Pediatric outpatient clinics under the epidemic of Mycoplasma pneumoniae: The peak of infection is expected to continue until the winter holidays
As an infectious disease doctor, Yu Huiju, a doctor from Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, lamented that this year was the first time she had encountered so many children with mycoplasma pneumonia in more than 30 years of practice.
“Mycoplasma pneumoniae exists in nature, but due to the COVID-19 epidemic for three years, we, who are accustomed to wearing masks and staying at home, have lost resistance to many germs.” Yu Huiju said that during this season, if symptoms such as cough and fever occur, from From an epidemiological perspective, we often consider that children are infected with Mycoplasma pneumoniae.
Yu Huiju said frankly that as early as the end of September this year, many respiratory and infectious diseases doctors generally felt that there was an increase in pneumonia patients this year. For this reason, the hospital has been working overtime to prepare enough manpower and beds. Except for the infectious diseases and respiratory departments, they are basically full. After removing the children, other departments such as hematology, rheumatology and immunology, cardiology, neurology, etc. have also freed up beds to treat the increasing number of children with pneumonia.
In Yu Huiju’s outpatient clinic, the majority of children with mycoplasma pneumonia are under 10 years old. Among the children treated in the hospital, some children whose condition has not been relieved after taking medicine have developed into children with severe pneumonia, and some even developed ” White Lungs”. According to hospital regulations, children with “white lung” will be sent to the emergency room for further treatment.
Similarly, the Children’s Hospital of Fudan University has been facing the epidemic of two infectious diseases recently, one is mycoplasma pneumonia and influenza, and the other is hand, foot and mouth disease. Among them, mycoplasma pneumonia is at a high epidemic level. According to monitoring data from the hospital’s fever clinic and internal medicine clinic since October, the detection rate of mycoplasma among the respiratory specimens submitted for examination accounted for approximately 30%, which is at a high level. “In previous years, it was generally between 5% and 10%. 10% is already relatively high, and the epidemic level this year is even higher.” Zeng Mei, deputy director of the Department of Infectious Diseases at the Children’s Hospital of Fudan University, said.
After the epidemic of mycoplasma pneumonia, the problem of drug resistance has also become one of the focuses of people’s attention. In this regard, Zeng Mei said that as early as around 2010, the resistance of mycoplasma pneumonia to drugs such as azithromycin and erythromycin had become obvious, and now the resistance rate has reached more than 90%. “Although mycoplasma infection can cause pneumonia, the proportion of clinical severe cases is not high. There are not many difficulties in the treatment of mycoplasma pneumonia. There are still many drugs that are still sensitive antibiotics for mycoplasma pneumonia.”
In addition to mycoplasma pneumonia, Zeng Mei believes that the public should also be more vigilant against influenza. In Yu Huiju’s view, autumn and winter are originally the seasons with high incidence of respiratory diseases, and most respiratory diseases are contagious. However, Mycoplasma pneumoniae and others are not necessarily classified as infectious diseases, but we still need to pay attention to it. “It is expected that this wave of The peak will likely continue into the winter holidays.”
Outpatient Clinic: A child has no fever but is infected with Mycoplasma pneumoniae
After 4:30 pm on October 20, it is night clinic time. At the registration desk of the Pediatric Outpatient and Emergency Building of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, parents are still constantly bringing their children for treatment. Most of the children who visit the hospital have symptoms such as fever and cough. The atomization area and the infusion area were full of children as far as the eye could see.
At close to 5 o’clock in the evening, parent Huang Yu (pseudonym) walked into Yu Huiju’s night clinic with her 7-year-old child Xiaoxuan.
Xiaoxuan is a child with pneumonia who is undergoing review. As early as October 14, he developed a fever. At first, the family gave the child Motrin to reduce the fever, but it failed to “suppress” it. On October 16, Xiaoxuan was taken to the hospital for medical examination, and a CT scan was performed. It was found that he was suffering from B-fluid infection and was also infected with mycoplasma. Over the next four days, he had recurring fevers that went away and came back again.
“I have had recurring fevers for more than a week. I have been taking azithromycin for 5 days. I still had a fever the day before, 38 degrees Celsius, and it has been dry for a day.” What worries parent Huang Yu is that the fever that lasts for more than a week will make the child My weight dropped from 53 pounds to 51 pounds.
6-year-old Xiao Xi is also a follow-up patient. On October 16, he was diagnosed with acute lower respiratory tract infection due to coughing. He had no vomiting, diarrhea, or even fever. However, he coughed for 4 days and received aerosol treatment. He also took azithromycin and erythromycin. The original cough The symptoms never improved. After examination, Xiao Xi was also diagnosed as weakly positive for Mycoplasma pneumoniae IGM.
