Atypical pneumonia surging after long lull

3 minute read

The shortage of azithromycin is bad timing, but one alternative is still available for severe cases.

Mycoplasma pneumoniae cases are surging in Queensland, especially among children, with 20,000 cases this year to date – 45 times last year’s total.

This data comes from a weekly report from Sullivan Nicolaides Pathology (the Queensland pathology branch of Sonic Healthcare) based on testing results at its dozens of branches across Queensland, Northern Territory and northern NSW.

The hardest hit age groups are children aged five to 14, followed by women aged 30 to 50 and toddlers one to four.

According to Sullivan Nicolaides pathologist Dr Jenny Robson, quoted in The Courier-Mail, there had been an increase in hospitalisations from the illness, which is sometimes called “walking pneumonia” because of its supposed mildness.

Victoria’s Health Department warned of a surge in March and a report from Sonic’s NSW pathology branch (Douglas Hanly Moir) shows testing positivity rates for mycoplasma at around 22% compared with 0-1% last July.

Paediatric infectious diseases clinician Professor Robert Booy said there hadn’t been a surge of mycoplasma in years, and now the bacteria was taking advantage of waning immunity overall, weaker immunity in children especially, winter driving people indoors together and a parallel surge in respiratory viruses, which could be setting the stage for secondary bacterial infections.

“We’ve got the whole shebang at the moment, especially influenza, in Queensland right now,” Professor Booy told TMR. “Classic flu and, to a lesser extent, RSV are damaging the linings of the throat and allowing the bacteria like mycoplasma and other bacteria like pertussis [to take hold].

“We’ve got a whole menagerie, a whole soup of infections.”

He said mycoplasma was usually self-limiting but was also effectively treated by antibiotics.

“Many healthy people will get over it themselves within a week or two. But for the more severe cases – with fever, shortness of breath, presentation to the GP – azithromycin and similar antibiotics could help.”

Azithromycin is in shortage in Australia – the problem is international – and is not expected to be resupplied until December. Erythromycin is not in shortage; tablet clarithromycin is available, but the oral formulation is in limited supply.

Professor Booy said this too could be contributing to the surge in cases as people were symptomatic for longer.

Professor Steven Djordjevic, a non-clinician infectious diseases professor at University of Technology Sydney and former chair of the International Organisation on Mycoplasmology, said Mycoplasma pneumoniae was the second-most common cause of pneumonia, especially in children, after Strep pneumoniae.

It was not uncommon to see spikes every three to seven years, though it had been longer in Australia.

“There were outbreaks in France and the Netherlands last year, and I know China also had quite a significant surge post-covid,” he told TMR. “So I suspect this is just the way it moves across the globe.”

He said only macrolide antibiotics were appropriate for mycoplasma, so the current shortage was “not good”.

“Many of the antibiotics we would normally use for respiratory infections, such as the beta-lactam class, are completely ineffective because they target the cell wall,” he told TMR. “Mycoplasmas don’t have cell walls, so we’re reliant on the macrolides family.

Unfortunately, Professor Djordjevic said, azithromycin resistance was spreading globally and was already bad in the Asia-Pacific and the US.

He said fluoroquinolones were sometimes used on mycoplasma, but he did not recommend them as it was easy for resistance to develop rapidly.

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