Mycoplasma pneumoniae infections

Mycoplasma pneumoniae is a frequent cause of community-acquired respiratory infections in children and adults. Although the organism is felt to be the most frequent 'atypical' pathogen responsible for community-acquired pneum onia in adults, the prevalence of M. pneumoniae varies greatly from study t o study, depending on the population and the diagnostic methods used. Recen t studies have found the prevalence of M. pneumoniae in adults with pneumon ia to range from 1.9 to over 30%. M. pneumoniae is also a frequent cause of outbreaks of respiratory disease in institutional settings. However, the d iagnosis of M. pneumoniae infection is hampered by the lack of standardized , rapid, specific methods. This problem was illustrated by the results of a n investigation of an outbreak of M. pneumoniae infection in a federal trai ning facility. Accurate diagnosis required a combination of polymerase chai n reaction and serology, as IgM antibodies were not present early in the co urse of the infection in many patients. Several papers evaluating various s erological and polymerase chain reaction assays were published during the p eriod of this review. An assessment of the actual performance of these test s was also hampered by the lack of standardized comparative methods. M. pne umoniae is susceptible in vitro to macrolides, tetracyclines and quinolone antibiotics; however, data are limited on the microbiological efficacy of t hese agents. Several pneumonia treatment studies were published during this period, practically all of them based the diagnosis of M. pneumoniae infec tion on serology; different methods and criteria were used in each study, a nd thus the microbiological efficacy could not be assessed. The Infectious Disease Society of America recently stated in their revised Practice Guidel ines for the Management of Community-Acquired Pneumonia in Adults that, as there were no diagnostic tests available that reliably and rapidly detect M . pneumoniae, therapy must usually be empirical. Curr Opin Infect Dis 14:18 1-186. (C) 2001 Lippincott Williams & Wilkins.