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With a current ‘soup’ of respiratory infections coupled with antibiotic shortages, an epidemiologist outlines basic advice for GPs.
Increases in Mycoplasma pneumoniae cases have been reported in all age groups, but mostly observed in children who present with ongoing respiratory symptoms.
Australia is experiencing a current spike in respiratory infections, and cases of Mycoplasma pneumoniae or ‘walking’ pneumonia are circulating in the community, particularly among children.
But with antibiotic shortages and low immunity to the infection post-pandemic, how can GPs be best prepared?
Professor Adrian Esterman is Chair of Biostatistics and Epidemiology at the University of South Australia. He told newsGP increased Mycoplasma infections have been reported in Australia over the last two years, after a very low incidence in 2000–22, when people were taking precautions against COVID-19.
‘The low incidence means that many children have not been exposed to Mycoplasma pneumoniae, and hence have little or no immunity,’ he said.
‘Outbreaks occur every 3–7 years, and seasonality is not a major factor.’
While Professor Esterman says the infection is a ‘leading cause’ of community-acquired pneumonia, only 5–10% of infected individuals develop pneumonia.
Mycoplasma pneumoniae infection spreads through respiratory droplets from coughing or sneezing and is most common in school-aged children and young adults.
Typical symptoms of Mycoplasma pneumoniae include fever, dry cough, sore throat, fatigue, headache, malaise, and shortness of breath, in some cases.
Atypical presentations in young children can include runny nose, sneezing, wheezing, earache, vomiting, and diarrhea.
‘GPs should also be aware of potential, but uncommon, complications like encephalitis, myocarditis, and Guillain-Barré syndrome,’ Professor Esterman said.
‘Chest X-rays and specific blood tests can aid diagnosis but aren’t always necessary for mild cases.’
‘For mild cases, GPs should advise patients on managing symptoms at home with rest, hydration, and over-the-counter pain relievers.’
As Mycoplasma pneumoniae is a ‘unique bacterium’ lacking a cell wall, Professor Esterman points out this makes it resistant to some antibiotics. Macrolides classes of antibiotics such as azithromycin and clarithromycin are the first line treatment, and doxycycline can also be used in adults.
However, current antibiotic shortages, including azithromycin and clarithromycin, are impacting supply, prompting health authorities to advise GPs to ‘carefully consider’ or limit prescribing.
Professor Esterman says because Mycoplasma pneumoniae is not a notifiable disease, statistics on prevalence come from the occasional report from state health departments that have tested children hospitalised with pneumonia, and some sentinel networks.
The NSW Department of Health published a surveillance report last week revealing ‘unseasonably high’ presentations to emergency departments (EDs) in the country’s most populous state for children and young adults with pneumonia, particularly in those aged 5–16 years, over the past few months. The last epidemic in NSW was before the COVID-19 pandemic.
The report notes that within EDs, most pneumonia presentations are classified as ‘unspecified pneumonia’, with this information becoming available later in the admission or following discharge from hospital. Both Mycoplasma pneumoniae and pertussis have also been known to cause pneumonia.
The Victorian Department of Health was contacted with a request for the latest figures in the state, but a spokesperson advised ‘we don’t have any further data since Mycoplasma pneumoniae infections are not notifiable and the majority of the testing has been done privately.’
Globally, the World Health Organization states that several European countries have reported recent increases in Mycoplasma pneumoniae detections at local levels and an increase in hospital admissions, ‘possibly reflecting typical periodic recurrence.’
In Australia, RACGP President Dr Nicole Higgins recently told media that GPs should keep respiratory infections on their radar particularly with mycoplasma likely to develop over time, and in children, ‘they just don’t get better’ and have a lingering cough.
‘We’ve got a respiratory bug soup at the moment, it’s multiple bugs that are impacting especially our children,’ she said.
‘The general rule of thumb is if your child’s not getting better, get them checked out [for mycoplasma].
‘Our initial swabs are for the respiratory viruses because we know they’re the most common … then we go back and do a re-swab and it’s coming back as mycoplasma, which has to be treated differently.’
And while there are some challenges in accessing appropriate treatment with antibiotic shortages, Dr Higgins reminds GPs to use guidelines around how to manage conditions with medication alternatives.
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