Mycoplasmosis in newborns symptoms. Pulmonary mycoplasmosis: symptoms, diagnosis, treatment. General characteristics of the disease

Mycoplasma in children is diagnosed quite often. Mycoplasmosis is an infectious pathology caused by Mycoplasma bacteria. There are four types dangerous microorganisms of this kind, but children most often suffer from respiratory mycoplasmosis, which is transmitted by airborne droplets. With respiratory mycoplasmosis, the upper respiratory organs are initially affected, and then the pathogen can spread further. Mycoplasma is sometimes transmitted to the baby while in the womb or during childbirth.

General characteristics of the disease

Respiratory mycoplasmosis in children begins against the background reduced immunity. Most often this happens during the cold season of the year. This disease responds well to therapy. In most cases it is acceptable to use traditional methods treatment. Such treatment methods have a good antibacterial and anti-inflammatory effect. In addition, the child’s immunity is strengthened and the body begins to fight dangerous pathogens on its own.

Mycoplasma greatly affects the mucous membrane of the genital or respiratory organs . In children, the respiratory form of the disease occurs even if the baby is infected during childbirth.

Pathogens are characterized by tiny sizes and complete absence own cell membrane. Because most of Antibacterial drugs destroy precisely the cell membrane of pathogenic microorganisms, then mycoplasma is not at all sensitive to such medications.

Causes

Mycoplasmosis in children is an infection that in all cases is transmitted from a sick person to a healthy person. Mycoplasma is very sensitive to any factors, so if it gets into any external environment dies very quickly.

There are three main routes of infection with mycoplasma infection respiratory tract in children:

1. From the mother, during the passage of the baby through the birth canal. If a woman was diagnosed with mycoplasma during pregnancy, then it may well be transmitted to the child during childbirth. This is how not only mycoplasmosis can be transmitted. In a similar way mycoplasma, chlamydia, fungi and some viruses can be transmitted. Urogenital infections often lead to the onset of respiratory mycoplasmosis, as well as eye inflammation. IN exceptional cases mycoplasma in the expectant mother causes intrauterine infection in the fetus. With intrauterine infection, the child lags behind in development and there is a risk of severe congenital pathologies. Mainly the heart, nervous system and liver are affected.
2. By airborne droplets. In this case, the pathogen is transmitted from sick people to healthy people. Most often this happens during the cold season of the year with an outbreak of colds. Children become infected in children's groups, as well as in various entertainment events. A predisposing factor is severely reduced immunity.
3. By everyday means. In a family setting, the disease can be transmitted to a child from a sick adult. This is possible when using one towel or linen. IN in this case The child begins to develop a urogenital form of the disease. The pathogen affects the genitals and urinary system.

Mycoplasma microbes are very small in size. They cannot be detected by ordinary or electron microscope. They cannot be treated with antibiotics, and diagnosis is very difficult.

Mycoplasma in children rarely occurs on its own. Quite often it develops in conjunction with ureaplasma and chlamydia.

Symptoms

The disease has a fairly short incubation period; it can range from several days to a couple of weeks. Mycoplasma in a child manifests itself with specific signs of respiratory pathology. Initially pathogenic bacteria multiply on the mucous walls of the upper respiratory organs, and then move to the bronchi and lungs. If the pathogen has affected the lungs, there is a high probability of developing mycoplasma pneumonia in the child.

The main symptoms of this respiratory pathology in a child are:

• Does not last for a long time low-grade fever. The mark on the thermometer does not rise above 37.5 degrees.
• Vivid symptoms of intoxication appear - this is a common headache, abnormal lethargy, drowsiness and dyspeptic symptoms.
• The nose is constantly stuffy.
• The throat hurts or it regularly feels tickling.
• The mucous membrane of the upper respiratory organs is hyperemic.
• If mycoplasma affects the mucous membrane of the eye, conjunctivitis develops. A sick child suffers from pain in the eyes and severe watery eyes.
• If the pathogen has entered the bronchi, the patient coughs all the time.

If the disease was treated incorrectly or not treated at all, then pneumonia develops. The symptoms of mycoplasma pneumonia in children are almost no different from the classic manifestation of pneumonia.

• The temperature rises. Most often the mark exceeds 39 degrees.
• At first the cough is dry, but as the disease progresses, some clear or whitish sputum may appear.
• Every day the cough becomes more intense.
• The child's condition is deteriorating greatly. He complains of headache and severe weakness. Little children become capricious and whiny.

The symptoms of respiratory mycoplasmosis are very similar to a cold. Before starting treatment, it is necessary to make a correct diagnosis.

Mycoplasmosis is especially severe in newborns. In some cases, the disease provokes meningitis or sepsis. This can lead to the death of the newborn.

Diagnostics

At the beginning of the disease, mycoplasma is very similar to colds. Many parents think that their baby has a typical cold, so they do not rush to the doctor. For staging accurate diagnosis Several types of research are needed. First, the doctor examines the patient and listens well to the lungs using a stethoscope. This makes it possible to detect wheezing in the lungs and identify lesions. The throat must be examined.

