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Mycoplasma Testing

Fom: 'Chronic Fatigue Syndrome, A Roadmap for Testing and Treatment' https://sites.google.com/site/cfstestingandtreatmentroadmap/home

Mycoplasma pneumoniae IgM and IgG antibodies. Dr A Martin Lerner only considers a ME/CFS patient to have a persistent Mycoplasma pneumoniae infection if their titer is 1:600 or more (Lerner uses LabCorp for testing).1 

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Patient symptoms, physical examination, radiology procedures and laboratory findings along with additional serologic and culture tests lead to an accurate diagnosis [1,153].

Laboratory Diagnosis of Mycoplasmas

Culture

Culturing M. hominis and U. urealyticumis relatively easy from urogenital specimens [154].

A culture of M. pneumoniae from clinical samples such as nose and throat swabs or sputum was considered standard for diagnosis several years ago [155].

However, the organism usually takes 2 to 3 weeks to grow, it requires specialized and expensive growth media, and the sensitivity of cultures may be as low as 60-70% [156].

Therefore, the culture method is rarely used for routine diagnosis of M. pneumoniae infections in specialized laboratories and should be done for epidemiological reasons [156].

Culture is rarely successful for M. genitalium[154].

Serology

Serologic tests are simple and very often used to diagnose M. pneumoniae respiratory infections [157].

Serologic tests measureantibodies specific for M. pneumoniae to show the presence of infection [157].

In all serologic tests, two blood specimens are collected 2 – 4 weeks apart, one taken in the acute and one in the convalescent stage of the illness. A fourfold rise in antibody level (titer) indicates recent infection [158].

Serologic tests include:

Antibody levels do not peak until 4 – 6 weeks after infection. Since antibodies may persist for up to 1 year, a sustained high level of antibodies does not necessarily indicate a current infection [155].

Approximately 30% – 60% of patients with M. pneumoniae infection develop cold agglutinins (IgM antibodies to the I antigen of red blood cells).

This test is not specific since positive results can be seen in infectious mononucleosis, influenza, cold agglutinin disease, and leukemia. However, if present in a patient with clinical signs of M. pneumoniae infection, a presumptive diagnosis can be made [159].

ELISA is used for the detection of IgM (shows the presence of acute infection) and IgG (shows prior exposure, remains positive for years) antibodies [160].

Antibodies can be detected after about 1 week of illness, and peaks at 3 – 6 weeks and then declines gradually.

Molecular Methods

Development of molecular methods such as polymerase chain reaction (PCR) assays improved diagnosis of Mycoplasmainfection in pediatric and adult patients [161,162].

Many studies have described the use of different molecular methods among which real-time PCR has both high sensitivity (true positive rate) and high specificity (true negative rate) [153].

Real-time PCR may detect Mycoplasmain 60 – 100% of people with the infection, and report an absence of infection in 96.7 – 100% of healthy people. In practical terms, this means that the PCR technique is extremely unlikely to report an infection in someone who doesn’t have one, but it has up to a 40% chance of reporting no infection in someone who is infected [163].

The PCR technique is practically the only method for detection ofM. genitalium [164].

Diagnosis is made only through nucleic acid amplification testing (NAAT), but there are no commercially available diagnostic tests [165

Blood looked at under microscope