History and exam

Key diagnostic factors

common

presence of risk factors

Risk factors include: close community settings, recent exposure, cigarette smoking, age <30 years.

persistent cough

May indicate Mycoplasma pneumoniae infection. Often does not resolve with time.

dry cough

May indicate Mycoplasma pneumoniae infection.

prolonged symptoms

Prolonged time from the onset of symptoms to the presentation may suggest Mycoplasma pneumoniae infection.

fever

May indicate Mycoplasma pneumoniae infection. Low-grade fever most common.

adventitious sounds on physical examination

May be mild or absent. Coarse crackles will change to fine crackles at a late phase (3-5 days after initial onset).

exposure to a person with respiratory tract infection

In many cases the patient will report close contact with a person who has had respiratory symptoms in the last few days or weeks.

Other diagnostic factors

common

throat involvement

Pharyngitis and hoarseness may be present with Mycoplasma pneumoniae.

rash

May accompany Mycoplasma pneumoniae pneumonia in 10% to 20% of cases.

uncommon

headache

May be present with Mycoplasma pneumoniae infection.

bullous myringitis

Rare sign (5%) suggesting Mycoplasma pneumoniae infection.

hepatitis

The presence of hepatitis with pneumonia may suggest that Mycoplasma pneumoniae is a pathogen.

Risk factors

strong

close community settings

Exposure to Mycoplasma pneumoniae in close community settings such as schools, universities, military training camps, nursing homes, or even hospitals can lead to outbreaks.[4] Transmission via aerosol occurs between people in close proximity to each other.[4][17]

recent exposure

Exposure to someone with respiratory infection.

cigarette smoking

Smokers have a higher risk for developing pneumonia due to Mycoplasma pneumoniae.[23][24][25] This may be related to damaged ciliated epithelium and/or modification of the host immune response.

age <30 years

Children and young adults appear to be the most susceptible population to Mycoplasma pneumoniae infection.[26]

weak

immunosuppression

Immunosuppressed patients tend to have more severe and invasive disease.[4]

Mycoplasma other than Mycoplasma pneumoniae have been isolated from invasive disease in HIV and other immunosuppressed patients.

Hypogammaglobulinaemia is also associated with increased risk of respiratory and joint infections due to M pneumoniae.[4]

asplenia

Sickle cell anaemia patients with functional asplenia tend to have more severe Mycoplasma pneumoniae disease.[27]

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