Mycoplasma pneumoniae

Archana1*, Poornima B2, Dhariniya S3, Ruby Ravichandran4

1Staff Nurse, Pediatric General Ward, Maa Kauvery, Trichy, Tamil Nadu

2Nurse Incharge, Pediatric General Ward, Maa Kauvery, Trichy, Tamil Nadu

3Nursing Educator, Maa Kauvery, Trichy, Tamil Nadu

4Senior Deputy Nursing Superintendent, Maa Kauvery, Trichy, Tamil Nadu

*Correspondence

Abstract

Mycoplasma pneumoniae is an important cause of community-acquired respiratory infection and atypical pneumonia in children. The clinical presentation may overlap with other respiratory infections, making appropriate investigation and clinical assessment important. This case presents a 4-year-old previously healthy female child who was admitted with a 5-day history of cough, coryza, intermittent high-grade fever, fast breathing, and vomiting. She had initially received outpatient treatment with oral antibiotics, oral steroids, nebulization, and symptomatic medications, but her symptoms persisted. On admission, she was conscious and hemodynamically stable, with an oxygen saturation of 96% on room air. Laboratory investigations demonstrated neutrophilic leukocytosis, markedly elevated C-reactive protein, and positive Mycoplasma pneumoniae IgM antibody, while blood culture was sterile. Chest radiography demonstrated right lower-lobe consolidation, and lung point-of-care ultrasound (POCUS) showed right middle- and lower-lobe consolidation without pleural effusion. The child was treated with intravenous fluids, ceftriaxone, azithromycin, nebulization, supportive care, and close monitoring. She showed progressive clinical improvement with resolution of fever and respiratory symptoms and was discharged in a stable condition. This case emphasizes the importance of early recognition, appropriate diagnostic evaluation, antimicrobial therapy, respiratory monitoring, and comprehensive nursing care in pediatric M. pneumoniae pneumonia.

Key words: Mycoplasma pneumoniae; Centers for Disease Control and Prevention

Introduction

Pneumonia is an infection of the lower respiratory tract involving lung parenchyma and alveolar spaces and remains an important cause of morbidity and hospitalization in children. Mycoplasma pneumoniae is an atypical bacterial pathogen that can cause community-acquired pneumonia, particularly in school-aged children, although younger children may also be affected. Unlie typical bacterial pathogens, M. pneumoniae lacks a cell wall and is therefore intrinsically resistant to beta-lactam antibiotics such as penicillin and other drugs that act on the bacterial cell wall (Centers for Disease Control and Prevention [CDC], 2026).

The clinical manifestations of M. pneumoniae infection may include cough, fever, coryza, malaise, and respiratory difficulty. Because these features overlap with viral and typical bacterial respiratory infections, laboratory and radiological investigations may assist in establishing the diagnosis. Current pediatric guidance recommends considering M. pneumoniae in children with community-acquired pneumonia when the clinical presentation is suggestive and using appropriate testing to guide antimicrobial therapy.

[OUP Academic +1]

Case Presentation

A 4-year-old female child, previously healthy, was brought to the hospital with complaints of cough and coryza for 5 days. The cough was wet-sounding and was reported to worsen during the evening. She had intermittent high-grade fever for 5 days and fast breathing from the first day of illness. In addition, she experienced vomiting approximately two to three times per day for the preceding 3 days; the vomitus was non-bilious and non-blood stained. Before hospitalization, the child received outpatient treatment consisting of oral antibiotics, oral steroids, nebulization, and symptomatic medications. However, there was inadequate clinical improvement, and the persistence of respiratory symptoms prompted hospital admission for further evaluation and management. There was no history of loose stools, dysuria, skin rash, neck stiffness, or recent travel.

Clinical Findings

On clinical examination, the child was conscious, alert, and oriented and was afebrile at the time of examination. Her heart rate was 106 beats/minute and blood pressure was 110/70 mmHg. Capillary refill time was less than 3 seconds, indicating adequate peripheral perfusion. Oxygen saturation was 96% in room air, and sinus rhythm was present. Respiratory examination revealed a respiratory rate of approximately 30 breaths/minute, with air movement present and decreased air entry over the affected lower lung region. The child did not require supplemental oxygen at the time of assessment. Overall, the clinical findings were consistent with a lower respiratory tract infection with pulmonary consolidation. Continuous assessment of respiratory rate, oxygen saturation, and work of breathing, breath sounds, hydration, and general activity was undertaken during hospitalization.

