MYCOPLASMA IN CHILDREN: SYMPTOMS AND TREATMENT.
Mycoplasmas are the smallest known free-living life forms. They are almost universally distributed both in the plant and in the animal kingdom as pathogenic objects. They look like microbes, but lack a cell wall. However, they have a unique cell membrane that contains sterols that are not found in bacteria or viruses. Mycoplasma infection threatens the child with the development of various variants of infection, depending on the defeat of a particular organ. Difficulties arise in their identification, correct diagnosis and treatment, since mycoplasma infection in children manifests itself in a special way.
Table of contents:
- General information about mycoplasma
- Features of mycoplasma infections
- Prevalence in children
- Symptoms of mycoplasma in children
- differential diagnosis
- Methods for the diagnosis of mycoplasma in children
- Methods of treating mycoplasma in children
GENERAL DATA ON MIKOPLASMA.
When they were first discovered, mycoplasma organisms were considered viruses because they pass through filters that trap bacteria. However, unlike viruses, they are able to grow in a cell-free environment and contain both RNA and DNA.
Mycoplasmas cause infection mainly as extracellular parasites, attaching to the surface of ciliated and epithelial cells of the respiratory and genital tract. The immune system responds to them, forming antibodies, but they are not completely destroyed. Mycoplasmas can cause direct damage to epithelial cells and an inflammatory response mediated by mononuclear cells or antigen-antibody reactions.
Mycoplasma pneumoniae is one of the few types of mycoplasmas that cause human diseases. Diseases are limited to the respiratory tract; however, respiratory infections of M. pneumoniae are also associated with various extrapulmonary manifestations. The mechanism of extrapulmonary complications is unknown, but it is believed to be an immune response. Systemic spread of bacteria is rare. Genital mycoplasmas are associated with numerous diseases of the genitourinary tract and reproductive organs, but can also cause infections in other places.
These include Mycoplasma hominis, Mycoplasma fermentans, Mycoplasma genitalium, Ureaplasma, they are transmitted sexually. The colonization frequency for the species M. hominis and Ureaplasma is 20–50% and 40–50%, respectively. These organisms provoke numerous diseases of the genitourinary tract and reproductive disorders. They may be associated with preterm birth and infections in deeply premature infants.
FEATURES OF MYCOPLASMA INFECTIONS.
The disease spreads worldwide, regardless of the time of year. Atypical organisms, such as M. pneumoniae, provoke up to 40% of cases of community-acquired pneumonia. The incidence can be much higher, because most cases are taken for ARVI and treated at home.
Most M. pneumoniae infections lead to a clinically severe upper respiratory tract disease. Symptoms include pharyngitis, cough, headache, chills, and myalgia (muscle pain). In 10% of small patients (the indicator depends on age), the infection progresses to tracheobronchitis or pneumonia and usually does not extend beyond the respiratory system. Pleurisy (usually minor) occurs in 5-20% of patients. M.pneumoniae is actively involved in the development of asthma, which leads to periodic and chronic wheezing in some children.
In addition, M. pneumoniae can also cause dermatological pathologies (25%) and central nervous system lesions (1-10%), although cardiac, musculoskeletal, hematological and gastrointestinal symptoms have also been reported. Children with weakened immunity, including those with humoral immunodeficiency, are more likely to have complications. In children with sickle cell anemia, mycoplasma infection can be severe, with acute respiratory failure.
An unusually severe M. pneumoniae infection has also been reported in children with Down syndrome, especially those with congenital heart disease.
PREVALENCE IN CHILDREN.
Children under 3 years of age develop an upper respiratory tract infection. M. pneumoniae infection in the first year of life is rare; however, in newborns this can cause severe respiratory infections and extrapulmonary lesions. M. pneumoniae infection is often found in schoolchildren and adolescents, with the highest infection rates in children aged 5–9 years who have a tendency to develop bronchitis and pneumonia. Colonization of infants with genital species of mycoplasmas usually occurs during passage through the infected birth canal, and genital mycoplasma organisms have been isolated from the upper respiratory tract in 15% of infants. Colonization usually lasts no more than 2 years.
Symptoms of mycoplasma in children.
