction.
In some cases, it is possible to prescribe antifungal medicines, especially if several types of pathogenic microorganisms became the cause of the disease.
Respiratory mycoplasmosis in children
According to statistics, the incidence of respiratory mycoplasmosis among children and adolescents is much higher than the number of infections in adults. The pathogenic pathogen causes in young patients the development of both nasopharyngitis and bronchial asthma, pneumonia. On average, the incubation period lasts about 3-10 days, but sometimes mycoplasmosis appears only 3 weeks after introduction into the body.
At the end of the asymptomatic phase, children develop significant hyperthermia of the body (up to 40 degrees), complaints appear about the inability to breathe through the nose, sore throat. There may be a dry paroxysmal cough, pain in the ears. When examining a child, the doctor notes signs of weakened breathing, wheezing, inflammation of the pharynx. With the development of a severe form of respiratory mycoplasmosis, an additional bacterial infection may be attached. When the child's immune system is weak, the risk of respiratory failure increases.
In medicine, there are cases of complications of an infectious disease, manifested by meningitis, which are accompanied by the following symptoms:
- loss of consciousness;
- convulsions;
- ataxia;
- pyramidal disorders.
For young children, respiratory mycoplasmosis is treated with antibacterial drugs from the macrolide group. Tetracyclines are used to treat adolescents.
Diagnosis
The diagnosis of an infectious disease caused by mycoplasma cannot be based solely on clinical symptoms. To make the correct diagnosis, laboratory tests are required. The bacteriostatic method using a microscope is not effective enough due to the small size of pathogenic microorganisms.
The following methods are currently used to detect mycoplasmosis:
- Immunofluorescence reaction (RIF). The study helps to identify the presence of foreign agents in the blood.
- Polymerase chain reaction (PCR). The method allows you to record the presence of foreign DNA in the serum.
- Enzyme-linked immunosorbent assay (ELISA). Diagnostics is based on the identification of protein formations to the pathogen. When immunoglobulins appear, we can talk about an acute form of respiratory mycoplasmosis. With the development of a cross reaction with a pathogen of another type, the method gives false positive results.
To confirm the diagnosis, several types of laboratory tests are carried out at once.
Prevention measures
Currently, there are no special techniques that allow specific immunoprophylaxis. Researchers in the field of microbiology are conducting work related to this area.
In order to prevent infection with respiratory mycoplasmosis, it is important to observe the following rules:
- isolate an infected person from healthy people;
- identify persons who have been in close contact with a sick person;
- diagnose in a short time and eliminate the focus of infection.
If a child with signs of immunosuppression came into contact with an infected mycoplasma, a prophylactic course of antibiotic therapy is necessary. Medications are also prescribed for children with severe somatic pathology, sickle-cell anemia. Dosages of medicines are selected individually, depending on the concomitant disease.
Mycoplasmosis of the throat
The development of mycoplasmosis of the throat begins with the ingress of a pathogenic pathogen on the mucous membranes. Infection occurs by airborne droplets. The disease is characterized by a rather mild course without complications. Mycoplasmosis of the throat is manifested by its hyperemia, soreness, difficulty breathing and swallowing. The patient may develop rhinitis, fever, headache.
Therapy of the disease involves the use of antibacterial drugs for the onset of complications. Patients are prescribed tetracyclines, macrolides. With severe hyperthermia, the use of antipyretic medications is indicated, with the appearance of a strong cough - expectorants. In the case when mycoplasmosis manifests itself only by symptoms of acute respiratory viral infections, antibiotic therapy is not used. Doctors prescribe antihistamines, drinking plenty of fluids, vasoconstrictor drops with signs of rhinitis, herbal syrups.
The respiratory form of mycoplasmosis is common and is diagnosed in most cases in children of preschool and school age, as well as in adults over 60 years of age. The likelihood of infection increases with prolonged stay in a closed, rarely ventilated room.
Antibacterial drug therapy is carried out only with the development of severe forms of respiratory mycoplasmosis or in the presence of immunosuppression and other serious pathologies.
Prevention of morbidity is to prevent close contact with patients and increase the body's defenses.
Mycoplasmosis Is an infectious disease caused by microorganisms from the Mycoplasma family. Various members of this family are capable of causing specific lesions of the respiratory tract and organs of the genitourinary system. Mycoplasmosis is urogenital and respiratory. Since the symptomatology of the disease in these forms is different, there is a need to dwell on each separately.