Investigations and results

Laboratory investigations revealed neutrophilic leukocytosis and markedly elevated C-reactive protein (CRP), suggesting significant inflammatory activity. Serological testing was positive for Mycoplasma pneumoniae IgM antibody, supporting recent M. Pneumoniae infection. Blood culture was sterile. Chest radiography demonstrated consolidation involving the right lower lobe. Lung POCUS further demonstrated consolidation involving the right middle and lower lobes, with no evidence of pleural effusion. Cardiac POCUS showed normal findings. The combination of compatible clinical symptoms, inflammatory markers, positive M. pneumoniae serology, and radiological evidence of pulmonary consolidation supported the diagnosis. Diagnostic testing for M. pneumoniae can be particularly useful in hospitalized children when atypical pneumonia is suspected.

Diagnosis

Based on history, clinical examination, laboratory findings, serological evidence, chest radiography, and lung POCUS findings, the child was diagnosed with right lower-lobe Mycoplasma Pneumoniae pneumonia associated with right middle- and lower-lobe consolidation. The absence of pleural effusion and the child’s stable hemodynamic and oxygenation status indicated that there was no documented complicated parapneumonic effusion at the time of assessment.

Management

The child was admitted for close observation and treatment. Medical management included intravenous fluids, intravenous ceftriaxone, azithromycin, Duolin nebulization, syrup P250 as prescribed, supportive care, and close clinical monitoring. Azithromycin was particularly relevant because M. pneumoniae lacks a cell wall and is therefore not susceptible to beta-lactam antibiotics as a treatment for the organism itself; macrolides are recommended treatment options for children with M. Pneumoniae infection.

Nursing management focused on maintaining respiratory function and monitoring for deterioration. Respiratory rate, oxygen saturation, breathing, breath sounds, temperature, heart rate, fluid balance, nutritional intake, and activity level were monitored regularly. The child was positioned appropriately, such as in a semi-Fowler’s position, to facilitate lung expansion and comfort. Prescribed nebulization and medications were administered accurately, and the child was observed for therapeutic response and adverse drug reactions. Adequate hydration was maintained because fever and vomiting can increase the risk of dehydration. Parents were educated regarding medication compliance, hydration, hand hygiene, respiratory hygiene, nutrition, and recognition of danger signs. Pediatric pneumonia management emphasizes appropriate antimicrobial selection together with supportive and clinical care based on disease severity.

Outcome

The child demonstrated steady clinical improvement following treatment. There were no further significant fever spikes, and her cough and respiratory symptoms gradually improved. Respiratory distress resolved, and follow-up lung POCUS demonstrated resolving consolidation. Inflammatory markers, including CRP, progressively decreased. The child remained alert, active, afebrile, and hemodynamically stable and tolerated oral feeds well. There was no documented pleural effusion or other major complication during hospitalization. The favorable response to treatment highlighted the importance of timely diagnosis, appropriate antimicrobial therapy, supportive management, and continuous nursing observation.

Discharge

Following significant clinical improvement, the child was discharged in a stable condition. The caregivers were advised to continue the prescribed oral medications and complete the recommended antibiotic course. Adequate oral hydration and a balanced diet were encouraged, along with sufficient rest and a gradual return to normal activities. The parents were instructed to monitor for recurrence of fever, worsening cough, difficulty in breathing, poor oral intake, lethargy, or other signs of clinical deterioration and to seek immediate medical attention if respiratory symptoms worsened. Follow-up with the treating pediatrician was advised to assess complete recovery.

Conclusion

This case demonstrates Mycoplasma pneumoniae pneumonia presenting as right lower-lobe consolidation in a young child with fever, cough, coryza, fast breathing, and vomiting. Although M. pneumoniae infection is often self-limiting, pneumonia may require hospitalization and antimicrobial treatment. The diagnosis in this child was supported by the clinical presentation, inflammatory laboratory findings, positive M. pneumonia IgM, chest radiographic consolidation, and lung POCUS findings. Early recognition and appropriate antimicrobial therapy, together with hydration, respiratory support, monitoring, and family education, contributed to complete clinical recovery. Comprehensive nursing care was essential in maintaining respiratory function, preventing dehydration, monitoring treatment response, and educating the caregivers. This case emphasizes that careful assessment and multidisciplinary management are important for achieving favorable outcomes in children with community-acquired Mycoplasma pneumoniae pneumonia.

References

  1. Centers for Disease Control and Prevention. (2026, May 18). Clinical care of Mycoplasma pneumonia infection. CDC – Clinical Care of Mycoplasma pneumonia Infection⁠
  2. Peter, S. D., Ampofo, K., Brogan, T., Cabana, M. D., Espinosa, C., Florin, T. A.. Shah, S. S. (2026). Clinical practice guideline by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society: 2026 guideline update on the management of community-acquired pneumonia in infants and children older than 3 months of age. Clinical Infectious Diseases. Advance online publication. https://doi.org/10.1093/cid/ciag186⁠

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment