Patient may remain asymptomatic or present with following signs and symptoms:

• Non-productive cough
• Pharyngitis
• Low-grade fever
• Headache
• Malaise
• Erythema multiforme (rash characterized by a varied skin presentations like macules, papules, vesicles and bullae, and targetoid lesions).

Pneumonia caused by Mycoplasma Pneumoniae is sometimes called "walking pnemonia" because it is usually mild and, more often, does not require hospitalization.

Specific systemic clinical presentations may appear, some more common than others, but their appearance is unusual. These systemic findings may also be non-specific, such as diarrhoea, nausea, vomiting, abdominal pain, myalgias and arthralgias (in the form of polyarthritis). Since Mycoplasmas disturb body's immune system, aberrant immune responses may appear as tolerance to self-antigens is lost. This autoimmunity can manifest as hemolytic anemia (present in 60% of people), myocarditis, pericardial inflammation and effusions, hepatitis, aseptic meningitis, transverse myelitis or peripheral neuropathy. Specific cranial nerve palsies and cerebellar ataxia can also develop [7] [8]. A specific rash may appear in course of disease.

Most of these signs and symptoms are immune mediated but they may also result from direct invasion by Mycoplasma. In joint manifestations (arthralgia, polyarthritis), Mycoplasma can be isolated from joint fluid after aspiration. 

Respiratory examination is normal in most cases, unless severe symptoms or pneumonia develops. Wheeze (especially in children with a history of asthma) and scattered crepitations (crackles on examination with stethoscope), may be sometimes be heard in some patients.

Cold agglutinin are specific for Mycoplasma infection. Cold agglutinins are autoantibodies formed against red blood cells that agglutinate at low temperature. This results in Raynauds phenomenon (bluish discoloration of extremities at low temperature).

Disease may follow a complicated course in immuno-compromised, organ translplant patients, diabetics, patients on chemotherapy or cytotoxic drugs, in children and elderly people. Pneumonia is a common complication. Sometimes, complications that develop in other systems are far more severe than pneumonia, especially those involving vital organs.

• Fever

  A girl aged 7 years 11 months presented with fever (temperature, 40°C) and cough. Although the fever disappeared after approximately 10 days, she complained that her mother's face suddenly appeared smaller to her. [ncbi.nlm.nih.gov]

  Customer: Im still feeling unclear about this fever. [justanswer.com]

  The patient should consult their GP if they observe any of the above symptoms and are unwell, especially if their fever lasts for more than a couple of days. [netdoctor.co.uk]

• Fatigue

  If you have Lyme disease, fibromyalgia, chronic fatigue, autoimmune disease, or possibly any other chronic illness, however…it is a microbe you should know about. [rawlsmd.com]

  Chronic Fatigue Changes Your Gut Microbiome Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) usually causes debilitating symptoms. [articles.mercola.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  Chronic Fatigue Syndrome CFS (Chronic Fatigue Syndrome) is a disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint [digitalnaturopath.com]

• Anemia

  Affiliations PMID: 15868814 Case Reports Mycoplasma pneumoniae infection associated with hemolytic anemia--report of one case Jinn-Li Wang et al. Acta Paediatr Taiwan. 2004 Sep-Oct. Abstract Immune hemolytic anemia is a rare condition in childhood. [pubmed.ncbi.nlm.nih.gov]

  People who have mycoplasma pneumonia have an increased risk of developing hemolytic anemia, according to MedlinePlus. [livestrong.com]

  Mycoplasma atypical pneumonia can be complicated by Stevens–Johnson syndrome, autoimmune hemolytic anemia, cardiovascular diseases, encephalitis, or Guillain–Barré syndrome. [en.wikipedia.org]

  Untreated or severe cases can affect the brain, heart, peripheral nervous system, skin, and kidneys and cause hemolytic anemia. In rare cases, MP is fatal. Early diagnosis is difficult because there are few unusual symptoms. [healthline.com]

• Malaise

  Typical symptoms include fever, cough, bronchitis, sore throat, headache and malaise (generalized tiredness). [jaxmed.com]

  Typical symptoms include malaise, aches and pain, fever, cough, headache, congestion,and earache. Common symptoms reported by people with mycoplasma infection Reports may be affected by other conditions and/or medication side effects. [patientslikeme.com]