Based on the results of the examination of the patient, one can only assume the disease. Laboratory tests will help establish an accurate diagnosis:

• Detailed blood test. Allows you to determine the degree of inflammation in the body.
• Research of biological material. Helps identify mycoplasma in cells.
• Sample culture. This type of research helps not only to identify the pathogen, but also to determine its sensitivity to antibiotics.
• Immunological examination. Antibodies to mycoplasma are detected in the plasma.
• The most accurate test for mycoplasma in children is PCR analysis. It helps identify pathogen genes in a biological sample.

If all studies confirm the previously made diagnosis, the doctor prescribes comprehensive treatment. It includes antibiotics to which the pathogen is sensitive, and traditional methods.

When diagnosing mycoplasmosis, an x-ray may be prescribed chest. This is necessary if pneumonia is suspected.

Treatment

For the treatment of mycoplasmosis in children are used antibacterial drugs different groups. They are prescribed taking into account the sensitivity of microorganisms. The most effective in combating this infection are macrolides. In addition to them, the following drugs may be prescribed:

• Clarithromycin.
• Azithromycin.
• Erythromycin.
• Josamycin.

Mycoplasma is not affected by drugs from penicillin series, cephalosporins and sulfa drugs.

It is worth considering that when treating children with antibiotics, the microflora is disrupted. digestive tract and immunity decreases. In addition, pathogenic microbes may develop resistance to antibiotics, and treatment will be ineffective.

The following folk recipes are used in treatment:

• Brew two teaspoons of crushed St. John's wort herb and 4 teaspoons of meadowsweet herb in two glasses of water, leave for 10 minutes and filter. Give children 50 ml of decoction before each meal.
• Take half a teaspoon of crushed immortelle grass, knotweed, bearberry, plantain and birch leaves. Pour two cups of boiling water and bring to a boil. Leave in a thermos for 8 hours. Then filter and drink. A sick child should drink 50 ml of decoction three times a day.
• Brew blueberry leaves and berries. This decoction is given to the child instead of tea, adding a little honey to it.

When treating respiratory mycoplasmosis, it is necessary to carry out steam inhalations With medicinal herbs . For brewing, take sage, St. John's wort, elecampane, chamomile, eucalyptus and other herbs.

The prognosis depends entirely on the form of the disease. With the intrauterine and congenital forms of the disease, the prognosis is unfavorable, as there may be severe complications diseases. With the respiratory form, the prognosis is good, complete recovery is observed after two weeks. If pneumonia occurs, it is mild and responds well to treatment.

How to identify mycoplasmosis in children and prescribe the correct treatment?

Mycoplasmas are single-celled organisms that are neither bacteria nor fungi. Gaining access to healthy cells, they capture them and feed on their energy, causing symptoms of the disease of the same name -.

Internal organs are affected, the immune system is weakened - these are the signs most often used to diagnose the disease. In its course, the disease has similar features to gonorrhea, chlamydia or trichomoniasis and can occur in very young children.

Types of mycoplasmosis

It is customary to distinguish different forms of the disease depending on which organ system is affected by microorganisms:

1. respiratory(damage to the upper respiratory tract);
2. pneumonic(pathology affects the lower respiratory tract);
3. urogenital(urinary tract suffers);
4. generalized(several organs/systems are affected by the disease);
5. perinatal(infection of the fetus during pregnancy or childbirth).

Symptoms

Below are the main symptoms of mycoplasmosis depending on the form of the disease:

Form	Manifestations
Respiratory	The child's temperature rises, a dry cough begins, gradually turning into a wet one. The throat is red, the nose is stuffy. Runny nose. A small, spotted rash with a pink color often appears on the surface of the epidermis.
Pneumonic	Along with the rise in temperature, appetite disappears. The child complains of headaches and wants to sleep a lot. There is shortness of breath and cough. When moving, there is pain in the joints.
Urogenital	Pain and itching during urination, discomfort also affects the lower abdomen. Discharge from the genitals. It is extremely rare in children.
Perinatal	The fetus is developmentally delayed and weighs too little. The newborn has breathing problems and the navel is not healing well. Brain functions suffer. Long-lasting jaundice skin, thrush, diaper rash on the surface of the epidermis.
Generalized	It manifests itself through reduced immunity and problems with the functioning of many body systems.

Most often, children are diagnosed with respiratory type diseases (it is easier to tolerate than those mentioned above). If the immune system has become weaker due to the influence of mycoplasma, the body often becomes infected with various infectious diseases respiratory system. The peak incidence of mycoplasmosis is the cold season.

