Mycoplasma pneumonia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Mycoplasma pneumonia is diagnosed by either culture, serology, or molecular methods. Other laboratory findings include elevated CRP and/or ESR, leucocytosis, or hemolytic anemia.

Laboratory Findings

• Mycoplasma pneumonia is diagnosed by either culture, serology, or molecular methods.
• The following table demonstrates the advantages and disadvantages of each diagnostic method for Mycoplasma pneumonia:

Table adapted from the Centers for Disease Control and Prevention (CDC).

Method	Advantages	Disadvantages	Test Setting
Culture	Provides clinical isolates for genotyping and antimicrobial susceptibilities testing 100% specificity when a positive result is obtaineda Commercially available SP4 media	Time-consuming Requires specialized expertise High potential for false negatives Slow growth	Reference laboratories only, not for routine diagnostics
Serology	Commercially available kits Quantification possible	Lacks specificity Need for acute and convalescent paired sera Test results turn-around time not optimal for treatment decisions Cumbersome and time-sensitive sampling Not FDA approved	Clinical Service: Sera provided to a clinical laboratory testing service for EIA testing
Molecular	Commercially available kits High sensitivity and specificity Rapid detection Results can be obtained in time to guide treatment decisions Useful for strain typing	Expensive Requires specialized expertise and equipment Not standardized Lack of clinical and comparative validation Limited FDA approval	Clinical Service: NP, OP, or sputum provided to a clinical laboratory testing service for qPCR testingb CDC: Multiplex qPCR used for M. pneumoniae detection in NP, OP, sputum tissue, or CSFc,d Commercial / FDA Approved: 1) FilmArray (BioFire Inc) is a nested multiplex PCR in a closed "lab-in-a-pouch" format, 2) Illumigene (Meridian Biosciences, Inc) is a loop-mediated isothermal amplification (LAMP) assay

^aProvided that appropriate additional procedures are used to identify the organism isolated to species level.
^b State and local departments of public health may offer these diagnostic tests for the detection of M. pneumoniae.
^c Various quality control measures in place for this assay including compliance with Clinical Laboratory Improvement Amendments standards and the use of proficiency testing through Quality Control for Molecular Diagnostics. ^dOther testing performed by the CDC only for special investigations include: using specialized SP4 media used for isolation and isolate typing, serology as a supportive measure, and molecular typing procedures such as macrolide susceptibility testing, P1 adhesion typing, and MLVA typing.
Abbreviations: SP4—modified Spiroplasma medium, EIA - enzyme immunoassay, qPCR—quantitative polymerase chain reaction, MLVA—multiple-locus variable number tandem repeat analysis, NP—nasopharyngeal, OP—oropharyngeal, CSF—cerebrospinal fluid

Other Laboratory Findings

Other laboratory findings that may be present among patients with Mycoplasma pneumonia include:

• Elevated CRP and/or ESR
• Leucocyte count may be normal or elevated
• Hemolytic anemia