New developments in diagnostic and treatment of mycoplasma infections in humans.

Several methods can be used for the diagnosis of mycoplasmal human infections. Culture is not satisfactory for fastidious species, while serological procedures allow only a retrospective diagnosis. Recently, rapid methods have become available. Antigenic detection proposed for Mycoplasma pneumoniae lacks sensitivity. Hybridization based techniques include DNA probes and mainly DNA amplification. The main usefulness of the polymerase chain reaction (PCR) is the detection of fastidious organisms such as M. pneumoniae, M. genitalium, M. fermentans, M. penetrans, but PCR can also be used for characterization of the strains for epidemiological purposes, or for detection of antimicrobial resistance genes. The major advantage of PCR for detection is its very high sensitivity. However, until now, the major drawback of this technique has been the lack of commercial kits. When available, they should provide better standardization of the technique and, if available at a reasonable cost, become the major technique for the diagnosis of mycoplasma infections. The antibiotics used for the treatment of mycoplasmal infections belong to tetracyclines, macrolides-lincosamides and fluoroquinolones. These products are highly active in vitro against mycoplasmas. However, some of them have a differential activity according to the species, and acquired resistance has been reported, mainly in genital mycoplasmas. Most of mycoplasmal infections are cured by adapted antibiotics, but they may be difficult to cure in immunosuppressed patients.