General symptoms of the presence of mycoplasma in a child’s body:

1. The child’s nose stops breathing normally, and the condition is accompanied by a runny nose and cough. The duration of symptoms is approximately 14 days.
2. Feverish condition in children 7-14 years old. The temperature rises to 39-40 °C. It is difficult to bring down such a temperature, and it usually lasts up to 3 days. My head hurts a lot.
3. The child’s desire to eat food decreases or completely disappears, and the urge to vomit appears. The condition is accompanied general weakness and stomach pain. Stomach cramps appear.
4. Pain is felt in the muscles and bones.
5. A bluish tint to the skin indicates that the disease has become severe.
6. If a child has pneumonia, a strong increase in heart rate is observed.

Causes

A child can get mycoplasmosis for two reasons:

1. Intrauterine infection/transmission of infection during childbirth(during pregnancy, infection of the fetus occurs when swallowing amniotic fluid, and during childbirth - through the birth canal). Microorganisms begin to multiply in the epithelium, gradually spreading to the mucous membranes of the eyes. Next, the infection affects the child’s respiratory tract and gastrointestinal tract, simultaneously affecting the genitals.
2. Entry of mycoplasma into the body by airborne droplets (a sick person transmits microorganisms to a child in public places - school, kindergarten, on the street, or in the family).

How does infection occur?

The causative agents of the disease enter the child’s body through the mouth or nose. They attach to the mucous membrane and begin to secrete adhesins - substances that have a toxic effect. It often takes from 1 week to a month until parents notice the first symptoms of the disease - the nature of the manifestations and their strength depend on the state of the child’s body, and especially the immune system. If mycoplasmosis develops quickly, then, as a rule, it is easier to tolerate.

Diagnostics

Even experienced doctors have problems making an accurate diagnosis: manifestations of mycoplasmosis can be mistaken for symptoms of other viral infections. Cough and heat may be mistaken by parents for a common cold or a harmless infection.

The final diagnosis can only be determined after thorough examination the child's body. You should contact doctors such as a pediatrician, neurologist and infectious disease specialist.

It is advisable to be tested for the presence of mycoplasma during pregnancy - for this purpose, tests are taken for STDs.

The following methods will help determine whether a child has mycoplasmosis:

1. Clinical blood test.
2. X-ray. If a child has pneumonia of the mycoplasma type, a reticular restructuring of the pulmonary pattern will be detected. Revealed a large number of small focal shadows, as well as rays (they are directed to the base of the lung from its root). The lesion is usually unilateral and is diagnosed in the lower lobes.
3. Microbiological method.
4. Direct and indirect immunofluorescence. Direct type - the test material is stained with fluorochrome-labeled antibodies of the monoclonal type. If mycoplasma is present, it is detected in a fluorescent microscope by the corresponding glow. The indirect type has great advantages in detecting pathogens: it is characterized by greater sensitivity and accessibility, and it becomes possible to determine antigens and antibodies. The use of only one labeled antiglobulin serum provides a detailed picture of viral antigens and bacteria.
5. Polymerase chain reaction. As a result of the selection of biological material for research, a DNA fragment of the pathogen is qualitatively identified.
6. Serological method. Mycoplasmosis is indicated by antibodies to mycoplasma genitalium. In the laboratory, a reaction of complement binding and indirect hemagglutination is carried out (adhesion of red blood cells, their precipitation).
7. Linked immunosorbent assay. Blood is given for analysis to determine the level of IgA (antibodies). Depending on the age of the child, this indicator varies (for example, in newborns - from 0.02 to 0.5 g/l, while in a child who is 3 years old - up to 1.5 g/l).
8. Cultural and bacteriological method. Material for research is selected and placed in a nutrient incubated medium to study the nature of its growth.

After the final diagnosis has been made, the question of where the child will be treated - at home or inpatient - is decided. It is worth noting that the generalized form of the disease requires being in medical institution, while the respiratory form is quite possible to cope with at home.

Treatment

Treatment with medications for mycoplasma infection in most cases is symptomatic:

1. Antipyretics. When the temperature rises, take Ibufen, Ibuprofen.
2. Expectorants. If a child has a cough, Mucaltin, Bronchicum, and breast preparations will help remove sputum.
3. Antibacterial. Used for severe conditions(Erythromycin, Tetracycline, etc.). Sumamed will help to stop the proliferation of pathological cells.
4. To strengthen the immune system multivitamins are used - Alphabet, Supradin.
5. For lesions nervous system – Benemicin, Tetraolean. Often, in parallel with antibiotics, the doctor may prescribe hormonal drugs (Prednisolone).
6. Means to prevent intoxication, sorbents – Regidron, activated carbon.
7. To enhance blood circulation, its dilution is Heparin.

For a speedy recovery, you must follow healthy diet, which will provide the body with all essential vitamins. Fried and fatty foods, as well as other junk foods, should be excluded. Limiting your salt intake will be beneficial. The diet should be rich fermented milk products, fresh fruits and vegetables. In order for the body to fight infection, it needs to be provided with liquid - drink enough pure drinking water in a day.

Attention! Under no circumstances should you self-medicate, as this can lead to dangerous consequences for the body! Consultation with a qualified specialist is required!