  Typical symptoms include fever, cough, bronchitis, sore throat, headache, and malaise. A common result of Mycoplasma infection is pneumonia (sometimes called "walking pneumonia" because it is usually mild and rarely requires hospitalization). [www1.nyc.gov]

  Symptoms develop over 1 to 3 weeks and include: fever dry cough headache chills heavy sweating scratchy sore throat sore trachea (the large airway between the mouth and the lungs) sore chest malaise (feeling of being unwell). [sahealth.sa.gov.au]

  Symptoms onset: Cough, sore throat,earache, headache,fever, Chills, and malaise. The frequency and severity of cough may increase over next few days after onset and may become debilitating. [lyme-symptoms.com]

• Cough

  To the Editor: Cough, one of the most common reasons patients seek medical attention [ 1 ], is categorised according to duration. Acute cough lasts 8 weeks [ 2, 3 ]. [erj.ersjournals.com]

  The two commonest symptoms were cough (98%) and fever (95%). Only 23% of children had cough of greater than one week's duration. Ninety one per cent had positive chest signs. Radiological abnormalities were seen in 95% of chest x-ray. [ncbi.nlm.nih.gov]

  Typical symptoms include fever, cough, bronchitis, sore throat, headache and malaise (generalized tiredness). [jaxmed.com]

  A persistent cough may linger for 6 weeks. [medical-dictionary.thefreedictionary.com]

  Prevention Exclusion from childcare, preschool, school or work is not necessary no vaccine is currently available cover a cough or sneeze with a tissue or your arm, not with your hand. [sahealth.sa.gov.au]

• Sputum

  Among this group of patients, 18 had one or more episodes of acute respiratory illness during which Ureaplasma urealyticum, Mycoplasma orale, or Mycoplasma pneumoniae were isolated from sputum. [ncbi.nlm.nih.gov]

  Sputum cultures are not usually done. The smear of sputum may show a predominance of monocyte type cells (initially neutrophiles) after symptoms have been present for several days which is suggestive. [jaxmed.com]

  If a Gram's stain (a common test done on sputum) does not indicate a gram-positive pathogen, the doctor will suspect a gram-negative organism, such as mycoplasma. [medical-dictionary.thefreedictionary.com]

  Myringitis (bullous) Acute bronchitis Bronchitis Pneumonia MCS sputum to exclude other pathogens. Meningitis Myocarditis NAA on CSF may be negative and a high index of suspicion is required. [rcpa.edu.au]

  The infection caused by this bacterium is called atypical pneumonia because of its protracted course and lack of sputum production and wealth of extrapulmonary symptoms. [en.wikipedia.org]

• Dry Cough

  Patients usually do not have severe shortness of breath, high fever, and a productive cough with MP. They more commonly have low-grade fever, dry cough, mild shortness of breath especially with exertion, and fatigue. [healthline.com]

  It takes two to three weeks from the time of infection for the following symptoms to appear: headaches muscle pain aching throat dry cough, which may last for weeks slightly raised temperature, though it should be noted that a high fever could still be [netdoctor.co.uk]

  Their cough can change from a dry cough to a phlegmy one. On rare occasions, youngsters may develop croup and a sinus infection (sinusitis). [healthychildren.org]

• Pleural Effusion

  Complications included dermatological (10%), pleural effusion (5%), neurological disorder (3%), septicaemia (1%), bronchiectasis (1%). Two children with Down's Syndrome died. A rare case of Mycoplasma bronchitis with Reye's Syndrome was observed. [ncbi.nlm.nih.gov]

  Small pleural effusions (fluid in the lining of the lungs) may be seen in up to 20% of cases. The results of routine blood testing are also non-specific. The total white cell count, and differential counts may be within normal limits. [dermnetnz.org]

  Pleural effusion (usually small) occurs in 5-20% of patients. [1] M. pneumoniae has been strongly implicated in the pathogenesis of asthma, leading to acute and chronic wheezing in some individuals. [19, 20, 21, 22, 23] Precedent M. pneumoniae respiratory [emedicine.medscape.com]

• Persistent Cough

  A persistent cough may linger for 6 weeks. [medical-dictionary.thefreedictionary.com]

  Signs and symptoms include chest pain, persistent cough, fever and/or a sore throat. Complications are rare, but it is important to know the risks. [livestrong.com]

