Mycoplasma pneumonia is threatening, and adults and children may get sick. How should we deal with it？

CCTV News:Recently, the number of patients infected with mycoplasma pneumoniae has increased in many places, especially in children, and the treatment time is long. Many patients and their families have questions. Why is it not good after treatment for a while? I’ve already hit pneumonia vaccine, why can I get mycoplasma pneumoniae pneumonia? How to prevent uninfected people?

Hao Hongwen, chief physician of Pediatrics, Oriental Hospital, Beijing University of Chinese Medicine, gave the following answers to nine common questions about mycoplasma pneumoniae pneumonia.

Question 1: Why did you get mycoplasma pneumonia after playing in pneumonia vaccine?

Hao Hongwen:This is actually a question that we often answer parents in clinic. Usually, children and the elderly are vaccinated with pneumonia vaccine, which is mainly aimed at Streptococcus pneumoniae. However, the pathogen of this popular pneumonia is Mycoplasma pneumoniae, and there is no vaccine against Mycoplasma pneumoniae at present. Therefore, even if vaccinated with pneumonia vaccine, pneumonia caused by Mycoplasma pneumoniae cannot be prevented, because the pathogen is different. Of course, pneumonia vaccine has positive significance in preventing pneumonia and other diseases caused by Streptococcus pneumoniae.

Question 2: I went to check my blood when I had a fever and cough. The antibody against Mycoplasma pneumoniae was also negative, but not positive. Why did it eventually become Mycoplasma pneumoniae pneumonia?

Hao Hongwen:This is because the most positive time of mycoplasma pneumoniae antibody is 5-7 days after infection, so the initial examination may be negative, and some of them will be false negative. Therefore, negative antibody to mycoplasma pneumoniae can not rule out mycoplasma pneumoniae infection.

Question 3: What are the characteristics of mycoplasma pneumonia? How to identify?

Hao Hongwen:Pneumonia caused by mycoplasma infection is characterized by "double weight and light weight".

First of all, the symptoms are serious. Children mainly have a severe fever and cough, and most of them will continue to have a high fever, or the low fever will continue all the time, and the cough will be very heavy. In the first day or two of the onset, the cough may not be obvious, and then the cough will gradually become obvious, mainly manifested as paroxysmal and irritating cough, that is, coughing up in a big array, and even coughing badly will vomit and shed tears. This kind of cough, often with little phlegm at the beginning, is characterized by dry cough, and phlegm will appear in the middle and late stage of the course of the disease, which is the "first weight".

Although this kind of pneumonia has a severe fever and cough, the rales of the lungs are often not heard in the early and middle stages of the disease. Therefore, there is no dry and wet rales after the doctor auscultates the lungs. In layman’s terms, it is no problem to auscultate the lungs. This is a "light".

The characteristic of this disease is twofold and lightness, and the "second weight" is that the chest radiograph is heavier. If a child has a fever for more than three days, high fever for more than three days or low fever repeatedly, and his cough gradually worsens for more than three or four days, he must also consider this kind of pneumonia. Although there is no obvious abnormality in auscultation, doctors will generally advise the child to take a chest film to see if there is any pneumonia. The chest film may show signs of lung inflammation, some of which may be patchy, some may even be large white consolidation, and even pleural effusion. This is the "second weight".

Therefore, we simply sum up the characteristics of mycoplasma pneumoniae pneumonia as "double weight and light weight". If parents and friends find that their children have such characteristics of fever and cough, they must also pay attention to the possibility of mycoplasma pneumoniae pneumonia, and if necessary, conduct chest X-ray or even chest CT examination under the guidance of a doctor.

Question 4: How is Mycoplasma pneumoniae infected? How to prevent it?

Hao Hongwen:The infection of mycoplasma pneumoniae is the same as our common respiratory infections, and it is mainly transmitted through the mouth and nose, so it is easy to be infected in crowded places or in close contact with patients if no protective measures are taken. Therefore, in view of this route of infection, we still have to emphasize that children should go to crowded, closed and unventilated places as little as possible. If the disease is at a high incidence, it is recommended that children wear masks as much as possible and wash their hands frequently when going to these places. Of course, it is necessary to have enough sleep, a reasonable diet, and timely increase or decrease clothes according to the weather conditions, so as to enhance the child’s resistance and avoid the infection of mycoplasma pneumoniae. If someone in the family has been infected with mycoplasma, try to wear a mask or live in a separate room, and open the window frequently for air at home. Especially for families with two children, it is particularly easy to infect each other.

Question 5: Pneumonia only affects the lungs. Will there be other complications?