Consequences

All complications caused by this disease can be divided into 2 groups:

Infection with mycoplasmas can cause problems intrauterine development in the fetus and even lead to its death. These microorganisms are capable of causing irreversible changes in the chromosomal cellular apparatus. The death of a child can also occur during maternal labor.

Prevention

In order to reduce the likelihood of mycoplasmosis in a child to a minimum, you need to undergo an examination of the body even when planning pregnancy. Those at risk are those who have had miscarriages, premature birth, salpingoophoritis in chronic form, as well as pyelonephritis.

It must be remembered that a recovered child can still be a carrier of the infection, so in order to protect others, it is best to leave the child at home for another week.

Additional measures to help your child avoid getting mycoplasmosis:

• Balanced diet.
• Hardening the body.
• Physical activity.
• Strengthening the immune system.
• Hygiene.
• Regular medical examinations.
• Maintaining a daily routine and sufficient time for rest.

Also, if possible, it is necessary to exclude the child’s contact with infected people. All family members should be examined for the presence of mycoplasmas.

In conclusion, it should be said that mycoplasmosis is easier to prevent using the above preventive measures than to fight it later. Timely and adequate treatment gives a good prognosis for the child’s full recovery - you should not hesitate when detecting the first symptoms of the disease!

Up to 20 percent inflammatory diseases in the lung area in humans it is mycoplasma infection that causes it. It is a single-celled organism, distinct from bacteria, viruses and fungi. The life activity of mycoplasmas is carried out at the expense of healthy cells. Thus, microorganisms destroy them, and subsequently, various internal organs and the immune system generally. In terms of progression, the disease is similar to chlamydia. In turn, mycoplasmas can “get along” with any other infections.

Causes

What can cause mycoplasmosis in children? Firstly, this is a hereditary factor. Infection of the fetus is possible even in the womb. In this case, the disease manifests itself either during pregnancy or after the baby is born. Intrauterine infection can cause ingestion of amniotic fluids directly through the layers of the placenta. Infection also occurs when overcoming natural birth canal if mycoplasmosis is urogenital in nature.

Children school age are infected with mycoplasmosis by airborne droplets. In this case, the infection enters the child's body through the mouth and nose. Microorganisms “cling” to the surface of the mucous membranes and secrete adhesins.

How congenital mycoplasmosis manifests itself depends on its type. Thus, the urogenital nature of the disease in the mother entails infection with hominis or genitalium. Pathologies in the presence of mycoplasma infection rarely occur independently. As a rule, microorganisms are activated “in combination” with other infections.

Symptoms

If the carrier of mycoplasmosis is a child of primary school age, then the manifestations of the disease are often minor and do not cause discomfort. Among adolescents, signs of the disease are accompanied by complications. The diagnosis of mycoplasmosis entails frequent acute respiratory diseases. The child becomes more susceptible to pneumonia. An acute respiratory infection caused by the activity of microorganisms begins with a sore throat. The cough is lingering, similar to that seen with whooping cough. Respiratory mycoplasmosis is characterized by a runny nose and fever. The first signs appear on the day of illness and persist for 7-14 days.

In case of "connection" adenoviral infections and chlamydia, mycoplasma cause symptoms of bronchitis, signs of pneumonia may be detected. The disease is accompanied by fever. The child complains of pain in chest area. Recognizing mycoplasmosis is not always easy, since it manifests itself in a similar way to typical viral infections.

Depending on the form of mycoplasmosis, the first signs may look like this:

• High temperature, dry cough turning into wet, “red” throat, nasal discharge and nasal congestion - typical symptoms respiratory form.
• Intense fever, loss of appetite, headache, fast fatiguability, pain syndrome in the area of ​​joints, coughing with shortness of breath indicate pneumotic mycoplasmosis.
• If we are talking about a urogenital disease, then there is discharge from the external genitalia, itching sensations, painful urination and nagging pain lower abdomen.

Diagnosis of mycoplasma in a child

Diagnosing mycoplasmas is difficult due to the disease being disguised as a cold. However, microscopy does not allow the detection of microorganisms due to their small size. The presence of infection can be determined by taking a smear and subsequent examination. Immunofluorescence is also used. Tests help determine the manifestations of mycoplasmosis venous blood, in which doctors will have to detect antibodies. In addition, X-ray examinations can diagnose the disease.

Complications

Parents who want to know why mycoplasmosis is dangerous in a child need to remember that it tends to develop into a chronic disease. Absence adequate treatment may lead to damage to the kidneys, liver, and nervous system.

Treatment

What can you do

It is possible to cure a disease characterized solely by acute respiratory infections symptoms without using antibacterial therapy. As a rule, it is enough to use vasoconstrictor drops, treat the nasopharynx, and take pills for better expectoration. Therapy may be supplemented antihistamines. If pneumonia is suspected, it is recommended to hospitalize the child and continue treatment in the hospital.

Parents should know what to do if a child’s illness indicates mycoplasmosis, and how to provide first aid to a small patient. Thus, a prerequisite is to immediately consult a doctor in case of any deviations from the norm. It is important to remember that a high temperature, runny nose and cough are not always harmless symptoms common cold.

