No M pneumoniae cases in samples tested since Jan in India: Health ministry

Mycoplasma pneumoniae, a bacteria, is linked to the surge in children's hospitalisation in China

Amid a rise in hospitalisations of children due to pneumonia in China, India has reported no cases of mycoplasma pneumonia — the pathogen suspected to be behind the surge in China — in the 611 samples tested since January 2023.

The Union health ministry iss­ued a statement clarifying that among the 611 samples analysed by the Dep­artment of Microbiology at the All India Institute of Medical Scien­ces (AIIMS) in New Delhi, no mycoplas­ma pneumonia cases were detected. This testing was part of the Indian Co­uncil of Medical Research’s (ICMR’s) comprehensive respiratory pathogen surveillance, primarily focusing on severe acute respiratory illness (SARI), which accounted for about 95 per cent of the cases, conducted through real-time PCR. ICMR serves as India’s apex medical research body.
 

 

The health ministry’s statement followed a media report suggesting that between April and September 2023, AIIMS Delhi had identified seven bacterial cases associated with the recent surge in pneumonia cases in China.

AIIMS did not respond to questions from Business Standard.

“It is clarified that these seven cases have no link whatsoever to the recent surge in respiratory infections in children reported from some parts of the world, including China. The seven cases have been detected as a part of an ongoing study at AIIMS Delhi in the six month period (April to September 2023) and is no cause for worry,” the statement added.

Doctor-Speak

Doctors said that there has not been any alarming rise in pneumonia cases recently.

Vivek Nangia, principal director and head of pulmonology at Max Super Speciality Hospital, Saket, New Delhi, told Business Standard: “Mycoplasma is normal bacteria. Some studies suggest that around 30 per cent of all pneumonia pat­ients have mycoplasma infection.”

“I would not say that there is a significant increase in incidence. In any case, we get patients with pneumonia and respiratory tract infections at this time of the year because of air pollution and viral infection spreading,” he said, adding that no new pathogen had come in recent times apart from Sars-CoV-2.

Viswesvaran Balasubramanian, consultant, interventional pulmonology and sleep medicine at Yashoda Hospitals, Hyderabad, said that they had seen a surge in pneumonia cases last month, but most were of mild severity. 

How­ever, currently there is a down­ward trend in patients presenting with pneumonia. “Genome sequencing in pneumonia plays a crucial role in understanding the genetic makeup of the microorganisms responsible for the infection. We routinely send the swabs for genome sequencing for identification of atypical bacterial organisms and viral infection,” Balasubramanian said.

On the other hand, Manoj Gupta, director, pulmonology, Fortis Memorial Research Institution, said that in most cases they don’t send samples for the Elisa test as there are other sets of tests that they opt for such as septum and blood culture. “The antibiotics prescribed generally cover mycoplasma and, therefore, there is no such need to diagnose it separately,” he said.

As such there has been no advisory for mycoplasma, he said.

Global rise in pneumonia

The World Health Organization (WHO) has attributed the increase in respiratory pathogens like Sars-CoV-2, respiratory syncytial virus (RSV), influenza and mycoplasma pneumoniae to the clusters of pneumonia cases observed in China. This bacterial infection, like several other common respiratory infections, remained subdued during the pandemic due to measures such as social distancing, wearing masks and reduced outdoor activities.

An article in The Lancet Microbe titled “Mycoplasma pneumoniae: delayed re-emergence after Covid-19 pandemic restrictions” highlighted that the most recent epidemic of M pneumonia occurred in late 2019 and 2020, predominantly in Europe and Asia.

The introduction of non-pharmaceutical interventions (NPIs) against Covid-19 in March 2020 abruptly halted these epidemics and significantly reduced M pneumoniae detection worldwide.

However, despite occurring at very low levels, a slight increase in case numbers was noted in several countries in the last months of the third year (January to March 2023), leading to heightened vigilance.

Reports from the Independent suggested a spike in pneumonia cases in the Netherlands and Den­mark as well. “In the Netherlands, the number of children aged 5 to 14 years with pneumonia increased to 130 per 100,000 children in the week leading up to 26 November, the Neth­erlands Institute for Health Services Research reported. At its peak last year, there were 58 cases per 100,000 children,” the report said.

Fact sheet

Pneumonia is an infection in which the air sacs in one or both of the lungs are filled with fluid or pus and become inflamed. The inflammation causes coughing with phlegm, along with fever, chills and breathing troubles. The Yale Medicine website says that there are more than 30 microorganisms (or microbes) that can cause pneumonia, and identifying the correct one isn’t always easy. The infection, which is caused by bacteria, viruses or fungi, can occur in one or both of the lungs. It can be mild or life-threatening, especially to the elderly, the very young or those with compromised immune systems.

Bacterial pneumonia: Caused by bacteria, the most common of which is streptococcus pneumoniae

Viral pneumonia: Responsible for about one-third of all pneumonia cases, this is caused by various viruses, including flu (influenza). People may be more likely to get bacterial pneumonia if they first have viral pneumonia. Viral pneumonia is usually not as serious as bacterial and typically vanishes more quickly.

Mycoplasma pneumonia: Also known as walking pneumonia, this type is considered atypical because its symptoms and physical signs may vary. Also, it causes a milder illness, and most often occurs in older children and young adults.
 

Fungal pneumonia: Fungi from soil or bird droppings can cause pneumonia in people who inhale large amounts of these organisms. 

Source: Yale Medicine