How to Diagnose Respiratory Mycoplasma Infection: Symptoms, Testing, and Treatment Options

Diagnosing respiratory mycoplasma infection, commonly caused by Mycoplasma pneumoniae, requires a combination of clinical evaluation and specific laboratory tests. One of the most reliable methods is detecting IgM antibodies against mycoplasma in the blood. A positive IgM result typically indicates an active or recent infection, as these antibodies appear early during the immune response.

Common Diagnostic Methods for Mycoplasma Infection

Serological Testing: IgM Antibody and Cold Agglutinins

Serology plays a crucial role in confirming mycoplasma infections. The presence of IgM antibodies suggests acute infection, especially when symptoms align with respiratory illness. Additionally, the cold agglutinin test—though not specific to mycoplasma—can support diagnosis. A titer of 1:32 or higher, measured two weeks after symptom onset, is often considered indicative of mycoplasma infection in the appropriate clinical context.

Direct Detection of Mycoplasma Antigens

Another effective diagnostic approach involves testing respiratory specimens such as throat swabs or sputum for the presence of Mycoplasma pneumoniae antigens. Rapid antigen detection kits can identify the pathogen directly, offering quicker results than antibody-based methods. A positive antigen test strongly supports a diagnosis of active infection.

Molecular Testing: PCR for Higher Accuracy

In modern clinical settings, polymerase chain reaction (PCR) testing has become the gold standard due to its high sensitivity and specificity. PCR can detect mycoplasma DNA in respiratory samples within hours, allowing for early and accurate diagnosis, which is essential for timely treatment and reducing transmission risks.

Recognizing the Symptoms of Mycoplasma Respiratory Infection

Clinically, mycoplasma infections often present with mild to moderate respiratory symptoms that may resemble a common cold or bronchitis. Common signs include persistent fever, fatigue, sore throat, and a distinctive dry, hacking cough that tends to worsen at night. The cough is typically non-productive or produces only small amounts of sticky mucus and can last for several weeks—even after body temperature returns to normal.

This prolonged coughing phase often leads patients to seek medical attention long after the initial fever has resolved, making it important for healthcare providers to consider atypical pathogens like mycoplasma, especially during community outbreaks or in school-aged children and young adults who are more frequently affected.

Treatment and Management Strategies

Antibiotic Therapy with Macrolides

Once diagnosed, respiratory mycoplasma infection is usually treated with antibiotics from the macrolide class, such as azithromycin or clarithromycin. These medications are effective because mycoplasma lacks a cell wall, rendering beta-lactam antibiotics (like penicillin) ineffective. Azithromycin is commonly prescribed in a five-day course, though treatment duration may extend to 2–3 weeks depending on symptom severity and patient response.

Supportive Care and Recovery

In addition to antibiotics, supportive care—including rest, hydration, and over-the-counter cough suppressants—can help manage symptoms. Most individuals recover fully without complications, although fatigue and lingering cough may persist for weeks. It's important to complete the full antibiotic course to prevent relapse and reduce the risk of developing antibiotic resistance.

Early detection and proper management not only improve individual outcomes but also help control the spread of this contagious respiratory pathogen in schools, households, and workplaces.