What does a doctor do

In order to cure a child from mycoplasmosis, doctors use methods appropriate to the form of the disease. If the disease is generalized, treatment is carried out in a hospital setting. Respiratory mycoplasmas can be treated at home.

Drug therapy involves the use primarily symptomatic remedies, namely drugs for:

• decrease in temperature,
• relief of expectoration,
• eliminating the infection.

In some cases, rehabilitation with physiotherapy and exercise therapy is required.

Prevention

You can prevent a child from becoming infected by limiting his contact with people who are carriers of mycoplasmas. Regular completion is highly recommended medical examinations by all family members. Early detection of the disease increases the chances of quickly and painlessly destroying microorganisms. The set of preventive measures for respiratory mycoplasmosis is similar to what is recommended for preventing viral diseases. There are no methods for minimizing the risk of infection with the urogenital form of mycoplasmosis for children.

Respiratory mycoplasmosis is a group of anthroponotic infectious and inflammatory diseases of the respiratory system caused by pathogenic microorganisms of the genus Mycoplasma. Main etiological role in this case, Mycoplasma pneumoniae (M. pneumoniae) plays. The significance of other mycoplasma pathogens in the genesis of respiratory infections in children still remains a subject of debate. Therefore, the term “respiratory mycoplasmosis” is mainly associated with M. pneumoniae, an infection of the respiratory system.

Respiratory mycoplasmosis is widespread in the human population, causing 10–16% of all cases of acute respiratory infections. It has been established that during epidemic outbreaks the share of M. pneumonia in the etiological structure of acute respiratory infections can reach 30–40%. It is also noted that respiratory mycoplasmosis is characterized by certain age-related characteristics. Most often acute respiratory infections M. pneumoniae – etiologies occur in children, adolescents and individuals young. Thus, in children aged 5–14 years, M. pneumoniae is the etiological agent of respiratory infections in 21–35%, and in adolescents and persons aged 19–23 years – in 16–20% of cases. E tholog y M. pneumoniae is a representative of the genus Mycoplasma (family Mycoplasmatac e ae, class Mollicutes). The causative agents of respiratory mycoplasmosis are very small, free-living, gram-negative, facultative anaerobic bacteria, lacking a true cell wall and characterized by pronounced polymorphism. The functions of the cell wall are performed by a three-layer cytoplasmic membrane. At the same time, M. pneumoniae is not able to synthesize the sterols necessary for the formation of lipid layers of this membrane. As a result of this, the pathogen fulfills the need for cholesterol and other sterols only by recycling them from the infected tissues of the macroorganism. The absence of a cell wall and the metabolic features of M. pneumoniae determine its low survival rate outside the host organism and increased sensitivity to environmental factors.

It has been found that ultrasound ultraviolet irradiation, fluctuations in pH and temperature, as well as traditional disinfectants have a pronounced inhibitory effect on M. pneumoniae.

Epidemiology

The source of infection are patients with manifest and subclinical forms of the disease. The role of M. pneumoniae carriers (both transient and convalescent) as sources of infection is not recognized by everyone. Transmission of infection occurs primarily through airborne droplets. In this case, infection occurs only through close contact between people, which is due to the instability of the pathogen in environment. Therefore, family foci of infection are typical for M. pneumoniae, and the highest incidence rate is noted in organized groups, especially closed ones. Cases of intrahospital spread of infection have also been described. Respiratory mycoplasmosis is registered everywhere (more often in countries with temperate climates). At the same time, every 4–8 years there is an epidemic rise in incidence. It has been established that M. pneumoniae infection can occur in people of any age, but most often in schoolchildren, adolescents and young adults. Manifest forms of the disease are also predominantly registered in these age groups. Thus, if in children of the first 5 years of life mycoplasma pneumoniae is quite rare, then in school-age children, adolescents and young adults M. pneumoniae is one of the main etiological factors community-acquired pneumonia. Incubation period illness lasts from 1 to 4 weeks. The period when infection is possible with M. pneumoniae affecting the upper respiratory tract is 5–7 days, with M. pneumoniae pneumonia – up to 2–3 weeks.

Pathogenesis and pathomorphology

The entry point for M. pneumoniae infection is the mucous membranes of the respiratory tract. The pronounced tropism of M. pneumoniae for the mucous membranes of the respiratory tract is due to the structural features of the surface antigens of the pathogen. The latter contain adhesins that provide ligand-receptor binding of M. pneumoniae to epithelial cells of the respiratory tract. In this case, enzymes synthesized by mycoplasma have an adverse effect on the epithelium. Damage to the cell wall of epithelial cells is accompanied by disruption of intercellular connections, inhibition of mucociliary clearance and ultimately leads to the death of epithelial cells. Inflammatory processes are often limited to the mucous membranes of the upper respiratory tract and bronchi. However, often (especially in school-age children and young people) the infectious process spreads to the terminal parts of the respiratory tract, leading to the development of pneumonia. In this case, dystrophy, destruction and metaplasia of some alveolar epithelial cells, as well as thickening of the interalveolar septa, are noted.