  Respiratory: Chronic bronchitis, congestion, coughing, persistent coughing, chest pain, breathing irregularities. [lyme-symptoms.com]

  These parameters were: 1) persistent cough, 2) limited auscultatory findings on chest examination, 3) minimal sputum production, 4) a peripheral white blood cell count below 10,000/mm3. 5) nonsevere co-morbid illnesses. [antimicrobe.org]

• Chest Pain

  Respiratory: Chronic bronchitis, congestion, coughing, persistent coughing, chest pain, breathing irregularities. [lyme-symptoms.com]

  Signs and symptoms include chest pain, persistent cough, fever and/or a sore throat. Complications are rare, but it is important to know the risks. [livestrong.com]

  You might have: Chest pain when you take a deep breath in Cough that may come in violent spasms Mild flu -like symptoms such as fever and chills Sore throat Headache Tiredness Lingering weakness that may last after other symptoms go away Some people with [webmd.com]

  The most common symptoms of pneumonia are: Chills Cough (with legionella pneumonia, you may cough up bloody mucus) Fever, which may be mild or high Shortness of breath (may only occur when you exert yourself) Other symptoms include: Chest pain that gets [nlm.nih.gov]

  Use a heating pad to treat any chest pains they experience. Your child’s MP infection will usually clear up after two weeks. However, some infections can take up to six weeks to fully heal. In some cases, an MP infection can become dangerous. [healthline.com]

• Thrombosis

  In addition, in a minority of patients, a syndrome of CNS cerebrovascular thrombosis involving large or small vessels has been reported in association with M pneumoniae infection. • A second Mycoplasma organism, M hominis, may occasionally cause meningitis [medlink.com]

  […] pneumoniae infections with exacerbation of Crohn’s disease and other chronic inflammatory bowel diseases (R). 12) Mycoplasma May be Linked to Blood Disease M. pneumoniae can cause hemolytic and aplastic anemia, thrombotic thrombocytopenic purpura, arterial thrombosis [selfhacked.com]

• Myalgia

  These systemic findings may also be non-specific, such as diarrhoea, nausea, vomiting, abdominal pain, myalgias and arthralgias (in the form of polyarthritis). [symptoma.com]

  Early descriptions of primary atypical pneumonia noted accompanying headaches and myalgias, and the first association of primary atypical pneumonia infection with neurologic symptoms was observed in 1943 ( Campbell et al 1943 ). [medlink.com]

  With the exception of headache, systemic symptoms such as chills, gastrointestinal manifestations, myalgias are uncommon. [antimicrobe.org]

  Mortality/Morbidity Most M. pneumoniae infections lead to clinically apparent disease involving the upper respiratory tract; the symptoms include pharyngitis, cough, headache, chills, and myalgias. [1] In 5-10% of patients (with the rate depending on [emedicine.medscape.com]

  Chronic Brucellosis") Rickettsia Diseases: Coxiella burnetii (Q-Fever and "Post-Q Fever Fatigue Syndrome") Staphylococcus Viruses: Epstein-Bar Virus (reactivation) Coxsackie B Viruses(1-6)("Chronic Coxsackie Infection" may cause or trigger fibromyalgia, myalgias [thepowerhour.com]

• Suggestibility

  Although specific causes and pathology have not been elucidated, an association between AIWS and infection has been suggested. To our knowledge, mycoplasma-induced AIWS has not been examined. [ncbi.nlm.nih.gov]

  Less information is available for tropical or polar countries; however, based on seroprevalence studies, the disease also occurs in these regions, suggesting that climate and geography are not important determinants in the epidemiology of M pneumoniae [emedicine.medscape.com]

• Headache

  Mycoplasmas have been identified as commensal microbial flora of healthy persons yet, infection of the upper and lower respiratory tracts can result in acute cough, fever and headache, and even chronic disease involving multiple organs. [ncbi.nlm.nih.gov]

  Headaches : find out what treatments are available. X-ray examination : is X-ray radiation dangerous? Antibiotics : find information about the different medicines for infections. Last updated 02.02.2014 [netdoctor.co.uk]

  Typical symptoms include malaise, aches and pain, fever, cough, headache, congestion,and earache. Common symptoms reported by people with mycoplasma infection Reports may be affected by other conditions and/or medication side effects. [patientslikeme.com]

