This year is the "big year" of mycoplasma pneumonia, how to deal with children at home?

 In recent months, the new term "Mycoplasma pneumoniae" has refreshed the health knowledge base of parents of new children, and the characteristics of repeated fever, gastrointestinal symptoms, and rapid "white lung" caused by mycoplasma infection have also allowed parents to understand the "lethality" of this pathogen, which makes many families very worried. It seems that this year is the "big year" for mycoplasma pneumonia. So, what exactly is the prevention method? Hear from your pediatrician.

This article is reproduced from the public number: Lilac Mama (ID: DingXiangMaMi)

Wen 丨Lilac Mama edited 丨May

Many parents said that their children were diagnosed with mycoplasma pneumonia one after another this year.

Some parents said that they had not known about mycoplasma pneumonia before, nor did they know that this year was in a pandemic, and their children were recruited if they were not careful.

Some parents said that the mycoplasma pneumonia suffered by the child was drug resistant, and the azithromycin medication was not effective. Children suffer, adults are distressed.

Is this really the "big year" of popularity? The child has a cough and fever, how to tell if it is mycoplasma pneumonia? What are the prevention methods?

We're asking the pediatrician to tell you more about it.

Is this the "big year" for mycoplasma pneumonia?

Mycoplasma pneumonia is a disease caused by Mycoplasma pneumoniae infection, transmitted by droplets produced when coughing or sneezing, typical symptoms are older children over 5 years old, fever, dry cough, fatigue, headache, etc., nasal congestion, runny nose and other slightly rare.

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Looking at the current national situation, this year may be a big year. This situation is speculated to be related to two factors:

1. This year, epidemic prevention and control will be liberalized. Not only mycoplasma infection, but subsequent respiratory syncytial virus also requires vigilance;

2. Mycoplasma pneumoniae is always epidemic about once every 3~7 years.

The figure below is the positive rate of Mycoplasma pneumoniae in acute respiratory infections in Beijing area in 2015~2020 (yellow line), which has been on the rise in 2015~2019, a peak in 2019, and a decrease in 2020. After a gap of 3 years, it is also in line with the epidemic law to become popular again this year.

Source: References[1]

Your child has symptoms such as fever and cough

How can I tell if mycoplasma pneumonia is good?

First of all, the symptoms of mycoplasma pneumonia are similar to those of other respiratory diseases, so even if the child has a fever and cough, it is difficult for parents to judge whether the child is infected with mycoplasma pneumonia.

Whether it is mycoplasma pneumonia or not, it is up to the doctor to confirm it.

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According to the recommendations of the American Academy of Pediatrics, if you consider that the child's symptoms are like mycoplasma pneumonia, when there is no need to be hospitalized, there is no need for pathogen testing, and you can directly go to azithromycin treatment, we do this without any problem.

If you want to undergo etiological examination, there are 3 common ways, you can understand the following:

01

Perform nucleic acid or multi-pathogen tests

If you can check mycoplasma nucleic acid, and you can get results quickly, check the nucleic acid.

A nucleic acid package, in addition to mycoplasma pneumoniae, there are a variety of pathogens, the price is more expensive, but the sensitivity and specificity are relatively high, and the detection can be more accurate treatment, in the doctor's opinion is a good way to examine.

02

Throat swab Mycoplasma antigen test

The antigen can be detected at the beginning of the disease, there is no need to draw blood, just check the throat swab, and the positive is considered to be an infection, which is simple and convenient.

If nucleic acid tests cannot be performed, then a variety of antigen tests are performed, antigens can be tested individually or in combination, such as Mycoplasma pneumoniae, respiratory syncytial virus, influenza and other tests at the same time, at this time it may also be necessary to refer to the comprehensive analysis of blood routine.

1. Virus positive, mycoplasma negative:

According to the virus treatment, it is basically observation; If the symptoms at this time are particularly similar to those typical of mycoplasma infection, they can be treated as mycoplasma;

2. Mycoplasma positive:

● If it is found to be positive for mycoplasma antigen, but there are no symptoms, it is carried and does not need treatment;

● If the antigen is positive and there are symptoms at the same time, it can be considered as mycoplasma infection, and treatment is required according to mycoplasma treatment, first azithromycin; To say more, if it is a simple upper respiratory tract infection caused by mycoplasma infection, it can also be good on its own.

3. Virus and mycoplasma are negative, refer to blood routine:

● If the white blood cells have no obvious changes or slightly low virus blood picture, it will be treated according to the virus;

● If the white blood cells are elevated, but not obvious, and the symptoms are like mycoplasma, according to mycoplasma treatment;

● If the blood routine shows white blood cells, neutrophils, and inflammatory indicators such as CRP and PCT are significantly elevated, there are symptoms and signs of focal infection of bacterial infection, as well as poor mental status, chills, persistent high fever, etc., consider bacterial infection, then treat according to bacterial pneumonia.

The effect of checking antigens before is quite good, such as fever, dry cough, poor mental state, headache, sore throat and other symptoms in autumn and winter, many of which can be detected positive.

