Walking’ Pneumonia (Mycoplasma pneumoniae) for GPs

https://www1.racgp.org.au/newsgp/clinical/what-do-gps-need-to-know-about-walking-pneumonia 12 Jul 2024

Overview:

• Current Situation: Australia is experiencing a spike in Mycoplasma pneumoniae cases, particularly among children, after a low incidence during the COVID-19 pandemic.
• Epidemiology: Mycoplasma pneumoniae infections tend to occur in outbreaks every 3–7 years, with no significant seasonality.

Transmission:

• Mode of Transmission: The infection spreads through respiratory droplets from coughing or sneezing.
• High-Risk Groups: Most common in school-aged children and young adults.

Symptoms:

• Typical Symptoms:
  • Fever
  • Dry cough
  • Sore throat
  • Fatigue
  • Headache
  • Malaise
  • Shortness of breath (in some cases)
• Atypical Symptoms in Young Children:
  • Runny nose
  • Sneezing
  • Wheezing
  • Earache
  • Vomiting
  • Diarrhea

Complications:

• Uncommon but Potentially Serious Complications:
  • Encephalitis
  • Myocarditis
  • Guillain-Barré syndrome

Diagnosis:

• Clinical Diagnosis: Based on symptoms and patient history.
• Additional Diagnostic Tools:
  • Chest X-rays (helpful but not always necessary for mild cases)
  • Specific blood tests (can aid in diagnosis)

Treatment:

• First-Line Antibiotics: Macrolides:
  • Azithromycin
    • Children ≥ 6 months: 10mg/kg/dose (to a maximum of 500mg) once daily for 3-5 days
  • Clarithromycin
    • ≥4 weeks to 18 years: 7.5-15mg/kg/dose (to a maximum dose of 500mg) 12 hourly
  • Note: Macrolides are preferred due to the unique nature of Mycoplasma pneumoniae, which lacks a cell wall.
• Alternative Antibiotics:
  • Doxycycline (used in adults)
• Current Challenges:
  • Antibiotic shortages (including azithromycin and clarithromycin) are impacting treatment availability.
  • GPs are advised to carefully consider or limit prescribing due to supply constraints.

Management of Mild Cases:

• Symptomatic Treatment:
  • Rest
  • Hydration
  • Over-the-counter pain relievers
• Patient Education: Advising patients on how to manage symptoms at home and when to seek further medical attention.

Public Health Data:

• Non-Notifiable Disease: Mycoplasma pneumoniae is not a notifiable disease, so official prevalence data is limited.
• Data Sources:
  • Occasional reports from state health departments
  • Sentinel networks
• Recent Trends:
  • NSW: Unseasonably high presentations to emergency departments for pneumonia among children and young adults.
  • Global: Increases in Mycoplasma pneumoniae detections and hospital admissions in several European countries.

Clinical Advice for GPs:

• High Vigilance:
  • Keep Mycoplasma pneumoniae on the radar, especially in children with persistent respiratory symptoms.
• Re-swabbing:
  • Consider re-swabbing for Mycoplasma pneumoniae if initial tests for respiratory viruses are negative and symptoms persist.
• Guideline Adherence:
  • Use clinical guidelines to manage respiratory infections and explore alternative treatments due to antibiotic shortages.
• Communication and Collaboration:
  • Stay updated with local health department reports and public health advisories.
  • Educate patients and caregivers about managing symptoms and the importance of follow-up.

Practical Considerations:

• Resource Management:
  • Carefully manage antibiotic prescriptions to ensure availability for those in need.
  • Discuss the importance of symptom management and follow-up care with patients.
• Patient Support:
  • Provide comprehensive care and support for patients, particularly those with prolonged or severe symptoms.
  • Ensure clear communication about the need for medical review if symptoms do not improve.