Respiratory (pulmonary) mycoplasmosis - an infectious disease of the human respiratory tract. The causative agent of pulmonary mycoplasmosis is the microbe Mycoplasma pneumonia (Mycoplasma pneumonia) and some other (more rare) representatives of the genus Mycoplasma. Pneumoplasma (also called mycoplasma pneumonia) causes characteristic reactions of lung tissues, which leads to their destruction, and in addition, causes an autoimmune reaction (an attack by the body's immune system on its own cells).
How is pulmonary mycoplasmosis transmitted?
The source of mycoplasma is a person with mycoplasmosis. The patient is able to excrete the pathogen within 10 days from the moment of illness, but if the disease is accompanied by a prolonged increase in temperature (chronic course of the disease), then the period of excretion of mycoplasma can lengthen up to 13 weeks.
The route of transmission of infection is airborne, that is, the same as with many others infectious diseases respiratory system.
A contact-household transmission path is also possible (through household items, toys, handshake). The transmission of infection by contact and everyday life is observed mainly in children's groups.
It is important to note that susceptibility to mycoplasma is genetically determined, i.e. different people have different susceptibility to mycoplasmas, and post-infectious immunity can persist for 5-10 years.
The incubation period (the period of time from the moment the microbe enters the body until the symptoms of the disease appear) in the development of pulmonary mycoplasmosis lasts an average of 7-14 days.
What are the symptoms of respiratory mycoplasmosis?
The first symptoms of respiratory mycoplasmosis are a short-term rise in temperature to 38 ° C, cough. sore throat, nasal congestion, and increased sweating. Redness of the mucous membrane of the mouth and pharynx. Since the development of the disease is gradual, when the bronchi are involved in the process, a dry, exhausting cough, sometimes with scanty sputum, appears. Further development disease leads to the development of mycoplasma pneumonia (see. Atypical pneumonia). In general, the symptoms of pulmonary mycoplasmosis are similar to those of the flu, but unlike the flu. in which all the symptoms of the disease develop within 1-2 days and disappear within a week, with mycoplasmosis, as already mentioned, there is a gradual and prolonged development of symptoms.
For respiratory mycoplasmosis, a gradual regression of the symptoms of the disease is characteristic - within 3-4 weeks, sometimes up to 2-3 months. In young people, the transition of mycoplasmosis to a chronic form can cause the development of bronchiectasis (irreversible expansion of the bronchi) or pneumosclerosis (growth of cicatricial connective tissue in the lungs).
What methods are used to diagnose respiratory mycoplasmosis?
- polymerase chain reaction (PCR) - detects DNA fragments that are characteristic only for mycoplasma, contained in the mucus of the nasopharynx and in sputum. This is a fairly effective and affordable diagnostic method. The result can be obtained within 0.5-1 hours.
- culture method - based on the cultivation of mycoplasma in a special environment. This is the most reliable way to identify the causative agent of the disease, but research takes long time (4-7 days) and is very time consuming.
- immunofluorescence method (RIF - immunofluorescence reaction) - detects specific antibodies (blood plasma proteins) that have the ability to neutralize mycoplasma.
- study of paired sera - detection of specific antibodies up to the 6th day of the disease (first test) and after 10-14 days (second test). This diagnostic method helps to assess the effectiveness of the treatment.
How is respiratory mycoplasmosis treated?
Most effective drugs for the treatment of respiratory mycoplasmosis, drugs of the macrolide group are considered. The most famous drug from this group is Macropen.
Macropen is used in the treatment of pulmonary mycoplasmosis in adults, but it can also be used in the treatment of mycoplasmosis in children over 8 years of age. As a rule, the drug is well tolerated by patients.
Macropen is contraindicated in patients with severe liver diseases (hepatitis, cirrhosis), as well as in patients with renal failure.
Children weighing more than 30 kg Macropen are prescribed 400 mg 3 times a day. For ease of use, the drug is available in the form of a suspension for oral administration.
In the treatment of pulmonary mycoplasmosis, antibiotics of the tetracycline series are also used (a common representative is Doxycycline). Antibiotics from this group are especially effective when several pathogens are associated, for example, mycoplasma pneumonia + pyogenic streptococcus or mycoplasma pneumonia + streptococcus pneumonia. Doxycycline dose is calculated as 4mg / kg body weight on the first day, followed by a dose reduction to 2 mg / kg body weight. The duration of the course of treatment is determined by the attending physician.