But the evil thing is that the positive rate of mycoplasma antigen this year is not high. Many older children over the age of 5, the symptoms are very similar to mycoplasma infection, nasopharyngeal swabs also exclude other common viruses, blood routine is not viral blood image, even if not detected positive for mycoplasma antigen, and finally according to mycoplasma infection treatment is effective.

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03

Blood is drawn for mycoplasma antibodies

At present, some hospitals still draw blood to check for antibodies, which is of little significance in the early stage of the disease, because it takes time to produce antibodies, generally appearing in about 7 days of illness, and checking as soon as you are sick, even if it is negative, it cannot be ruled out that it is mycoplasma infection.

If we find out that we are positive for antibodies just after getting sick, we will not consider that it is mycoplasma infection, why? Because the antibody has not been produced this time, after the antibody is produced, it will last from a few months to a year, and if it is positive when you are just sick, it is basically the antibody left after the previous infection with mycoplasma.

So when do antibodies make sense? That is, the antibody test is negative when you are just sick, and the retest is positive after a week or 4~5 days of illness, which indicates that it is this infection.

As can be seen above, symptoms are still an important reference. This year's infectious diseases, many symptoms are atypical, mycoplasma infected children, coughing up yellow sputum also have, which is why pathogenic testing is recommended.

Of course, our diagnosis should also be combined with the wishes of parents, if you do not want to carry out these examinations, there is no problem with empirical treatment, and adjust the plan while treating.

5 conditions that require medical attention as soon as possible

● Dyspnea: children under 1 year of age with a respiratory rate greater than 50 breaths per minute when calm; Children over 1 year of age with a respiratory rate greater than 40 breaths per minute at calm; The child appears inhaled and inflammatory

● Children can't eat, drink water, and naturally can't take medicine;

● The child seems to be very sick, always sick, has a poor mental reaction, ignores people and always sleeps, even after using antipyretic drugs, there is no improvement;

● The child's blood oxygen is relatively low, and the blood oxygen (SpO2) is less than 95%;

● After 3 days of oral medication, the child's condition worsens and the above manifestations appear.

After your child is diagnosed with mycoplasma pneumonia

What should I do if it does not work well with azithromycin?

For Mycoplasma pneumoniae infection, azithromycin is currently preferred in children.

Many parents come to consult and report that the treatment effect of azithromycin is not good. This is because the domestic Mycoplasma pneumoniae drug resistance rate is high, up to 75~95%.

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If it is clear that it is mycoplasma infection, and the symptoms are also high fever, cough affects life, and azithromycin is not effective for 3 days, it is recommended to replace doxycycline or levofloxacin with doxycycline or levofloxacin under the guidance of a doctor, combined with the child's condition.

If the drug resistance test has been carried out before, it is clear that the infected mycoplasma is resistant to azithromycin, it is recommended that parents change the drug directly under the guidance of a doctor.

● Doxycycline:

Parents' first impression is that they are worried about the side effects of tetracycline teeth, and the current study has not found a dental effect on children. So it is generally no problem to use it for children under 8 years old.

Dosage reference: 2~4 mg/kg/day, 1~2 times a day, the maximum daily dose is 200 mg, and the course of treatment is 10 days.

● Levofloxacin:

If it is not clear whether mycoplasma is resistant or co-bacterial infection, and the child's symptoms are more severe, or it may be a bacterial infection problem, it is better to use levofloxacin and cover a wide range.

Levofloxacin is generally used in people over 18 years of age and, in cases of allergy or antibiotic resistance, in young children. Don't worry about the effects on the bones, even if there is, it is short-term, and there is no long-term effect.

Dosage Reference:

* ≥ 6 months of age and

* ≥ 5 years old: 10mg/kg/time, once a day (maximum 750mg/day), treatment course 7~10 days.

Will Mycoplasma pneumoniae still be endemic this winter?

What are the prevention methods?

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In the northern region, autumn and winter are still the epidemic season of Mycoplasma pneumoniae, and there is currently no vaccine to prevent Mycoplasma pneumoniae infection, and it is still necessary to pay attention to strengthening protection.

Later, respiratory syncytial virus will also reach the high season, and this virus will cause bronchiolitis in infants and young children.

However, parents do not have to be overly anxious, for children, illness is also a process of fighting monsters and escalating, what we can do is to teach children to develop good personal hygiene habits, through reasonable diet, regular schedule, moderate exercise, and timely vaccination of various vaccines, to help children build better immunity.

bibliography

[1]. Wang X, Li M, Luo M, et al. Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: a multicentre, population-based epidemiological study between 2015 and 2020[J]. Emerging Microbes & Infections, Informa UK Limited, 2022, 11(1): 1508–1517.

Author:

Kong Lingkai: Cooperative expert, master of pediatrics and attending doctor of pediatrics at the Second Military Medical University of the Chinese People's Liberation Army.

Liu Hua: Audit expert, attending physician of pediatrics at Beijing United Family Hospital.

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