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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #4

Have a patient complaining of respiratory symptoms including cough, sinus congestion, rhinorrhea, sore throat, etc…? Have symptoms been lingering for over 10 days? Ask if they are having actual fatigue as well. If so, consider Mycloplasma as the causative organism. This is an atypical organism, therefore penicillin and cephalosporins would have no effect. You need to treat these patients with azithromycin or doxycycline instead.

Often times these patients will have been on amoxicillin, cephalexin, cefdinir, etc… and return to you with no improvement. Atypical organisms also can cause non specific and bizarre symptoms. I had a pregnant patient once who was complaining of nausea, vomiting, diarrhea and cough. I tested her for Mycloplasma and lo and behold it was positive. I started her on azithromycin and she was better in 24 hours.

Fatigue with common URI symptoms? Think Mycloplasma. Start them on azithromycin or doxycycline instead!

6 Responses

  1. Also in pediatrics I have seen it as urticaria and cough failing treatment or recurring after prednisone and benadryl.

    1. Mycoplasma is part of the standard Respiratory Pathogen Panel (R.P.P.), which is a nasopharyngeal swab. Its part of the “walking PNA” syndromes, which also includes Chlamydia pneumoniae. Part of the evaluation should include physical exam, which will reveal bilateral diffuse crackles, and low grade fever. A CXR will reveal bilateral interstitial densities, characteristic of atypical pneumonia. Additionally, you can perform a blood test for IgM cold agglutinins, although this test has a low sensitivity for Mycoplasma. Classically, Mycoplasma occurs in young adults.

      I’m not sure how this is considered a “clinical pearl”, since is an extremely common disease and is taught as part of all undergraduate medical curriculums. This type of knowledge is typically acquired during a 2nd year medical student’s study.

  2. I catch mycoplasma related Illnesses all the time. I have had it myself. I was so tired, I wanted to put my head on my desk and sleep.

  3. Asking questions are really good thing if you are not understanding anything fully, however this post offers pleasant understanding even.

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