Hao Hongwen:Mycoplasma pneumoniae pneumonia, its impact on the human body is relatively extensive. The mild pneumonia will gradually recover after a few days of medication, and it will have a greater impact on the severe pneumonia or the pneumonia with long fever time and heavy lung imaging. The common complications are divided into two parts: intrapulmonary and extrapulmonary. The intrapulmonary complications include plastic bronchitis, embolism (which can be independent or combined with other parts), pleural effusion, and some children may be complicated with acute asthma attack and mixed lung infection. Extrapulmonary, including nervous system, circulatory system, blood system, skin, liver damage, kidney damage, etc., among which myocarditis, myocardial damage and liver damage are more common, and in addition, in the nervous system, encephalitis may be common. Skin complications will have some rashes, and the blood system may have some changes in blood cells such as platelets. Each system will also have serious complications, even life-threatening, so we can’t take it lightly.

Question 6: Why did the symptoms get worse after taking cephalosporin from the beginning?

Hao Hongwen:This is because penicillin and cephalosporins play a role by inhibiting the synthesis of cell walls, but when mycoplasma pneumoniae is infected, mycoplasma pneumoniae has no cell walls, so cephalosporins can’t play a role. The use of macrolides such as azithromycin or erythromycin mainly inhibits the synthesis of protein, thus inhibiting the activity of mycoplasma and playing an anti-infection role. Therefore, if mycoplasma pneumoniae is infected, cephalosporins are ineffective. However, some patients may be complicated with bacterial infection and also use cephalosporins.

Question 7: Mycoplasma pneumoniae pneumonia, how should it be treated?

Hao Hongwen:If it is mycoplasma pneumoniae pneumonia, it is generally divided into mild and severe. Mild pneumonia is treated with macrolides such as azithromycin for three days, which may be extended to five days according to the condition, or cyclic erythromycin and roxithromycin can be used. At the same time, you can use some drugs to relieve cough and phlegm. Traditional Chinese medicine can generally use Shegan Mahuang Decoction and Maxing Shigan Decoction after syndrome differentiation.

Severe mycoplasma pneumonia is mainly treated with azithromycin for 7 days, and then stopped for 3-4 days. According to the situation, a second course of treatment or a third course of treatment may be needed, with cough relieving, phlegm resolving, aerosol inhalation, etc., and anticoagulation treatment if necessary. Chinese medicine can be treated with Maxing Shigan Decoction combined with Sanzi Yangqin Decoction and Huanglian Jiedu Decoction. In this process, if the symptoms are not relieved, fever or severe cough persist, it is necessary to consider whether it belongs to drug resistance, mixed infection or other complications according to the situation, and consider switching to other antibiotics, adding hormones, combining antibiotics, bronchoscopic lavage, immunoglobulin and other treatments. This needs the doctor to decide according to the situation.

Quinolones are the first choice for adult treatment, as well as new tetracyclines.

In short, each patient’s situation is different. Under the guidance of treatment principles, specific problems are analyzed and solved. During the period, children should drink water properly, atomize to dilute sputum, and eat digestible food.

Question 8: Why did you use azithromycin and erythromycin, but your condition still hasn’t improved?

Hao Hongwen:This is because the improvement of the disease is related to the following factors: the first is to feel the virulence of this pathogen, the second is whether our body’s resistance is moderate (too weak or too strong), and the third is whether the drug is resistant. If you feel that the pathogen is more virulent, the child’s immunity is weak or too strong, then the drug is not enough to weaken the pathogen or inhibit the excessive immune response, so even the drug can not quickly inhibit the development of the disease. Mycoplasma pneumoniae pneumonia can be divided into mild pneumonia and severe pneumonia, as well as refractory mycoplasma pneumonia. It refers to that after 7 days of treatment with regular macrocyclic lipid antibiotics such as azithromycin, the clinical symptoms and signs or imaging examination have not improved, or other complications have occurred. This year’s guide in 2023 also mentioned "macrolide nonreactive mycoplasma pneumonia", which means that the condition has not improved after 72 hours of treatment with regular macrolide drugs. If drug resistance is considered, new tetracycline drugs such as doxycycline and minocycline can be selected. These drugs are suitable for children over 8 years old, and those under 8 years old are beyond the instructions, which need full evaluation and informed consent of parents. So it is also mycoplasma infection, but the development and changes of the disease are different because of different factors. However, this kind of refractory pneumonia or unresponsive pneumonia is often easy to develop into severe pneumonia. In addition to antibiotic treatment, it is often necessary to cooperate with a variety of therapeutic drugs and means.

Question 9: In the late stage of mycoplasma pneumoniae infection, the child has a bad appetite and a persistent cough. What should I do?

Hao Hongwen:Some children with mycoplasma pneumoniae pneumonia still have some cough symptoms after 2-3 courses of anti-infection treatment, or at the later stage of disease treatment, the children show poor appetite and cough with persistent phlegm. At this time, considering that there may be airway hyperresponsiveness or other sequelae from western medicine, we can continue to adopt corresponding treatment and atomization. Traditional Chinese medicine treatment also has advantages. Traditional Chinese medicine believes that the residual evil is not exhausted and the healthy qi has been injured in the later stage of the disease. Traditional Chinese medicine is used to clear the residual evil and help the healthy qi. At the same time, some other treatments of traditional Chinese medicine, such as cupping and massage, can be used to assist the recovery of pneumonia. (Reporter Yan Yan)