Mycoplasma Pneumoniae and PANS: Understanding the Connection

In my experience in Hong Kong, Mycoplasma Pneumoniae is the most common trigger for PANS (Paediatric Acute-onset Neuropsychiatric Syndrome), a condition characterised by a sudden onset of neuropsychiatric symptoms, such as obsessive-compulsive disorder (OCD), anxiety, irritability, tics, and other severe psychiatric symptoms. Mycoplasma Pneumoniae is typically known for causing respiratory tract infections in both adults and children. 

How Mycoplasma Pneumoniae Leads to PANS 

Mycoplasma Pneumoniae can lead to the autoimmune condition PANS through immune system mechanisms such as molecular mimicry. This occurs due to the structural similarity between Mycoplasma antigens (such as adhesin proteins P1, P30, and P116) and host cell components (e.g., cytoskeletal proteins like troponin, keratin, and fibrinogen). This autoimmune activation induces neuroinflammation and neurological symptoms. 

Challenges in Treating Mycoplasma Pneumoniae Infections 

Mycoplasma Pneumoniae is an unusual bacterium due to its cell wall deficiency. Many common antibiotics, such as Augmentin and Zinnat, target the bacterial cell wall and are therefore ineffective against Mycoplasma Pneumoniae. In recent years, Mycoplasma Pneumoniae has also developed resistance to another common antibiotic, Azithromycin. As a result, our primary antibiotic option is the tetracycline antibiotic Doxycycline. Treating Mycoplasma Pneumoniae-related PANS requires administering Doxycycline for a longer duration than when treating respiratory infections; typically, we prescribe Doxycycline for several weeks, along with an anti-inflammatory such as Low-Dose Naltrexone (LDN). 

The Impact of Mycoplasma Pneumoniae on Children's Mental Health 

In summary, Mycoplasma Pneumoniae infection can trigger PANS in children by causing an abnormal immune response that affects the brain, leading to acute neuropsychiatric symptoms such as OCD and tics. Understanding this connection is crucial for timely diagnosis and treatment. 

OT&P: Supporting your Child's Health in Hong Kong

At OT&P Healthcare, we have a dedicated team of healthcare professionals who can help you understand these symptoms and recommend a suitable treatment. Our child psychologists and functional medicine doctors are knowledgeable to answer any questions you might have. 

Related Blogs

• Understanding PANS and PANDAS: Sudden-Onset Neuropsychiatric Disorders in Children

• Understanding Low Dose Naltrexone (LDN)

• Hong Kong Child Health: An Investigation into PANS and PANDAS, and the Causes of Tics and OCD in Children

References

1. Sun, B., Ling, Y., Li, J., Ma, L., Jie, Z., Luo, H. et al. (2025) 'Advances in adhesion-related pathogenesis in Mycoplasma pneumoniae infection', Frontiers in Microbiology, 16, 1613760. doi:10.3389/fmicb.2025.1613760.

2. Wang, Y.-S., Zhou, Y.-L., Bai, G.-N. et al. (2024) 'Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children', World Journal of Pediatrics, 20(9), pp. 901–914. doi:10.1007/s12519-024-00831-0.

    

3.  Waites, K.B., Xiao, L., Liu, Y., Balish, M.F. and Atkinson, T.P. (2017) 'Mycoplasma pneumoniae from the respiratory tract and beyond', Clinical Microbiology Reviews, 30(3), pp. 747–809. doi:10.1128/CMR.00114-16.