“Mycoplasma antibodies generally do not appear until 5 days after the onset of the disease. In severe cases, they will not appear until 10 days after the onset of the disease. The later they appear, the more serious the condition is.” Yu Huiju said.
The reporter observed that in Yu Huiju’s night clinic, most children aged 5-7 years old were seen, and a high proportion of them were found to have pneumonia. Most of them had symptoms such as fever and cough, but some were only 2 or 3 years old. , most of which can be improved after drug treatment. Yu Huiju said that from an epidemiological perspective, if symptoms such as cough and fever occur during this season, it is often considered that the child is infected with Mycoplasma pneumoniae.
As social attention increases, the awareness of “mycoplasma pneumonia” among parents is also increasing. When Wang Meng (pseudonym) brought her 4-year-old child Xiao Yun to see a doctor, she asked the doctor: “My child had a fever when he came back from kindergarten yesterday afternoon, with the highest fever reaching 40 degrees Celsius. I heard that pneumonia is particularly severe this year. I don’t know what it is.” Isn’t it mycoplasma pneumonia?”
Xiaoyi, 2 and a half years old, developed fever symptoms more than 10 days ago and was subsequently diagnosed with weak Mycoplasma pneumoniae antibodies. After taking medication, the fever subsided, but the coughing and wheezing continued. When they came to see a doctor, Xiaoyi’s parents and grandparents also came. “Our whole family has been infected with pneumonia. The symptoms of the adults don’t matter, but the child kept gasping and couldn’t see well.” Xiaoyi’s grandmother was a little nervous. .
For pathogen detection in children with fever, cough, etc., Yu Huiju said that a five-joint respiratory test is often prescribed, which covers Mycoplasma pneumoniae IGM, Chlamydia pneumoniae IGM, syncytial virus IGM, adenovirus IGM and Coxsackie B virus IGM.
The proportion of severe cases is not high, and the prognosis of the children is relatively good.
Yu Huiju said that currently in the Department of Infectious Diseases of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, children under 10 years old are a high-risk group for Mycoplasma pneumoniae infection. There are some severe cases, but there are currently no deaths. Confined spaces such as school classrooms and unventilated home environments are a major way for the spread of Mycoplasma pneumoniae. In addition, there are also some preschool children aged between 2 and 3 years old, mostly due to family infection. “Although mycoplasma pneumonia is not defined as an infectious disease, it is contagious to a certain extent, and the elderly and parents will passed on to children.”
The Children’s Hospital of Fudan University has been mainly facing the epidemic of two infectious diseases recently, one is mycoplasma pneumonia and influenza, and the other is hand, foot and mouth disease. Among them, mycoplasma pneumonia is at a high epidemic level.
Zeng Mei said that judging from the monitoring data of the hospital’s fever clinic and internal medicine clinic since October this year, the detection rate of mycoplasma among the respiratory specimens submitted for inspection accounted for about 30%, which is at a high level. “In previous years, it was generally at a high level. Between 5% and 10%, 10% is already relatively high, and the level of popularity this year is even higher.”
In general hospitals, the number of cases of Mycoplasma pneumoniae infection in adults is not high, and the number of cases among the elderly is relatively low. Xu Xianghuai, executive director of the Department of Respiratory and Critical Care Medicine of Tongji Hospital, said that the hospital only treats patients over 12 years old. Among the patients infected with mycoplasma pneumonia, most of them are teenagers aged 12-18 years old. Their body temperature has not gone down, but the serious illness is very serious. few.
Zeng Mei also said that although mycoplasma infection can cause pneumonia, the proportion of severe cases is not high. It usually presents with persistent fever, lung symptoms, and rarely dyspnea. In terms of the hospital’s overall response to children with mycoplasma pneumonia, in addition to the heavy workload and outpatient load, the prognosis of the children is relatively good.
Yu Huiju pointed out that, in fact, Mycoplasma pneumoniae infection occurs in any season. It is more prevalent in autumn and winter in northern areas, while it is more prevalent in summer and autumn in southern areas. Children and teenagers are high-risk groups for infection with Mycoplasma pneumoniae.
“When Mycoplasma pneumoniae invades our body, it can lead to respiratory infections such as laryngitis, bronchitis, and pneumonia. Pneumonia does not always occur.” Yu Huiju said that judging whether children are infected with Mycoplasma pneumoniae relies more on the comprehensive evaluation of doctors. Analysis, including age, symptoms, laboratory tests, imaging tests and other information to make a final judgment. The clinical manifestations of Mycoplasma pneumoniae infection also vary depending on individual differences. Some children may only show mild symptoms, while others may have relatively obvious symptoms. If the child has cough, fever, runny nose, wheezing, headache, earache, muscle pain, etc. If you experience symptoms such as pain, especially when accompanied by shortness of breath or high fever, you should seek medical attention promptly.