• Meningism

  Mycoplasmas were isolated from the joint fluid (Ureaplasma urealyticum) of two PAD patients with arthritis and from the cerebral spinal fluid (Mycoplasma maculosum) in one with meningitis, the latter probably originating from the patient's dog. [ncbi.nlm.nih.gov]

  Meningitis Myocarditis NAA on CSF may be negative and a high index of suspicion is required. [rcpa.edu.au]

  Erythromycin and tetracyclines have traditionally been used to treat cases of acute M pneumoniae meningitis or encephalitis, although a variety of other antibiotics have been used in individual patients. [medlink.com]

  This autoimmunity can manifest as hemolytic anemia (present in 60% of people), myocarditis, pericardial inflammation and effusions, hepatitis, aseptic meningitis, transverse myelitis or peripheral neuropathy. [symptoma.com]

  Incubation: varies Found: Worldwide Rash: Sometimes Some diseases it causes: Blood and lung infection in newborn, neonatal meningitis, Infectious, Crohn’s Diseasearthritis/septic arthritis,Irritable Bowel Syndrome,Inflammation of the uterus,Pelvic inflammatory [lyme-symptoms.com]

• Guillain-Barré Syndrome

  Abstract The authors previously reported the presence of antibody against galactocerebroside (Gal-C) in sera from patients with Guillain-Barré syndrome subsequent to Mycoplasma pneumoniae infection. [ncbi.nlm.nih.gov]

  Abstract Background: Patients with Guillain-Barré syndrome (GBS) after Mycoplasma pneumoniae infection often have antibodies to galactocerebroside (GalC). Electrodiagnosis may show acute inflammatory demyelinating polyneuropathy (AIDP). [n.neurology.org]

  Mycoplasma atypical pneumonia can be complicated by Stevens–Johnson syndrome, autoimmune hemolytic anemia, cardiovascular diseases, encephalitis, or Guillain–Barré syndrome. [en.wikipedia.org]

Following specific diagnostic modalities can be employed for Mycoplasma infection:

• Polymerase chain reaction (PCR)
• Serological tests for Mycoplasma

Unlike other bacterial species, Gram stain cannot be performed to identify organism in microscopy because of lack of cell wall.

Polymerase chain reaction (PCR) is the most accurate method (sensitivity 78-100%) to detect pathogen within leukocytes. Human leukocytes are split open and Mycoplasma nucleic acid is amplified and analyzed in this procedure. This test may also be very useful for making a diagnosis in immunocompromised patients, in which serological tests or complete blood count (CBC) do not give specific findings. Enzyme-linked immunosorbent assay (ELISA) and gene tracking can also be performed.

Serlogical tests are useful as long as person's humoral immunity is viable to form antibodies against Mycoplasma. Sensitivity is less than PCR (50-66%). Serum IgG and IgM can be tested at 70-10 days and 3 weeks respectively and 1:32 titre is diagnostic. Serological tests can also be performed during active phase and convalescent phase (10 days to 3 weeks following infection), by which time patient's condition may be recovering or medical treatment started. Thus, serological tests are also not useful at the time of presentation in medical facility (definite diagnosis is made retrospectively). They may however be used when an epidemic is suspected. A four fold rise in titre during convalescent phase is diagnostic. In order to start prompt treatment, or to rule out the suspicion of other pathogens (bacterial/viral), nasopharyngeal swabs, blood or sputum cultures and Gram staining may be done [9] [10].

In severe cases, liver function tests (LFTs) may reveal an elevated level of liver enzymes in blood. Concurrence of hepatitis and pneumonia in patient should raise the suspicion of Mycoplasma infection. CBC often reveals leukocytosis, and reduced number of red blood cells (due to formation of autoantibodies). Blood urea nitrogen (BUN) may be raised in case of kidney damage. Blood oxygen saturation tests are done at the time patient presents in hospital with severe disease. ESR and CRP are also non-specific.

Chest X-rays give non-specific findings; unilateral or bilateral patchy consolidation and small amount of pleural infiltrates. These findings are common to various pneumonia caused by other organisms. Cold agglutinin test is very useful for making a differential diagnosis in patients. Isolation of organism can be done with media supplemented by serum, but cultures are rarely performed because Mycoplasma is a fastidious organism and there is a risk of spread.