In the early stages of the disease, epithelial cells retain contact with the wall of the alveoli, but later they desquamate and undergo lysis. In young children, hyaline membranes may develop. At the same time, limited infiltrates are observed in the pulmonary interstitium, mainly peribronchial and perivascular, which are represented by lymphocytes, plasma cells, histiocytes, monocytes and single neutrophils. It has been noted that chronic interstitial pulmonary fibrosis may develop as a result of severe respiratory mycoplasmosis. Cases of the development of generalized M. pneumoniae infection involving the circulatory system, nervous system, joints in the inflammatory process, as well as damage to the skin, mucous membranes and blood cells have been described. IN last years The role of M. pneumoniae in the development of various immunopathological conditions (bronchial asthma, rheumatoid arthritis, Stevens-Johnson syndrome, immune cytopenias, etc.).

Immunity

M. pneumoniae infection is accompanied by the formation of specific humoral and cellular immune reactions aimed at eliminating the pathogen. However, the immunity that develops does not last long, resulting in possible re-infection.

Expressiveness clinical manifestations M. pneumoniae infection is very variable and can be characterized by both subclinical and manifest course (Scheme 1). Manifest forms of respiratory mycoplasmosis in children most often manifest themselves as acute inflammatory changes in the upper respiratory tract (URT). The leading clinical variant of infection in this case is pharyngitis. Mycoplasma rhinitis, sinusitis, otitis media, myringitis (inflammation of the tympanic septum), which can be bullous, and laryngitis. It should be noted that the symptoms of M. pneumoniae-pharyngitis and other mycoplasma lesions of the upper respiratory tract have few specific features and practically do not differ from similar diseases of other etiologies. The infection begins acutely, with a rise in body temperature to febrile levels and malaise; in some cases, headache and other symptoms of intoxication are noted. There is a sore throat, sore throat, and a feeling of “stuffy nose.” Less common are a runny nose, ear pain and manifestations of conjunctivitis (usually “dry”). Fever usually resolves within 3–5 days, but low-grade fever may persist for another 1–2 weeks.

Catarrhal symptoms of the disease in the vast majority of cases regress within 7–10 days, however, the release of the pathogen with nasopharyngeal secretions may still occur long time– up to several weeks. M. pneumoniae – infection of the lower respiratory organs is accompanied by the development of inflammation of the bronchi (mycoplasma bronchitis) and lungs (mycoplasma pneumonia). The most common clinical form of the disease is bronchitis. However, with an epidemic rise in incidence, the incidence of mycoplasma pneumonia increases significantly. It was established that during this period up to 40–60% of all pneumonia in school-age children have M. pneumoniae etiology. The clinical debut of mycoplasma pneumonia resembles the development of M. pneumoniae infection of the upper respiratory tract (see above). However, febrile fever persists longer. At the same time, the symptoms of intoxication are usually mild, which is one of the few specific signs mycoplasma pneumonia.

In addition, a few days after the onset of the disease, a dry, obsessive and/or paroxysmal cough appears, which persists for a long time - from several weeks to several months. In older children and adolescents, the cough gradually becomes productive. Scattered dry and varied moist rales may be heard in the lungs. X-ray examination reveals bilateral foci of inhomogeneous infiltration in the lungs. Approximately 10% of children with mycoplasma pneumonia have a transient maculopapular rash. In the vast majority of cases, the disease is not severe, characterized by a smooth course and the absence of respiratory failure or its mild severity. At the same time, children with immunodeficiencies, sickle cell anemia, severe cardiopulmonary diseases, as well as patients with Down syndrome are at risk of developing complicated forms of mycoplasma pneumonia. Laboratory diagnostics Given the lack of specific clinical signs M. pneumoniae infections, the disease is verified based on the results of a laboratory examination. Classic microbiological methods are of little use for identifying M. pneumoniae. Thus, light microscopy for this infection is characterized by extremely low sensitivity, which is associated with the very small size of the pathogen. Sowing and cultivation on specially enriched media require a significant duration of research - from 1 to 3-6 weeks.

Therefore, these laboratory methods should not be used for diseases in the genesis of which mycoplasmas are suspected. Currently, for rapid and reliable identification of M. pneumoniae, methods are used aimed at identifying its antigens using immunofluorescence (IF) or its genome using polymerase chain reaction(PCR). At the same time, PCR is characterized by the greatest specificity and sensitivity.

