After China, some European countries have also started witnessing an increase in cases of severe pneumonia in children. While China has not provided information on the cluster of pneumonia cases, the World Health Organisation (WHO) has quoted its health agency as attributing the increase to common respiratory pathogens such as Sars-CoV-2, RSV, influenza and mycoplasma pneumoniae.
Among them, the surge of mycoplasma pneumoniae, a bacterial infection that remained suppressed for three years, is making headlines. While the world had witnessed a decline in common respiratory infections during the pandemic owing to measures such as social distancing and masking, the numbers are bouncing back as restrictions have been done away with.
Why is the pathogen that causes “walking pneumonia” resulting in severe symptoms?
Mycoplasma pneumoniae is one of the common causes of walking pneumonia — a mild form of the disease that does not need bed rest or hospitalisation.
One of the reasons could be China coming out of the harsh, long lockdowns implemented during COVID-19. The long absence of mycoplasma pneumoniae has made people vulnerable and incapable of fighting it. An international consortium monitoring mycoplasma pneumoniae infections in a paper published earlier this year warned that when the infection does emerge, it is likely to result in “rare severe disease and extra-pulmonary manifestations” with waning herd immunity and populations not exposed to the infection for years. A paper published by the consortium on the same day as WHO’s statement about the situation in China said that after three years, there were signs of resurgence in mycoplasma pneumoniae in Europe and Asia.
The second reason could be high levels of resistance to antibiotics that work on the pathogen.
What is the role of antimicrobial resistance?
Dr Rama Chaudhary, the only collaborator for the consortium from India and dean of research at NIMS (National Institute of Medical Sciences) Jaipur, explains how the indiscriminate use of antibiotics during the pandemic has made them ineffective against what it was intended for, combatting mycoplasma pneumoniae. “The unusual suppression of mycoplasma pneumoniae cases could be due to people consuming azithromycin — one of the drugs effective against the bacteria — during the pandemic. This probably resulted in antibiotic-resistant bacteria,” says the former HOD of microbiology, AIIMS, New Delhi.
Is drug-resistant mycoplasma pneumoniae a new thing?
No. China has previously reported high resistance of the pathogen to the category of drugs called macrolides that includes azithromycin. “In a study, macrolide resistance of mycoplasma pneumoniae in Beijing was at a high rate of more than 90 per cent between 2008 and 2012. The authors of this study recommended establishing long-term monitoring of the pathogen to guide clinical treatment of the infection,” says Dr Kamini Walia, senior scientist and programme officer of antimicrobial resistance at the Indian Council of Medical Research.
Mycoplasma pneumoniae is a peculiar bacterium. It doesn’t grow on commonly used culture mediums, making it difficult to identify. Sometimes molecular tests that look for genetic material are needed to diagnose it. It is also extremely small and without a cell wall. The missing cell wall means certain categories of common antibiotics such as penicillin and cephalosporin do not work on it. Only drugs such as azithromycin and doxycycline work on the infection.
Is there a threat of the disease spreading to India?
Dr Chaudhary says that mycoplasma pneumoniae is not new and India has previously seen such cases. It can re-emerge in India as well. It is possible for the infection to spread through travel. But antibiotics exist to fight it.
© The Indian Express Pvt Ltd
First published on: 05-12-2023 at 14:39 IST
