"...Mycoplasma is responsible for approximately 20 percent of all
cases of pneumonia and recovery may be improved with certain
antibiotics..."

Pneumonia refers to many different diseases
By DR. TERRY GAFF
KPCnews.com  - Kendallville, IN. USA  - Sunday, March 06, 2005

During the past month or so, many people in our communities have come down with pneumonia.
Although my first statement makes it seem like I
am referring to one thing, pneumonia is really many different
diseases that involve infection or inflammation of the lungs. It is
caused by a variety of bacteria, viruses, mycoplasmas, or even fungus
(or a combination of these).

Comparing one case of pneumonia to another is like comparing one car
to another. Just as any car may get you where you are going, each one
looks and acts differently. Some are so much different that it is
hard to imagine they have anything in common.

What every case of pneumonia shares is the fact that pneumonia is an
infection of the lung tissue. It occurs in two ways.

Lobar pneumonia affects one or more of the five sections (lobes) of
the lungs and bronchial pneumonia affects patches throughout the
lungs. "Double pneumonia" just means that both lungs are infected.

In 1996, there were an estimated 4.8 million cases of pneumonia. In
2000, there were approximately 1.3 million hospitalizations, 1.3
million emergency room visits, and 63,548 deaths due to pneumonia
recorded in the United States. So the chances are that you know
someone who has, or has had, pneumonia.

Some people are more likely to get pneumonia than others, especially
the old, the very young, and those with other health problems, such
as chronic obstructive pulmonary disease (COPD), diabetes mellitus,
congestive heart failure and sickle cell anemia.

Patients with diseases that impair the immune system, such as AIDS,
or patients with other chronic illnesses, such as asthma, or those
undergoing cancer therapy or organ transplantation, are particularly
vulnerable.

Most pneumonia in the very young is caused by viral infections,
including respiratory syncytial virus (RSV). Approximately 50 percent
of all pneumonia cases are believed to be caused by viruses and tend
to result in less severe illness than bacteria-caused pneumonia. The
symptoms of viral pneumonia are similar to influenza symptoms,
including fever, dry cough, headache, muscle pain, weakness, high
fever, and increasing breathlessness. In fact, some pneumonia is
actually caused by the influenza virus.

For the most part, the treatment of viral pneumonia amounts to
treating symptoms and giving other supportive care, such as extra
oxygen. It is possible to prevent some of these by getting the
influenza vaccine (flu shot) or taking anti-viral medicines like
Tamiflu (for Flu) or Synagis (for RSV).

Streptococcal pneumonia, which is also called Pneumococcal pneumonia,
is the most common type of bacterial pneumonia. It accounts for 25 to
35 percent of all community-acquired pneumonia and an estimated
40,000 deaths yearly. It can come on gradually or suddenly. In the
most severe cases, the patient may experience shaking chills,
chattering teeth, chest pains, sweats, cough that produces rust
colored or greenish mucus, increased breathing and pulse rate, and
bluish-colored lips or nails due to lack of oxygen.

Although bacterial pneumonia is treated effectively with antibiotics
in many cases, it can be partially prevented with the Pneumococcal
vaccine (pneumonia shot). People over age 65 and those in high-risk
groups (like those with diabetes, asthma, COPD, heart or kidney
disease, cancer or other chronic diseases) are advised to receive the
pneumonia vaccine. The vaccine is effective in approximately 80
percent of healthy young adults, but may be less effective in people
in high-risk groups.

A vaccine known as Prevnar can also help protect young children
against Pneumococcal pneumonia. It is recommended for all children
under age 2 and for children 2 years and older who are at high risk
of pneumococcal disease, such as those with an immune system
deficiency, cancer, cardiovascular disease or sickle cell anemia.

Pertussis (whooping cough) vaccine is also included in the "baby
shots" which helps to keep that disease from progressing to pneumonia.

Mycoplasmas are the smallest free-living agents of disease in man,
with characteristics of both bacteria and viruses. They generally
cause a mild and widespread pneumonia, which is commonly
called "walking pneumonia." The most prominent symptom of mycoplasma
pneumonia is a cough that tends to come in violent attacks, but
produces only sparse whitish mucus. Mycoplasma is responsible for
approximately 20 percent of all cases of pneumonia and recovery may
be improved with certain antibiotics, but not by penicillin.

There are whole books written about pneumonia, so I will not try to
cover every aspect of the disease. But I will encourage you to see
your doctor if you develop any of the symptoms mentioned above or if
you have a chronic disease that may make you more prone to develop
pneumonia or have been exposed to pneumonia.

Dr. Terry Gaff practiced family medicine in Albion and is now medical
director at Parkview Noble Hospital's emergency department.

2005 KPC Media Group, Inc.

* * * * * * * * * * * * * * ** ** * * * * * * * * * *

Sample type is crucial to the diagnosis of Mycoplasma pneumoniae pneumonia by PCR.
Raty R, Ronkko E, Kleemola M.
Laboratory of Respiratory Viruses and Mycoplasmas, Department of
Microbiology, National Public Health Institute, Mannerheimintie 166,
FIN-00300 Helsinki, Finland.
J Med Microbiol. 2005 Mar;54(Pt 3):287-91.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15713613

Sensitive and specific methods for rapid laboratory diagnosis of
Mycoplasma pneumoniae were not available until nucleic acid
amplification methods were developed. The choice of sample type and
method of sampling are crucial to optimal diagnostic efficacy. Three
types of respiratory samples from 32 young military conscripts with
pneumonia were collected during an outbreak of M. pneumoniae
infection. Sputum, nasopharyngeal aspirate and throat swab specimens
were tested by 16S rRNA gene-based PCR with liquid-phase probe
hybridization, and the results were compared with serology.
The PCR result was positive for 22 (69 %) of the sputa, 16 (50 %) of
the aspirates and 12 (37.5 %) of the swabs. Serology with increasing
or high titres supported the positive findings in all instances.
Sputum, when available, is clearly the best sample type for young
adults with pneumonia.

* * * * * * * * * * * * * * ** ** * * * * * * * * * *

Clinical presentation, diagnosis and treatment of Mycoplasma pneumoniae pneumonia [Article in German]
Kluge S, Azizi M, Baumann HJ, Meyer A, Kirsten D.
Zentrum fur Innere Medizin, Medizinische Klinik I,
Universitatsklinikum Hamburg-Eppendorf.
Pneumologie. 2004 Oct;58(10):733-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15476112

Mycoplasma pneumoniae is a common respiratory pathogen in community
acquired pneumonia. In severe cases extrapulmonary manifestations of
the disease may be prominent. Proof of infection is found, though
usually delayed, through serologic methods. A calculated therapy of
community acquired pneumonia, especially in younger patients with
interstitial infiltrates, should therefore include effective
treatment for Mycoplasma pneumoniae.

Macrolide antibiotics are the most commonly used antibiotics in the
treatment of mycoplasma infection, alternatives include ketolides,
quinolones and tetracyclines.