Abstract
Parapneumonic effusions often complicate Mycoplasma pneumoniae (MP) pneumonia, contrary to the notion that they are a rare feature of MP infection. Increased research and evidence on MP parapneumonic effusions (MPPE) can help elucidate its clinical significance as one of the variable manifestations of MP infection. This article aims to summarize the existing literature about the clinical characteristics of MPPE in adults and discuss its diagnostic implications from the perspective of pleural fluid analysis. Approximately 20–25% of adult patients with MP pneumonia develop MPPE, and its frequency in children and adults seems to be similar. Although the pathogenesis of MPPE remains to be elucidated, MP-induced cell-mediated immune mechanisms might be partially associated with the development of MPPE. MPPE usually shows mononuclear leukocyte predominance with elevated adenosine deaminase (ADA) activity, similar to tuberculous pleural effusion (TPE). The degree of increase in pleural fluid ADA levels and serum inflammatory biomarkers may help differentiate between MPPE and TPE. During the acute phase, a single positive IgM and positive polymerase chain reaction results allow for a precise and reliable MP infection diagnosis. The mainstay of treatment is the selection of adequate anti-mycoplasma antibiotics with or without corticosteroid, based on the local epidemiologic data on macrolide resistance.
Highlights
Mycoplasma pneumoniae (MP), which was first discovered in the 1940s, causes a wide spectrum of clinical symptoms and diseases [1,2]
Pleural effusions frequently complicate MP pneumonia similar to complications in pneumonia caused by other bacterial pathogens [3–8], which is contrary to the notion that MP parapneumonic effusions (MPPE) are so rare that they receive a different diagnosis than MP infections [9]
Among adult patients with MP pneumonia, pleural effusions were detected in 24% of them using computed tomography (CT), while only a half of them could be detected using posteroanterior and lateral chest X-rays [3]
Summary
Mycoplasma pneumoniae (MP), which was first discovered in the 1940s, causes a wide spectrum of clinical symptoms and diseases [1,2]. Pleural effusions frequently complicate MP pneumonia similar to complications in pneumonia caused by other bacterial pathogens [3–8], which is contrary to the notion that MP parapneumonic effusions (MPPE) are so rare that they receive a different diagnosis than MP infections [9]. Based on the literature from the last few decades, approximately 20–25% of patients with MP pneumonia develop parapneumonic effusion [3–6,8]. The latest reports suggest that the clinical significance of MPPE needs to be emphasized in terms of differential diagnosis with tuberculous pleural effusions (TPE) [8,10–14]. A better understanding of the characteristics of MPPE will contribute to the accurate diagnosis and appropriate treatment of the condition. The present review focuses on the clinical and diagnostic implications of MPPE from the perspective of pleural fluid analysis in adults
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