Mycoplasma: a stealthy guest and a nuisance for many athletes

A mycoplasma is a small but persistent microbe, which may cause long-term infections in the respiratory tract. There are almost two-hundred known mycoplasmas known, but only about ten of these cause diseases for people. The clinical picture of a mycoplasma varies, as a mycoplasma infection causes a fierce pneumonia for some, while others escape with mild symptoms, without the need for medication. For most of the people, the clinical picture is somewhere in between.

Considerations related to mycoplasma – actual diseases and mere suspicions – are met at the sports doctor’s reception on a weekly basis. As for any infection, mycoplasma is characterised by the inability of the athlete to recover normally. Mycoplasma is discussed in the sports circles year after year, and this bleak microbe is often sought after, if respiratory symptoms are experienced and the training does not progress as planned or the recovery is hard.

A typical feature of the mycoplasma is that the condition and symptoms vary. One step forward, two steps back. One day the heart pounds, it’s hard to breathe and the tiredness is overwhelming. The next day is vivid, and even light sports go well. The day after that there’s a setback and we’re back to square one. It’s hard for the athlete to observe how the body does not function normally, and those close by follow helplessly how symptoms vary each day. The situation is not getting any better by performing self-observation and internet diagnostics, which usually just adds to the concern.

Mycoplasma enters the body through droplets or contact of respiratory secretions. The incubation period is a few weeks. Usually the body has gotten acquainted with mycoplasma before as it is found in many as early as in childhood. A mycoplasma infection activates the production of antibodies, and antibodies are left over in the body after the infection due to the defence mechanisms. The antibody level is at a high level permanently. It is often called an immunological scar. However, the scar does not result in immunity – the infection may just as well come again.

Practical medical science is rarely an exact science. The detection and treatment of a mycoplasma infection is a good example of this as even doctors aren’t unanimous about its treatment methods. Detecting a fresh mycoplasma infection requires experience. It can rarely be detected with certainty by drawing a blood sample, because interpreting the antibody levels requires that the clinical picture and symptoms are analysed as well. The antibody levels can be elevated or low in a fresh mycoplasma infection, because the production of antibodies starts off with a delay. The mycoplasma antibodies aren’t always detectable in the beginning of the infection. On the other hand, the antibody levels can be elevated for a long period of time, even years, which makes it hard to determine the starting point of the infection.

Mycoplasmas differ from regular bacteria as they have no cell wall. This is why few antibiotics penetrate the membrane of the mycoplasma microbe and affect the mycoplasma. Medicine combinations are often used when treating mycoplasma, where medication for calming the infection level of the bronchus and body are added to the macrolide and doxycycline antibiotics. The exceptional wall structure of mycoplasmas provide them the ability to multiply within the cells of the human body, where the microbe can hide from the antibiotics. Antibiotics help reduce the multiplication of mycoplasma, but it doesn’t get rid of it altogether. This is where the body’s defence mechanism is needed. That’s why the recovery from mycoplasma takes a long time, even though the medication calms the infection. Mycoplasma has a long tail, which extends throughout the training and competition season. Only then does the exceptional strain settle and body starts to recover into a normal balance and exercise condition.

Diagnosing mycoplasma requires differential diagnostics, because there are so many things that can cause under-recovery for the athlete. Chronic under-recovery and fatigue can be caused by another infection, such as chlamydia pneumoniae or the Lyme disease, a prolonged viral infection, thyroid diseases, vitamin and micronutrient deficiency, which stops the athlete from practising with full force and results. Young athletes may find themselves in a similar situation of under-recovery when taking too short rests or nourishing or training inappropriately.

Some athletes are afraid to be considered crazy, because the diversity of the symptoms of mycoplasma and the psychological stress factors may lead to wrong conclusions. The antibiotic medication is just a part of the mycoplasma treatment for athletes. In my work I’ve encountered situations where a doctor who doesn’t treat athletes often examines the patient from the perspective of his line of specialisation, but the instructions regarding the training remain scarce. The doctor’s notes may tell them to train according to their gut feeling or encourage them to continue training. I’m sure they mean well, but several athletes feel like they’re left alone with the diagnosis and the situation. That’s when training, the thing that matters the most to them, is left unnoted. This is why it is important that an athlete suffering from mycoplasma should be directed to a doctor specialised in sports medicine, and who can provide adequate treatment and give training instructions for the whole recovery process.