Even in pediatric medicine, things are not always what they seem. After calling with complaints of painful urination, a high school student was brought into the office with the expectation that we would soon be treating her for a bladder infection.
I talked to the young lady when she arrived and reviewed her recent history. She'd had a high fever for a few days the previous week, but then cooled off.
The teen also mentioned that she had a few lesions on her vulva. On further questioning, it turned out that she wasn't really having painful urination, a typical sign of a UTI, but was instead experiencing discomfort when urine hit the skin lesions.
The girl was coughing as she described her symptoms, so I asked her to hop up on the exam table so I could check her. She cooperated with some deep breaths and, as I listened with my stethoscope, it was easy to hear crackles throughout her right lung field.
My patient had a negative urinalysis, no history of sexual activity, and clear evidence of pneumonia.
I was less suspicious of a urinary or sexually transmitted infection and more inclined to put her symptoms together as a case of mycoplasma pneumonia.
Mycoplasma bacteria are a recognized cause of respiratory infection and, according to experts at the Royal Children's Hospital of Melbourne, also make the list of possible sources of non-sexually transmitted vulvar ulcers in the pediatric population.
According to the American Academy of Pediatrics Red Book, the bacterial species Mycoplasma pneumoniae is a top cause of school-age and young adult pneumonia. Close contact with an infected individual can lead to disease sharing since these bacteria hitch a ride on respiratory droplets. In fact, families are often hit hard, with about 30 percent of household contacts of a Mycoplasma pneumoniae victim also contracting pneumonia.
The AAP notes that mycoplasma pneumonia has a one- to four-week incubation period and once coughing starts, affected individuals can hack for up to a full month. Unfortunately, immunity after this prolonged disease is rather brief.
Children with mycoplasma pneumonia have been shown to improve more quickly and with fewer relapses when treated with antibiotics. Redbook authors list the antibiotics erythromycin, azithromycin (Zithromax), and clarithromycin (Biaxin) as effective in combating mycoplasma pneumonia.
Tetracycline and doxycycline also treat this type of pneumonia, but are usually avoided in kids less than 8 years of age due to the potential for staining of developing teeth. Fluoroquinolones are also recognized mycoplasma antibiotics but are still generally reserved for use in the adult population.
While many kids and parents understandably get a bit panicky when they hear a diagnosis of pneumonia, most pediatric pneumonias do not require the use of oxygen and hospitalization and can be effectively treated with oral antibiotics and close follow-up.
My teen patient started a five-day course of the antibiotic azithromycin and improved within 48 hours and was clear on her recheck visit.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.