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Pneumonia China, why mycoplasma pneumoniae divides experts

Pneumonia China, why mycoplasma pneumoniae divides experts

In many cases, the bacterium mycoplasma pneumoniae is responsible for pneumonia among children in China (and elsewhere). Not a new virus, therefore, but experts are divided between those who reassure and those who see something anomalous in it. Facts and comments

The world does not want to be caught unprepared again. After the outbreak of the Covid-19 pandemic, and the news arriving sadly late, the alert regarding the unusual increase in pneumonia and respiratory diseases among children in China has attracted the attention of health authorities and experts who want to see clearly .

The World Health Organization (WHO) asked Beijing for more data and information which, this time, immediately responded, assuring that this is a normal consequence of the end of anti-Covid restrictions and pathogens already known as influenza, rhinovirus, respiratory syncytial virus (RSV), adenovirus and bacteria, including mycoplasma pneumoniae, which particularly affects children.

China's reassurances, however, do not convince everyone, especially after Vietnam and France have also reported an anomalous increase in cases of pneumonia among children.


In the teleconference with the WHO , health authorities from the Chinese Center for Disease Control and Prevention and Beijing Children's Hospital provided the requested data. From these, the WHO reports, an increase in outpatient consultations and hospital admissions of children has emerged due to mycoplasma pneumoniae pneumonia since May and Rsv, adenovirus and influenza virus since October.

Therefore, no "unusual or new pathogens or unusual clinical presentations" were indicated, not even in Beijing and Liaoning, where the largest number of cases has been found so far. Health authorities also stated that "the increase in respiratory diseases has not resulted in a patient load exceeding hospital capacity."

However, some videos circulating on X show the opposite :

For China, the unusual detection of reports could also be attributed to “increased outpatient and hospital surveillance for respiratory diseases covering a broad spectrum of viruses and bacteria, including, for the first time, mycoplasma pneumoniae”.


Mycoplasma pneumoniae is a bacterium that frequently causes respiratory tract infections in humans, particularly during childhood. Its adhesion proteins, explains the Bambino Gesù Children's Hospital, have a particular affinity for the epithelium of the respiratory tract, which is why it causes pneumonia. The infection occurs most especially during the summer and early autumn, but can develop year-round. It is found in children of all ages, with an increasing frequency up to 6 years of age.

After acute infection, a long phase of asymptomatic presence persists (for weeks or months) which allows person-to-person transmission through close contact. The incubation period after exposure is approximately 23 days. Furthermore, the co-occurrence of other pathogens is frequent.


Mycoplasma pneumoniae causes a broad spectrum of diseases, although many infections are asymptomatic. The clinical manifestations of symptomatic infection are mainly affecting the respiratory tract and, in children, the most common is pneumonia, the onset of which is gradual and characterized by headache, malaise and low-grade fever; the cough is usually dry and can persist for weeks or months; children often experience fatigue, sometimes difficulty breathing and a sore throat.

Currently there is neither a vaccine nor a rapid test to identify the presence of mycoplasma pneumoniae, but only a laboratory PCR test.


An increase in cases linked to already known pathogens, such as mycoplasma pneumoniae, may be credible because the first winter since the abolition of anti-Covid measures – which for China is this – may lead to a greater circulation of other diseases that seemed disappeared but are seasonal. Even in Europe, last year there was an unusual number of hospitalizations among children, who, after being closed at home due to the restrictions, did not have adequate immunological defenses against common bacteria.

For Alexandre Bleibtreu , member of the Société de pathologie infectieuse de langue française (Spilf), in fact, "we are not in a situation similar to Covid" but "it is only the reappearance of a known pathogen" which had not circulated epidemically for around 10 years .

“Mycoplasma pneumoniae epidemics occur every 3-7 years and we don't really know why,” added Antoine Flahault, director of the Institute of Global Health in Geneva.

Furthermore, recalls Bleibtreu, "we are dealing with a population that has not had an immune response for 5 years and is therefore not equipped to defend itself." For the expert, at the moment, the hypothesis of a new variant of this bacterium is "highly unlikely".

Those who agree with Bleibtreu then underline that if it were a new virus, not only children would get sick.


However, there are also those who believe that some facts need to be explored further. This is the case of US epidemiologist Eric Feigl-Ding, who in addition to showing images of hospitals in China, observed that the same situation is also occurring in Vietnam . Among the aspects that deserve the most attention are the localization of the epidemic, only in Beijing and Liaoning, which are 800 km away from each other; the lack of information about the beginning of the spread and the speed with which cases rose.

For other epidemiologists cited by Nature , what is unusual in China is the high prevalence of pneumonia because in other countries, following the abolition of anti-Covid restrictions, the disease peaks mainly concerned influenza and the respiratory virus syncytial. And, as Benjamin Cowling, an epidemiologist at the University of Hong Kong, points out, “this finding is surprising because bacterial infections are often opportunistic and arise after viral infections.”


Those who raise doubts note that mycoplasma pneumoniae is usually relatively mild and does not require bed rest or hospitalization. It is true, however, that, as we read on The Conversation , there are various explanations for the high number of admissions to Chinese healthcare facilities.

In the case of mycoplasma pneumoniae, for example, the country is among those with the highest level of antibiotic resistance (70-90%) and therefore the common azithromycin, among the favorite drugs for its treatment, may not be sufficient. While for patients with flu, Rsv or adenovirus – which can cause dehydration and explain the photos of children with drips – it must be taken into consideration that in children under 5 years of age these are all diseases that can be more serious than in adults.


But although various causes have been identified, what worries some experts , including Feigl-Ding, is avian influenza and its possible mutation that would allow it to make the leap from species and therefore become transmissible from man to man.

Although China was in the past the epicenter of the disease, which then spread to Europe, America and Africa, there is currently no indication that a new pandemic is underway but it is still important to identify and monitor undiagnosed pneumonia clusters.

This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/polmoniti-cina-il-mycoplasma-pneumoniae-divide-gli-esperti/ on Tue, 28 Nov 2023 12:34:27 +0000.