• Pulmonary Infiltrate

  Seite 643 - Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. ‎ [books.google.de]

  In 1944, Eaton discovered that sputum and lung tissue from such cases contained an agent that could pass through 45 µm filters permeable to viruses but not bacteria and that caused focal pulmonary infiltrates in rodents ( Eaton et al 1944 ). [medlink.com]

• Mycoplasma Hominis

  Hominis 19a) EXTRAGENITAL MYCOPLASMA HOMINIS INFECTIONS IN ADULTS, Am J Med, 1990, Sep; 89(3):275-281. 20) NONGENITOURINARY INFECTIONS CAUSED BY MYCOPLASMA HOMINIS IN ADULTS, Rev Infect Dis, May - June, 1988, v10, n3. 21 ) EXTRAGENITAL MYCOPLASMA HOMINIS [sites.google.com]

  Clinical and laboratory investigations established a lumbar paraspinal soft tissue infection with Mycoplasma hominis associated with severe spondylarthrosis at L5/S1. A relationship to a recently performed hysterectomy must be considered. [ncbi.nlm.nih.gov]

• Pleural Effusion

  Complications included dermatological (10%), pleural effusion (5%), neurological disorder (3%), septicaemia (1%), bronchiectasis (1%). Two children with Down's Syndrome died. A rare case of Mycoplasma bronchitis with Reye's Syndrome was observed. [ncbi.nlm.nih.gov]

  Small pleural effusions (fluid in the lining of the lungs) may be seen in up to 20% of cases. The results of routine blood testing are also non-specific. The total white cell count, and differential counts may be within normal limits. [dermnetnz.org]

  Pleural effusion (usually small) occurs in 5-20% of patients. [1] M. pneumoniae has been strongly implicated in the pathogenesis of asthma, leading to acute and chronic wheezing in some individuals. [19, 20, 21, 22, 23] Precedent M. pneumoniae respiratory [emedicine.medscape.com]

• Leukocytosis

  CBC often reveals leukocytosis, and reduced number of red blood cells (due to formation of autoantibodies). Blood urea nitrogen (BUN) may be raised in case of kidney damage. [symptoma.com]

Mycoplasma infection is treated on the basis of presentation of disease in patient. While a mild infection may require only a symptomatic treatment and antibiotics, treatment of complications and systemic involvement can be varied depending upon involvement of various organs.

Antibiotics

Antibiotics used against Mycoplasma Pneumonia infection are:

• Macrolides: Azithromycine, erythromycine, clarithromycine and roxithromycine
• Fluoroquinolones: levofoxacine, moxifloxacine
• Doxycycline

Penicillin and other beta-lactam antibiotics that act through cell wall of organism are not effective in this case. Clinical trials have shown maximum efficacy of azithromycine [11], and fluoroquinoles, levofloxacine [12], and moxifloxacine [13]. Studies have also shown azithromycine as the most effective drug in Mycoplasma Pneumoniae infection. Resistance to this drug did not develop despite multiple passages in the presence of azithromycine. Patients allergic to, or those who develop drug interactions or side effects of macrolides are given doxycycline and moxifloxacine.

Antibiotics are not much beneficial in patients who develop cross-reacting antibodies in Mycoplasma infection, for example those presenting with hepatitis, or more importantly those with nervous system involvement (cranial nerve palsies, transverse myelitis, etc.).

Other therapies

1. Plasma exchange therapy (in case of immune-mediated reactions).
2. Plasmapheresis (to remove cross reacting antibodies)
3. Patients presenting with CNS symptoms may also be treated with steroids (glucocorticoids), diuretics and antiinflammatory drugs.
4. Cold agglutinin disease/hemolytic anemic patients may also be treated with plasmapheresis [14], glucocorticoids and warming.

Glucocorticoids are known to have an antiinflammatory action. Studies have shown an effective role of glucocorticoids in ameliorating condition of patients with CNS symptoms, particularly children [15].

The spectrum of disease varies from person to person depending upon virulence of organism, amount of infection and host factors (including immune system). A wide disseminated disease can cause serious complications of respiratory, neurological, muscular or gastrointestinal origin, and a protracted disease course in an immuno-compromised host. On the other hand, disease restricted to respiratory tract may resolve in a few days or weeks, or lung function may not improve before many months pass. Lower respiratory tract involvement can prolong the duration of illness in patients.