Urogenital (genitourinary) mycoplasmosis - an infectious disease characterized by inflammatory lesions of the genitourinary system. The causative agents of mycoplasmosis of the genital organs are representatives of the Mycoplasma family - mycoplasma hominis and mycoplasma urealiticum (ureaplasma).
How does urogenital mycoplasmosis become infected?
The source of mycoplasma (ureaplasma) is a sick person or a carrier of infection. The period of infectiousness has not been sufficiently studied to date. The route of transmission of infection differs from that in the pulmonary form: urogenital mycoplasmosis is classified as a sexually transmitted disease (STD). since the main route of transmission of infection is sexual (during unprotected intercourse).
Possible transmission of infection from mother to fetus through the placenta (transplacental transmission), as well as when the child passes through the birth canal of the mother during childbirth.
In men, mycoplasmas and ureaplasmas often affect the urethra (urethra), and in women, the vagina.
Post-infectious immunity is very weak, that is, after being cured of mycoplasma, you can become infected and get sick again (especially with a decrease in immunity).
The incubation period for urogenital mycoplasmosis is 3-5 weeks.
How does urogenital mycoplasmosis manifest?
Mycoplasmosis "in its pure" form occurs only in 12-18% of cases. In most cases (85-90%) mycoplasma infection is associated with other microbes (for example, chlamydia, gonococcal infection), so the symptoms of the disease are mixed.
Urogenital mycoplasmosis in women is often asymptomatic, which contributes to the delay in treatment and the transition of the disease into a chronic form.
As in women, in men, mycoplasmosis is often asymptomatic.
Patients with urogenital mycoplasmosis complain of discharge from the urethra (in men) or from the vagina (in women). This discharge may be white, yellow color or completely transparent. Often, the discharge is accompanied by a burning sensation and soreness during urination and sometimes during intercourse. Patients feel itching in the urethra. There may be swelling and redness of the outlet of the urethra, as well as pain in the lower abdomen, itching and pain in the anus.
If untreated, mycoplasmosis affects the internal genital organs (uterus, the fallopian tubes, ovaries in women and vas deferens and testes in men). In such cases, men have pains in the scrotum, rectum, perineum, and women are concerned about low back pain and pain in the lower abdomen.
In some cases, mycoplasmosis is combined with joint damage (arthritis), conjunctivitis (inflammation of the outer transparent membrane of the eye).
There is evidence that mycoplasma, especially in combination with other types of urogenital infections, adversely affects hematopoiesis, reduces immunity and causes autoimmune reactions (impaired recognition of foreign agents and the direction of the body's protective functions against its own organs and tissues).
What diagnostic methods are used to detect urogenital mycoplasmosis?
In the diagnosis of urogenital mycoplasmosis, the following diagnostic methods are used:
- polymerase chain reaction (PCR) allows the isolation of mycoplasma DNA from urine, semen, urethral secretions, vagina and prostate
- cultural method
- paired sera study
- immunofluorescence (reaction of immunofluorescence - RIF).
Read more about these diagnostic methods in the section Respiratory mycoplasmosis (see above).
Treatment of urogenital mycoplasmosis
Due to the fact that mycoplasmosis is asymptomatic, a doctor is usually consulted after the onset of complications or after the transition of the disease to a chronic form.
Treatment of urogenital mycoplasmosis includes agents that affect the causative agent of the disease (kill the infection).
Treatment for each patient is selected individually, depending on the form of the disease, its severity, the presence of concomitant diseases or complications.
To combat urogenital infection (mycoplasma, ureaplasma) in modern medical practice, antibiotics of the tetracycline series (Tetracycline, Metacyclin, Doxycycline), macrolides and azalides (Erythromycin, Roxithromy. Josamycin, Azithromycin, etc.) and fluoroquinolones, Cinefloxinolones (Ofphloxiploxinolones ...
In cases of mixed infection, the described drugs are combined with other antimicrobial agents (Metronidazole, antifungal drugs).
This treatment should take place under strict dispensary supervision, long-term and complex.
Some drugs and their doses used in the treatment of urogenital infections: