As an infectious disease doctor, Yu Huiju, a doctor from Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, lamented that this year is the first time she has encountered so many children with mycoplasma pneumonia in more than 30 years of practice.

"Mycoplasma pneumoniae exists in nature, but due to the new crown epidemic for three years, we who are used to wearing masks and staying at home have lost resistance to many germs." Yu Huiju said that in this season, if there are symptoms such as cough and fever, from an epidemiological point of view, we often consider that the child is infected with Mycoplasma pneumoniae.

Yu Huiju said frankly that as early as the end of September this year, many respiratory and infectious disease doctors generally felt that this year's pneumonia patients have an increasing trend, so the hospital has worked overtime, prepared enough manpower and beds, in addition to the infection department, respiratory department is basically full of children, other departments such as hematology, rheumatology and immunology, cardiology, neurology, etc. have also vacated beds for the treatment of the increasing number of pneumonia children.

In Yu Huiju's outpatient clinic, children under the age of 10 account for the majority of children with mycoplasma pneumonia, and among the children treated in the hospital, some children who have not been relieved after taking the drug have developed into children with severe pneumonia, and even some people have "white lung". According to hospital regulations, children with "white lung" will be sent to the emergency room for further treatment.

Similarly, in the Children's Hospital of Fudan University, there have been two major epidemics of 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 the monitoring data of the hospital's fever clinic and internal medicine clinic since October, the detection rate of mycoplasma accounted for about 10% of the respiratory specimens sent for testing, which was at a high level. "In previous years, it was generally between 30% and 5%, 10% is already relatively high, and this year's epidemic level is 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 attention. In this regard, Zeng Mei said that as early as around 2010, the resistance of mycoplasma pneumonia to azithromycin, erythromycin and other drugs has been obvious, and now the drug resistance rate has reached more than 90%. "Although mycoplasma infection can cause pneumonia, the clinical proportion of severe disease is not high, the treatment of mycoplasma pneumonia is not too difficult, and 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 vigilant against influenza. In Yu Huiju's view, autumn and winter are originally the high season of respiratory diseases, and most respiratory diseases are contagious, but such as Mycoplasma pneumoniae are not necessarily listed as infectious diseases, but they still need our attention, "It is expected that this wave of peaks may continue until the winter vacation." ”

Outpatient: There is a child who does not have a fever but is infected with Mycoplasma pneumoniae

After 10:20 p.m. on October 4, it was night clinic hours. At the registration desk of the Pediatric Emergency Building of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, parents continue to bring their children to see patients. Most of the children present have symptoms such as fever and cough. In the atomization area and infusion area, there are also children sitting as far as the eye can see.

Near 5 o'clock in the evening, parent Huang Yu (pseudonym) took his 7-year-old child Xiaoxuan into Yu Huiju's night clinic.

Xiao Xuan is a child with repeat pneumonia. As early as October 10, he developed a fever, and at first the family gave the child Merrill Lynch to reduce the fever, but could not "suppress" it. On October 14, Xiao Xuan was taken to the hospital, had an examination, and also had a CT taken, and found that it was B flu and was infected with mycoplasma. Over the next four days, he had repeated fevers that receded and started again.

"I have been having a fever for more than a week, azithromycin has been eating for 5 days, and the day before I was still having a fever, 38 degrees Celsius, and I have been hanging water for a day." What worries parent Huang Yu is that the fever that lasted for more than a week made the child's weight drop from 53 pounds to 51 pounds.

6-year-old Xiaoxi is also a repeat patient. On October 10, because of cough, he was diagnosed with acute lower respiratory tract infection, no vomiting, no diarrhea, or even no fever, but coughed for 16 days, did atomization treatment, and also took azithromycin and erythromycin, and the original cough symptoms have not improved. Upon examination, Xiaoxi was also diagnosed with a weak positive for Mycoplasma pneumoniae IGM.

"Mycoplasma antibodies generally appear 5 days after the onset, and if it is a severely ill patient, it will appear 10 days after the onset, and the later it appears, the more serious the disease." Yu Huiju said.

The reporter observed that in Yu Huiju's night clinic, there were mostly children aged 5-7, and the proportion of pneumonia found to be very high, most of them had fever, cough and other symptoms, but some were only 2 or 3 years old, most of which could be improved after drug treatment. Yu Huiju said that from an epidemiological point of view, if there are symptoms such as cough and fever this season, it is often considered that the child is infected with Mycoplasma pneumoniae.

With the rise of social attention, the awareness of "mycoplasma pneumonia" in the circle of parents is also increasing. When Wang Meng (pseudonym) brought her 4-year-old child Xiaoyun to see the doctor, she asked the doctor: "My child came back from kindergarten yesterday afternoon with a fever, the highest fever reached 40 degrees Celsius. I heard that pneumonia is particularly severe this year, I don't know if it is mycoplasma pneumonia? ”

Xiaoyi, 2 and a half years old, developed fever symptoms more than 10 days ago, and was subsequently diagnosed with Mycoplasma pneumoniae antibody weak positive, and the fever subsided after taking medication, but the cough and asthma have not stopped. When he came to the doctor, Xiao Yi's parents and grandparents also came, "Our family is infected with pneumonia, and the symptoms of adults do not matter, but the child has been panting and has not been able to see well." Xiao Yi's grandmother was a little nervous.

For the detection of pathogens in children with fever and cough, Yu Huiju said that a respiratory quintuple 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 disease is not high, and the prognosis of children is relatively good

Yu Huiju said that at present, in the Department of Infectious Diseases of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, children under the age of 10 are a high-incidence group of Mycoplasma pneumoniae infection, and there are some severe cases, but there are currently no deaths. Some confined spaces, such as school classrooms and unventilated home environments, are a major way to cause the transmission of Mycoplasma pneumoniae. In addition, there are some preschool children between the ages of 2-3 years, mainly in the family infection of the cause, "mycoplasma pneumonia although not defined as an infectious disease, but it has a certain contagion, the elderly, parents will be transmitted to children." ”

The Children's Hospital of Fudan University has recently faced an epidemic of two infectious diseases, 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 from the monitoring data of the hospital's fever clinic and internal medicine clinic since October this year, among the respiratory specimens sent for testing, the detection rate of mycoplasma accounted for about 10%, which was at a high detection level, "In previous years, it was generally between 30% and 5%, 10% was already relatively high, and the level of epidemic this year was higher." ”

In general hospitals, cases of Mycoplasma pneumoniae infection are not high in adults and fewer in the elderly. Xu Yihuai, executive director of the Department of Respiratory and Critical Care Medicine of Tongji Hospital, said that the hospital only accepts patients over 12 years old, and among the patients infected with mycoplasma pneumonia, most of them are adolescents aged 12-18, and their body temperature has not receded, but there are very few severe cases.

Zeng Mei also said that although mycoplasma infection can cause pneumonia, the proportion of severe disease is not high, usually fever does not subside, lung symptoms, rarely breathing difficulties. In the overall response of the hospital to children with mycoplasma pneumonia, in addition to the large workload and large outpatient load, the prognosis of the children is relatively good.

Yu Huiju pointed out that in fact, Mycoplasma pneumoniae infection is more common in any season, more in autumn and winter in the northern region, and more epidemic in summer and autumn in the southern region, and children and adolescents are at high risk of infection with Mycoplasma pneumoniae.

"When Mycoplasma pneumoniae invades our body, it can lead to respiratory infections such as laryngitis, bronchitis, pneumonia, etc., and pneumonia does not always occur." Yu Huiju said that judging whether a child is infected with Mycoplasma pneumoniae depends more on the doctor's comprehensive 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 from individual to individual, some children may show only mild symptoms, some symptoms will be relatively obvious, if the child has cough, fever, runny nose, wheezing, headache, earache, muscle pain and other symptoms, especially accompanied by shortness of breath or high fever, should seek medical attention in time.

Drug resistance is obvious, but treatment is not too difficult

After the epidemic of mycoplasma pneumonia, azithromycin was on the hot search, and the problem of drug resistance has also become one of the focuses of attention, and many children have not recovered from the disease for a long time.

In this regard, Zeng Mei said that this is actually an "old problem". As early as around 2010, the resistance of mycoplasma pneumonia to azithromycin, erythromycin and other drugs has been obvious, and the drug resistance rate has now reached more than 90%.

Although there is drug resistance, Zeng Mei also said that there are not too many difficulties in the treatment of mycoplasma pneumonia, and many drugs are still sensitive antibiotics for mycoplasma pneumonia. For example, in recent years, drugs such as the new generation of tetracyclines can still produce sensitivity, and the drug is safe. In addition, fluoroquinolones are also effective, short-term use, it does not cause significant negative effects in children. "Including combined short-course hormone therapy, the overall treatment effect is still very good, I hope everyone is not too nervous, although mycoplasma pneumonia is endemic, but the harm is limited."

Yu Huiju also admitted that in her outpatient clinic, although azithromycin is the preferred drug in the diagnosis and treatment guidelines, there are indeed some children who have not improved with azithromycin, "Usually, we will carry out drug resistance gene testing for some hospitalized children who still do not improve after taking drugs, and this test is also being carried out in the outpatient clinic, but it takes 2-3 days to report, and not everyone needs this type of testing." ”

Yu Huiju further said that although the drug resistance rate has increased, macrolide antibiotics are still the first choice for pediatric mycoplasma pneumonia, and if the clinical effect is not good after a period of use, drug resistance testing should be done as soon as possible and drug modification should be considered.

"If macrolide-resistant Mycoplasma pneumoniae develops, newer tetracycline antimicrobials, including doxycycline and minocycline, can also be tried, which are also alternatives to the treatment of drug-resistant Mycoplasma pneumoniae pneumoniae. Although these drugs may cause yellowing of teeth or dysplasia of tooth enamel, they are recommended for children over 8 years of age, but they are relatively safe to use clinically. In addition, there are quinolone antibacterial drugs, including levofloxacin, moxifloxacin, etc., which are alternative drugs for the treatment of drug-resistant Mycoplasma pneumoniae pneumoniae. Yu Huiju said.

The above experts further pointed out that because quinolone antibacterial drugs may cause joint and muscle dysplasia, they are off-label drugs in children under 18 years of age, and if they need to be used beyond the age group, they need to be used on the basis of communicating with their families, and such drugs are often used in resistant children.

The peak of infection is expected to continue until after the winter holidays, and it is also necessary to be wary of influenza

In addition to mycoplasma pneumonia, Zeng Mei believes that the public should also be vigilant against influenza.

According to the data of the Children's Hospital of Fudan University since late August this year, children with influenza have been at a moderate level of epidemic, and there is no downward trend in children, and influenza is expected to continue until winter and spring. Zeng Mei suggested that parents raise their awareness of influenza vaccination and vaccinate their children in a timely manner.

Some parents wonder, why do children still get mycoplasma pneumonia after vaccination against pneumonia? Zeng Mei said that no one vaccine can prevent all pneumonia, and the pathogens that cause pneumonia are diverse, including influenza virus, Streptococcus pneumoniae, measles and so on. "The pneumonia vaccine that parents usually understand is the Streptococcal pneumoniae vaccine, but it does not prevent all pneumonias. Moreover, in particular, mycoplasma pneumonia has not been vaccinated so far, and it cannot be prevented by vaccines. ”

"This peak of infection is expected to continue after the child's winter vacation." Yu Huiju said that in addition to the peak of Mycoplasma pneumoniae infection, influenza virus, respiratory syncytial virus, etc. may also become more popular in winter and spring, and there may also be bacterial and viral co-infection, so this wave of respiratory disease infection peak will not pass so quickly.

In response to how to prevent respiratory diseases, Yu Huiju said frankly that in fact, everyone has a very comprehensive understanding after the new crown epidemic, "Wearing masks is definitely the best way to prevent respiratory diseases, and it is also the most effective." At the same time, maintaining hand hygiene, more indoor ventilation, especially the elderly and children to avoid crowded places, these means can achieve a good effect of preventing infectious diseases. ”

In addition, the above experts recommend that for children, to prevent respiratory diseases, to maintain adequate sleep and moderate exercise, a balanced diet, these can help build stronger immunity.