Primary and secondary complications are usually a bad prognostic sign. They must be mitigated or resolved as soon as possible. Some people may recover spontaneously.

Mycoplasma Pneumonia infection is a common cause of community acquired pneumonia throughout the world. Generally all the organisms within class Mollicutes are referred to as "Mycoplasma" organisms. Mycoplasma are rod-like and can reside inside cells of immune system to cause immune dysregulation in host.

Pathogenesis of following Mycoplasma species is well established in humans:

• Mycoplasma pneumonia
• Mycoplasma hominis
• Mycoplasma genitalium
• Ureaplasma urealyticum

Transmission of Mycoplasma pneumoniae in humans occurs through respiratory aerosols or respiratory droplets from nose and throat of an infected individual and hence, spread though coughing, sneezing, and during speech. Moreover, infection can also occur by:

• Contact with contaminated hands or skin surface
• Fomites and other contaminated surfaces
• Sexual contact (Ureaplama urealyticum, Mycoplasma hominis and Mycoplasma genitalium are genitourinary organisms)
• Tranplacental transmission from mother to child during pregnancy, is also reported.

Organism adheres to pseudostratified ciliated columnar lining of respiratory tract through a specialized organelle. It exhibits gliding motility on respiratory mucosal surface, another factor that may aid in its infection [2].

Immunocompromised people, such as patients of AIDS or diabetes, are at increased risk of acquiring an infection. Children, elderly people and pregnant women are also susceptible. A person may be infected with more than one species of Mycoplasma at a time.

Mycoplasma Pneumoniae is the cause of 20% cases of community acquired pneumonia. Epidemics occurs in people living in close community settings such as military camps, boarding schools and hostels. Hospital based epidemics can also occur. Incubation period is from one to three weeks and period of communicability of organisms is generally 20 days. Mode of transmission of organism is respiratory droplets and close contact with people infected with organism, and other routes mentioned above. Epidemics tend to occur at an interval of three to five years. There has been a relative increase in the incidence of infection in last summer or fall in some countries [3]. In New York city, no precise estimate for occurrence of disease is available because it is not a report-able disease.

The organism is associated with mucosal surfaces rarely invading submucosa, except in people with immunosuppression. Prevalence of genital infections is also higher among HIV patients [4]. Other species that reside in genital tract i.e, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, are the cause of 20% cases of non-gonococcal urithritis, post-pregnancy pelvic inflammatory disease (PID) and cervicitis. In other cases, organism does not cause an active infection in host.

Mycoplasmas are rod-like in shape and possess a special adherence protein with which they adhere to respiratory epithelium. Absence of a rigid cell wall aids the organism in gaining entry inside cells. In the cells of respiratory epithelium, this organism behaves much like a retrovirus. It utilizes cell's nutrients and induces the host cell to work as a machinery for the generation of its own proteins to carry out its own replication.

CD-4+ cells that get activated by (Mycoplasma protein binding) macrophages produce pro-inflammatory cytokines including Interleukin-1, Interleukin-6 and Tumor Necrosis Factor-alpha (TNF-a) [5]. These cytokines, in turn, take part in generating further immune response in body.

Mycoplasmas mostly remain extracellular, restricted to mucosal surfaces and rarely a systemic involvement occurs; although the main mechanism by which Mycoplasmas cause damage to body organs is through dysregulation of immune system. When Mycoplasmas break out of cells they had infected, they take host cell membrane fragment with them. Immune system, thus starts recognizing self-proteins as foreign and an abnormal, auto-immune response is generated against body's own proteins, causing damage to various organs. Antibodies produced against glycolipids antigens of Mycoplasma pneumonia may act as cross-reactive antibodies and attack red blood cells, heart, brain, skin or liver cells. Cold agglutinins are cross reactive antibodies against red blood cells. These cross-reactive antibodies are specific (and diagnostic) for Mycoplasmas infection and some other diseases. Autoimmunity against joint cells causes arthritis. When they develop against TSH receptors of thyroid, they can cause Hashimoto's thyroiditis or Graves disease). Similarly myalgias, meningitis, transverse myelitis and hepatitis can be produced when these cross-reactive antibodies react against cellular proteins of muscle, brain, spinal cord and liver respectively.