Resistance is obvious, but treatment is not difficult
After the epidemic of mycoplasma pneumonia, azithromycin became a hot topic, and the issue of drug resistance has also become one of the focuses of people’s attention. Many children have been ill for a long time.
In this regard, Zeng Mei said that this is actually an “old problem.” As early as around 2010, the problem of resistance of mycoplasma pneumonia to drugs such as azithromycin and erythromycin has become apparent, and now the resistance rate has reached more than 90%.
Although there is drug resistance, Zeng Mei also said that there are not many difficulties in the treatment of mycoplasma pneumonia, and many drugs are still sensitive antibiotics for mycoplasma pneumonia. For example, in recent years, new generation tetracyclines and other drugs can still cause sensitivity, and the drugs are very safe. In addition, fluoroquinolones are also effective and will not cause significant negative effects on children when used for short periods of time. “Including combined with short-term hormone therapy, the overall treatment effect is still very good. I hope everyone will not be too nervous. Although mycoplasma pneumonia is prevalent, the harm is limited.”
Yu Huiju also admitted that in her outpatient clinic, although azithromycin is the drug of choice in the diagnosis and treatment guidelines, there are indeed some children who do not get better after taking azithromycin. “Normally, we will carry out tolerance tests on some hospitalized children who still do not improve after taking the medicine.” Drug genetic testing is also currently being carried out in outpatient clinics, but it takes 2-3 days to get the report, and not everyone needs this kind of testing.”
Yu Huiju further stated that although the drug resistance rate has increased, macrolide antibiotics are still the first choice drug for mycoplasma pneumonia in children. If the clinical effect is not good after a period of use, drug resistance testing should be done as soon as possible and drug changes should be considered. .
“If macrolide-resistant Mycoplasma pneumoniae occurs, new tetracycline antibacterial drugs, including doxycycline and minocycline, can also be tried, which are also alternative drugs for the treatment of drug-resistant Mycoplasma pneumoniae pneumonia. Although these drugs may Causes yellowing of teeth or hypoplasia of enamel. It is recommended for children over 8 years old, but it is relatively safe to use clinically. In addition, there are quinolone antibacterial drugs, including levofloxacin, moxifloxacin, etc., which are resistant to treatment Alternative drugs for Mycoplasma pneumoniae pneumonia.” Yu Huiju said.
The above-mentioned experts further pointed out that because quinolone antibacterial drugs may cause joint and muscle dysplasia, they are off-label use in children under 18 years old. If they need to be used beyond the age range, they need to be used after communicating with their families. It is often used in drug-resistant children.
The peak of infections is expected to last until after the winter holidays, so be wary of influenza
In addition to mycoplasma pneumonia, Zeng Mei believes that the public should also be more vigilant against influenza.
According to the data from the Children’s Hospital of Fudan University since late August this year, the prevalence of influenza in children has been at a moderate level, and there is no downward trend among children. It is expected that influenza will continue into winter and spring. Zeng Mei suggested that parents increase their awareness of influenza vaccination and vaccinate their children in time.
Some parents wonder why their children still get mycoplasma pneumonia after receiving the pneumonia vaccine? Zeng Mei said that no vaccine can prevent all pneumonia, and there are many pathogens causing pneumonia, including influenza virus, Streptococcus pneumoniae, measles, etc. “The pneumonia vaccine that parents usually understand is the pneumococcal vaccine, but it cannot prevent all pneumonia. Moreover, there is no vaccine for mycoplasma pneumonia in particular, and it cannot be prevented by vaccines.”
“It is expected that this peak of infection will last until after the children’s winter vacation.” Yu Huiju said that in addition to the peak of Mycoplasma pneumoniae infection, influenza viruses, respiratory syncytial viruses, etc. may also become more popular in winter and spring, and bacteria may also be present. Viruses are co-infected, so this wave of respiratory disease infection peaks will not pass so quickly.
Regarding how to prevent respiratory diseases, Yu Huiju said frankly that after the COVID-19 epidemic, everyone has a comprehensive understanding. “Wearing a mask is definitely the best way to prevent respiratory diseases and is also the most effective. At the same time, maintain hand hygiene and indoor hygiene More ventilation, especially the elderly and children, should avoid going to crowded places. These measures can achieve good results in preventing infectious diseases.”
In addition, the above-mentioned experts suggest that for children, to prevent respiratory diseases, they must maintain adequate sleep, moderate exercise, and a balanced diet, which will help build stronger immunity.