Symptoms of Mycoplasma pneumoniae infection are often non-specific. The onset is usually similar to SARS, with fever, malaise, headache and cough. Coughing is a hallmark of M. pneumoniae infection. The frequency and severity of coughing may increase within a few days after the onset of the disease, a wet cough may be prolonged. In patients in whom the infection progresses to lower respiratory tract disease, the symptoms persist and worsen, and the cough becomes stronger. In some cases, as a result of damage to the mucous membranes, white or streaked sputum and chest pain may be present. Otitis media and sinusitis are rare. Post-infectious bronchitis can persist for weeks. M. pneumoniae infection can complicate asthma and exacerbate chronic obstructive pulmonary disease. Against the background of mycoplasmal infection, asthma may worsen for the first time.
Infection with genital mycoplasmas can have various manifestations, including with burning pain during urination (non-gonococcal urethritis); pain in the lower abdomen, fever and chills (suggestive of pyelonephritis). Girls may have vaginal discharge; symptoms of pelvic inflammation, fever. Newborns may have symptoms of coughing, meningitis, or brain abscess.
Patients with M. pneumoniae infection do not usually seem sick, and the disease is often referred to as “walking pneumonia.” The pharynx may be red, but the lymph nodes are not enlarged. Listening to the chest and lungs reveals slight abnormalities. A distinctive feature of mycoplasma pneumonia is the mismatch between physical data (relatively few) and radiographic data on pneumonia. Shortness of breath may occur, especially in children with asthma. Rarely, fulminant pneumonia with respiratory failure may occur.
The physical signs of genital mycoplasma infection vary depending on the type of infection. Newborns, especially premature babies, may have wheezing, blue around the mouth, and respiratory failure or signs of brain meningitis / abscess (e.g., cramps, lethargy, crying, and crying).
Extrapulmonary manifestations of mycoplasma infection may include the following:
- a red rash in the form of small tubercles;
- red spots;
- small bubbles in the body;
- Stevens-Johnson syndrome (with or without classic skin lesions);
- urticaria – Raynaud’s phenomenon.
Possible cardiac manifestations in the form of arrhythmias or ECG disorders (conduction defects), pericarditis, myocarditis, endocarditis. In rare cases, the infection leads to meningitis or encephalitis, acute arthritis, pancytopenia.
Mycoplasma infection in children should be distinguished from diseases such as:
- Chlamydia (chlamydial infections of the genitourinary system).
- Legionella infection.
- Parainfluenza virus.
- Respiratory syncytial viral infection.
- Rhinovirus infection.
- Rickettsial infection.
DIAGNOSTIC METHODS OF MYCOPLASMA IN CHILDREN
Diagnostic tests for M. pneumoniae are most useful in hospitalized children who may be at risk for fulminant pulmonary disease and complications of extrapulmonary infection. The basis is blood tests and antibodies to mycoplasma.
Crops do not help detect infection, since mycoplasma does not grow well on culture media.
ELISA is used to detect immunoglobulin M (IgM) and immunoglobulin G (IgG) directed against M. pneumoniae. Specificity exceeds 99%, and sensitivity is 98% when both results are obtained. The IgM result may be negative at an early stage (after 7-10 days) and may not help with the initial treatment.
Polymerase chain reaction (PCR) analysis reveals mycoplasma DNA. This analysis reveals her first.
A chest x-ray reveals the characteristic features of M. pneumoniae infection: bilateral lung damage, multifocal or diffuse dimming, and reticular infiltrates. In rare cases, pleural effusions can overlap with parenchymal diseases.
A high-resolution CT scan can detect lobe lesions and interstitial disorders in M. pneumoniae pneumonia better than chest x-ray. However, high-resolution computed tomography is more expensive and exposure is increasing.
High-resolution CT scans are usually not performed during routine examinations of children.
METHODS OF TREATMENT OF MYCOPLASMA IN CHILDREN
Mycoplasma infection in children is treated at home, only in difficult situations children are hospitalized. Commonly used antibiotics – penicillins and cephalosporins are not effective. Macrolides are the drugs of choice. Tetracyclines can be used in patients older than 8 years. Fluoroquinolones can be considered after 12 years if macrolides or tetracyclines are not suitable due to allergies.
The response to therapy is usually excellent, the child recovers quickly with a full course of treatment. Further inpatient care for patients with mycoplasma infections is usually only necessary if severe pneumonia or extrapulmonary complications occur.
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