A worldwide cause of atypical bacterial pneumonia, Mycoplasma pneumoniae affects all populations and age
groups and is especially common in young adults and children. In the United States alone, M. pneumoniae causes up to
40% of community-acquired pneumonia (CAP) cases in some populations and is characterized by relatively long incubation
periods and a wide spectrum of clinical symptoms and disease manifestations. The varied presentation and limited diagnostic
methods available present unique challenges for accurately identifying M. pneumoniae cases, which can lead to
inappropriate treatment of patients and/or an ineffective (or nonexistent) public health response to outbreaks. Recent advancements
in diagnostics, laboratory techniques, and whole genome sequence information are addressing these issues.
Newly developed and highly innovative approaches and techniques have allowed for unprecedented characterization of
this organism and have led to improved awareness of many facets of M. pneumoniae. Still, considerable challenges remain
for gaining a comprehensive understanding of the epidemiology and pathogenesis of this organism. Lack of standardized
and reliable diagnostic tests for use in clinical laboratories and in state and local public health laboratories continues
to impede efficient detection of clusters and outbreaks. Clear recommendations for outbreak control are also lacking.
Worldwide emergence of macrolide resistance is a particular area of concern facing physicians who seek safe and effective
alternative treatment regimens, especially for children. This review summarizes the current state of understanding
of the many aspects surrounding M. pneumoniae infection and addresses outstanding domestic issues still confronting
public health. A unique prospective and overview of the many features involved in conducting an outbreak investigation
and effective public health response is also reported.