Among the serological (immunological) methods for diagnosing M. pneumoniae infections, the most common modern stage enzyme-linked immunosorbent assay (ELISA) is used. In this case, the detection of IgM antibodies to M. pneumoniae by ELISA indicates a current or recent infection. The presence of a specific infectious process is also confirmed by a 4-fold or more increase in concentration IgG antibodies to M. pneumoniae when studying “paired sera” of the patient. It should be especially noted that in some cases positive results ELISA for M. pneumoniae infection may be associated with cross-reactivity with mycoplasmas of other species (false-positive result). False-negative ELISA results cannot be ruled out. Therefore, laboratory diagnosis of respiratory mycoplasmosis is considered optimal if a combination of methods is used aimed at identifying pathogen antigens in the test materials (naso-pharyngeal mucus, sputum, pleural exudate, etc.) using the IF method or its genome using PCR, as well as characterizing the patient’s immune response for M. pneumoniae, detecting specific antibodies of the IgM and IgG classes when performing ELISA (Scheme 2).

Treatment

Etiotropic therapy for respiratory mycoplasmosis is indicated for pneumonia, severe bronchitis, as well as for damage to the upper respiratory tract in children at risk (patients with Down syndrome, immunodeficiency conditions, sickle cell anemia, severe cardiorespiratory diseases). There is an opinion that for M. pneumoniae infection of the upper respiratory tract in “initially healthy children,” antibiotics are not required. It should be especially emphasized that M. pneumoniae is resistant to natural and semi-synthetic penicillins, cephalosporins, carbopenems, and co-trimoxazole. Therefore, their use for M. pneumoniae infection is unacceptable. The drugs of choice for etiotropic therapy of respiratory mycoplasmosis in children aged the first 8 years of life are macrolides. In children over 8 years of age and in adolescents, in addition to macrolides, tetracyclines can be used. In pediatric practice, treatment of M.

pneumoniae infections are most often treated with macrolide antibiotics. Macrolides are a group of bacteriostatic antibiotics, the chemical structure of which is represented by a macrocyclic lactone ring. Depending on the number of carbon atoms in the lactone ring, there are 3 main subclasses of macrolides - 14-, 15- and 16-membered macrolide antibiotics, and depending on the origin, natural and semi-synthetic drugs are distinguished.

It has been established that the microbiological effectiveness of various macrolides against M. pneumonia is almost the same. However, when choosing a drug, it is necessary to pay attention not only to the spectrum of antibacterial action, but also to its safety profile, as well as to interactions with other drugs (Table 2). Thus, only a detailed analysis of the patient’s anamnestic data, clinical picture disease and the concomitant therapy carried out allows us to make an adequate choice of antibacterial agent. So, if mycoplasma bronchitis or pneumonia occurs with obstructive syndrome and the prescription of theophylline is required, then it is necessary to pay attention to the compatibility of macrolides and theophylline derivatives. This is due to the fact that the metabolism of data medicines carried out with the participation of the same liver enzymes - oxidase of the cytochrome P450 system. Their simultaneous use leads to inhibition of the activity of cytochrome P450. As a result, the biotransformation of theophylline is disrupted, which leads to an increase in its serum concentration. At the same time, given the extremely small breadth of the range of therapeutic concentrations of theophylline, there is a real threat of developing its overdose (anxiety, agitation, sleep disturbance, muscle tremors, nausea, vomiting, tachycardia, arterial hypotension, cardiac arrhythmia; in severe cases– hallucinations, convulsions, heart failure). However, not all macrolide antibiotics equally strongly inhibit the oxidase systems of the liver.

It has been established that 14-membered macrolides, both natural (erythromycin, oleandomycin) and semi-synthetic (roxithromycin, clarithromycin), have the maximum effect on cytochrome P450. Therefore, their combined use with methylxanthine derivatives (theophylline) should be considered inappropriate (Table 2). In this case, preference should be given to 16-membered macrolides (Macropen ® and others) and azalides, which have the least inhibitory effect on cytochrome P450.

Erythromycin and clarithromycin are also inappropriate to use in those clinical situations when children with respiratory mycoplasmosis are simultaneously receiving carbamazepine (epilepsy, essential neuralgia of the trigeminal and glossopharyngeal nerves) due to the fact that 14-membered macrolides reduce the metabolism of carbamazepine. As a result, an overdose of carbamazepine may occur with the development of its toxic effects (impaired consciousness, convulsions, myoclonus, hypothermia, cardiorespiratory changes, etc.). It should also be noted that it is undesirable to use macrolides together with antihistamines due to high risk development at the same time ventricular arrhythmias. Therefore, it is unacceptable to routinely prescribe H1-histamine blockers to prevent possible allergies to antibiotics (the so-called “cover-up”). Moreover, allergic reactions when using macrolide antibiotics are observed infrequently. And in general, macrolides are reliably considered one of the safest antibiotics. When using macrolide antibiotics, serious adverse reactions are extremely rare. Among the undesirable manifestations, nausea, vomiting, abdominal pain are most often observed, and diarrhea is less common. As a rule, these side effects are more common when using 14-membered macrolides, both natural and semi-synthetic. It has also been established that long-term use of natural 14-member macrolides can be accompanied by the development of cholestatic hepatitis, including due to the synthesis of hepatotoxic antibiotic metabolites (nitrosoalkane forms).