Mycoplasmas can both, stimulate or depress the activity of B and T cells. They can also evade immune response, as they can reside inside certain cells of immune system such as Natural Killer cells (NK-cells). Infection of NK-cells reduces their number and weaken the innate immune mechanism of body against viral (e.g, HHV-6; Human Herpes virus-6) and other pathogens. Since organism resides inside cells, conventional serological techniques may not be useful for detection [6]. In order to confirm the presence of microorganism, leukocytes are split open and analyzed using PCR (Polymerase Chain Reaction). Otherwise, disease can go undetected in human body for many years.

Chronic Fatigue Syndrome (CFS), Chronic Fatigue and Immune Dysfunction Syndrome (CFID), Fibromyalgia Syndrome (FMS) and Multiple Chemical Sensitivity (MCS) are a group of overlapping disorders that share some common symptoms and often occur together. Mycoplasma pathogenesis is likely to be involved in the causation of these syndromes. Mycoplasmas can cause an increased production of cytokines, reduce the amount of Natural Killer cells (NK-cells), cross the blood brain barrier, invade central or peripheral nervous system and trigger an autoimmunity that damages cells of limbic system and other brain areas, causing symptoms that are associated with above mentioned disorders. Neurological symptoms are caused by:

• Increased production of inflammatory cytokines (through the stimulation CD-4+ cells)
• Activation of pituitary-hypothalamic axis
• Damage to cells of limbic system.

Mycoplasma infection spread through respiratory aerosols, contact with contaminated articles, and less commonly, through sexual contact. There is no vaccine for Mycoplasma pneumoniae infection. Following preventive measures can be adopted in order to prevent infection or a serious pneumonia epidemic in close communities.

• Maintaining personal hygiene (frequent hand-washing, using handkerchief while sneezing, coughing)
• Isolation of diagnosed case
• Chemoprophylaxis: Azithromycine or doxycycline are used for prevention in close contacts and health care personnel [16].

Mycoplasma species are wall-less, bacteria-like organisms that have been known as smallest free-living organisms. They can survive in aerobic as well as in anaerobic condition. Mycoplasma infection generally refers to an infection from any of the organisms belonging to class Mollicutes that includes 120 named species of Mycoplasma. Thirteen Mycoplasma species, two Ureaplasma species and two Acholeplasma species have been isolated from humans. Ureaplasma urealyticym, Mycoplasma hominis and Mycoplasma Genitalium also cause known infections in humans. These organisms are often involved in non-gonococcal urithrits, cervicitis or pelvic inflammatory disease, more commonly in women. Genital Mycoplasmas occur in 80% of sexually active women.

Lack of cell wall imparts this species some special properties:

• They cannot be visualized by Gram staining [1].
• Penicillin and other Beta-lactam drugs have no effect on them.

Infection more commonly manifests as respiratory tract symptoms, although rarely there may be a multi-system involvement, if dissemination occurs, as in immunocompromised hosts, or after instrumentation.

Mycoplasma infection refers to an infection from any of the organisms belonging to class Mollicutes that includes 120 named species of Mycoplasma. Mycoplasma pnemoniae is an important cause of community-acquired pneumonia.

Transmission

• Respiratory droplets from infected person, released during coughing, sneezing or talking.
• Contact with contaminated articles and surfaces.
• Direct transmission through sexual contact.

Disease is most common in close-community setting (boarding schools, camps).

Clinical features

• Fever
• Cough
• Sore throat
• Headache
• Malaise
• Muscle and joint pain
• Pneumonia (mild, hence called "walking pneumonia")
• Rash

Other clinical features are nausea, vomiting, abdominal pain, diarrhoea, meningitis, nerve palsies, hepatitis.

Diagnosis

Diagnosis of infection is made through:

• Clinical features
• Polymerase chain reaction (PCR)
• Serological tests (antibody IgM and IgG)
• ELISA

Treatment

Antibiotics treatment comprising of azithromycine, erythromycine, doxycycline, moxifloxacine and levofloxacine. In rare cases, patients may require plasmapheresis or plasma exchange therapy. Glucocorticoids, antiinflammatory drugs and diuretics are sometimes included in regimen to alleviate systemic symptoms.

Prevention

• Avoid contact with an infected person
• Chemoprophylaxis (azithromycine, doxycycline)

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