At the same time, it was noted that the risk of developing liver damage is significantly lower when using 16-membered macrolides, because their metabolism does not produce nitrosoalkane metabolites. Considering that in children there are often cases of association between mycoplasma and typical pneumotropic infections (M. pneumoniae + S. pyogenes or M. pneumoniae + S. pneumoniae), it seems important to pay attention to the need to select adequate etiotropic therapy. It has been established that macrolide antibiotics have high activity against both pyogenic streptococcus and pneumococcus. It was noted that almost all macrolides exhibit a comparable high level of activity against S. pyogenes. The activity of macrolides against penicillin-sensitive strains of S. pneumoniae looks similar, while only 16-membered macrolides are active against penicillin- and erythromycin-u1088-resistant strains of S. pneumoniae.

At the same time, one cannot fail to note the increase in recent years in the resistance of typical pneumotropic microflora to macrolide antibiotics, which in the vast majority of cases is cross-resistance among all 14- and 15-membered drugs. At the same time, it was noted that penicillin- and erythromycin-resistant pneumococci, as well as erythromycin-resistant pyogenic streptococci, remain sensitive to 16-membered macrolides. Obviously, this is due to the fact that 16-mer macrolide antibiotics do not induce adenine methylation in the 23S ribosomal RNA of bacteria and, therefore, are not able to stimulate MLS bacterial resistance. In addition, there is evidence that resistance mechanisms such as antibiotic inactivation and changes in cell wall permeability are less typical for 16-membered macrolides. Therefore, bacterial pathogens resistant to 14- and 15-member macrolides may remain sensitive to 16-member macrolide antibiotics. Thus, the drugs of choice for etiotropic therapy of respiratory mycoplasmosis in children during the first 8 years of life are 16-member macrolide antibiotics (Macropen ® and others) and azalides (Scheme 2). At the same time, our own experience indicates the high clinical effectiveness and good tolerability of Macropen ® in children, starting from the first weeks of life. In children weighing less than 30 kg, Macropen ® is prescribed in the form of a suspension. The dosage regimen depends on the severity of the disease. Thus, for pneumonia, Macropen ® is advisable to use at a dose of 50 mg/kg/day (in 2–3 doses), while for bronchitis and diseases of the upper respiratory tract the daily dose is 20–40 mg/kg (in 2 doses). In children weighing more than 30 kg, Macropen ® is prescribed 400 mg 3 times a day. Macropen ®, like other macrolides, is contraindicated in serious illnesses liver. In the treatment of respiratory mycoplasmosis in children over 8 years of age, in addition to macrolides, tetracycline antibiotics can be used. In this case, doxycycline and its analogues are most often used. Dosage regimen of the drug: on the first day – 4 mg/kg, with a transition to 2 mg/kg/day – in subsequent days.

When using doxycycline, dyspeptic disorders, glossitis, esophagitis, anemia, neutro- and thrombocytopenia, photosensitivity and other pathological conditions may develop. The simultaneous use of doxycycline with barbiturates, carbamazepine, antacids, rifampicin leads to a decrease in its therapeutic effect.

In addition to age restrictions (up to 8 years), the drug is also contraindicated in severe liver diseases, leukopenia, porphyria. The duration of etiotropic therapy for respiratory mycoplasmosis, regardless of the antibiotics used, should not be based on the isolation of the pathogen from the body and the levels of specific antibodies. It should be remembered that M. pneumoniae, even after treatment, can persist in the body for several weeks. Antibodies of the IgM class specific to M. pneumoniae can be detected within several months, and antibodies of the IgG class can be detected even several years after the infection. Therefore, the duration of antibiotic treatment should be determined by clinical rather than laboratory criteria. With adequately selected etiotropic therapy, the course of antibiotic use in the vast majority of cases does not exceed 10–14 days. We did not find convincing data on the effectiveness of immunomodulatory therapy for respiratory mycoplasmosis in the available literature. Moreover, given the complex immune reactions that occur during mycoplasmosis, including the triggering of autoimmune mechanisms in certain situations, one should be very careful about the uncontrolled use of immunotropic drugs for this infection. According to indications, depending on clinical severity, symptomatic treatment is carried out (antipyretic, cough, runny nose, etc.). At the same time, the tactics for choosing drugs and their dosage regimen are based on generally accepted rules.

Prevention

Measures specific immunoprophylaxis M.pneumoniae infections have not yet been developed, but such work is underway. Exposure prevention includes measures traditional for the prevention of respiratory infections (isolation of patients during the period of clinical manifestation of the disease, monitoring of people in contact with us, timely identification of new patients in foci of infection, etc.). The need for specific chemoprophylaxis (macrolides, doxycycline) is discussed if a family outbreak of M. pneumoniae infection is registered or there are cases of the disease in a closed community (orphanages, kindergartens with round-the-clock attendance, boarding schools, etc.). In addition, the possibility of antibiotic prophylaxis is being discussed in cases where children with Down syndrome, immunodeficiencies, sickle cell anemia, severe respiratory and circulatory diseases have close contact with patients with respiratory mycoplasmosis.

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