2023-11-23 20:03:22
by Maria Giovanna Faiella
ISS: «For now no anomalous increase; if a new virus were to emerge, the surveillance system would be able to detect it”
Following the alarm over the pneumonia epidemic in China and the hypothesis that these are infections caused by mycoplasma pneumoniae – but infections caused by respiratory syncytial virus and C0-infections are also on the increase -, we asked the expert what are, how to prevent and treat pneumonia caused by mycoplasma pneumoniae and respiratory syncytial virus, as well as how to avoid the possible risks deriving from “mixed” infections.
What is Mycoplasma pneumoniae bacterial infection?
The pediatrician and infectious disease specialist Guido Castelli Gattinara, of the Institute for child and adolescent health of the Bambino Gesù pediatric hospital in Rome, member of the technical table on infectious diseases of the Italian Society of Paediatrics (Sip), explains: «The infection it is due to a bacterium – mycoplasma – “atypical” because it lacks a cell wall, which has the ability to bind to lung tissue and cause a form of atypical pneumonia.”
Transmission of infection
How does contagion happen? «The bacterium enters the lungs through the air, transmitted through “droplets” of saliva or breath (droplets) in the air spread by infected people» explains the pediatrician and infectious disease specialist. «It is a germ that we know, also present in Italy, and it is easier for it to be transmitted in “closed” communities, such as in schools. It affects small but also older children (it is more frequent among those of school age, between 6-7 years old) and adults.”
Symptoms and diagnosis What are the symptoms? «The clinical manifestation is pneumonia (atypical) usually characterized by a low fever (in some cases it is high), a small dry cough (in some cases however it lasts a very long time); the child, then, is asthenic, that is, weak, and has signs of general malaise. These symptoms, if they last over time and get worse, can cause significant pneumonia that requires hospitalization.”
How is this atypical pneumonia recognized? «In these forms there is no nasal discharge (rhinitis), nor a red throat – explains Professor Castelli Gattinara -. The advice, especially if fever and cough last over time, is to contact the family paediatrician, who will visit the child and evaluate whether to have more in-depth tests carried out. School-age children often have so-called “community” pneumonia which rarely becomes serious.”
How do you arrive at the diagnosis?
Castelli replies: «To make a certain diagnosis, in-depth investigations are needed such as a chest x-ray and specific tests to identify the presence of mycoplasma via a nose/throat swab and a PCR (Polymerase chain reaction) test».
Therapies As for therapies, the infectious disease specialist states: «We know that antibiotics have a defense function against bacterial infections and not viral infections, but unfortunately, all over the world as soon as a child has a fever, antibiotics are given, and this has led to an increase in drug resistance. Mycoplasma pneumoniae pneumonia is treated not with classic antibiotics but with specific antibiotics called macrolides, which act inside the atypical bacterium (which does not have a cell wall, ed.) – specifies the expert -. Unfortunately, these antibiotics have also been used recklessly, even in Italy, and recent scientific data tell us that resistance to these antibiotics is on average above 50%, in some countries it is higher and in China it even reaches up to 97 percent. The antibiotic, the right one and in the right dosage – underlines the infectious disease pediatrician once again – must be prescribed by the doctor”. So no to DIY.
How to prevent mycoplasma pneumonia?
«In the meantime, one form of protection is to get all the recommended vaccinations, including the flu vaccination (in pediatric age recommended for children from 6 months to six years and, for “fragile” ones, even after the age of six, ed.) – advises Castelli – . Another characteristic of this mycoplasma is its association with viral diseases; in the most severe forms – which may require hospitalization – we often find a co-infection of more than one infectious agent (virus or bacterium), i.e. the mycoplasma infection is particularly serious when there is also a viral infection, whether it is due to the respiratory syncytial virus, or the influenza virus (not to be underestimated, since it still causes between 6-8 thousand deaths a year in Italy alone)”.
Other forms of prevention (valid for all airborne infectious diseases)
Other ways of protection are the ones we learned to use during the pandemic. Professor Castelli reminds you: «Keep your distance from people who cough and have a cold (in any case you have to cough and sneeze into the crook of your elbow, ed.); wash your hands often, before eating and touching your mucous membranes, and when you return home; use of the mask in crowded places or if you live with people who have respiratory diseases. They are all systems that serve to prevent all infectious diseases that are transmitted through the air.”
Respiratory syncytial virus, what it is, how to prevent it
«The respiratory syncytial virus, which strikes mainly in winter (unlike mycoplasma which also strikes in summer), had almost disappeared during the Covid-19 pandemic but, as soon as the restriction measures ended, it recorded an increase in spread , greater than in the past – recalls Professor Castelli –. This virus can cause serious damage especially in premature or fragile children – for example, with lung, heart or neurological diseases – and also in the elderly. Antivirals do not work against the syncytial virus and there is not yet a vaccine on the market for children. Therefore, for the most fragile young children, prevention systems must be activated by administering specific monoclonal antibodies in the winter (in hospitals and vaccination centers).”
Syncytial virus infection, symptoms and what to do
In the unfortunate event the respiratory syncytial virus were to infect the child, how is it recognized and what should be done? «The virus affects the lungs and creates an inflammation (edema) of the wall of the mucous membranes of the small bronchi of the lung, the bronchioles, hence the name of the disease “bronchiolitis” – explains Professor Castelli -. As for the clinical manifestations, there is usually no fever, but the child has a cough and, above all, has difficulty breathing (with polypnea, i.e. a greater respiratory frequency) and has intercostal indentations, i.e. he has difficulty expanding the lung to allow let the air in. Respiratory syncytial virus infection, which is diagnosed by the pediatrician, usually does not present particular characteristics of severity; However, if the clinical manifestations worsen, the child is dejected, does not eat, even has cyanotic bluish lips, it is advisable to take him to hospital because intensive therapy may be necessary (especially for fragile children).”
Also in this case it is necessary to adopt, starting from the family, all the necessary precautions to protect the child, especially if fragile, with the recommended prevention measures.
More dangerous co-infections
The expert further underlines: «Co-infections are those that characterize the most serious diseases, therefore precautions against the various infections are important, including influenza and Covid, which if they are associated with another infection (especially if they are affected the lungs), can cause serious clinical manifestations. Furthermore, it should be remembered that many infections such as mycoplasma, the syncytial virus, influenza, Covid itself, can also be acquired asymptomatically, therefore they can be transmitted to children and fragile people. Hence the importance of prevention” concludes the expert.
Risks in Italy? The response of the Istituto Superiore di Sanità
What is the situation in Italy regarding pneumonia? What if a new virus were to emerge? The Istituto Superiore di Sanità tells Corriere Salute: «The surveillance system for respiratory diseases RespiVirNet is fully operational and monitors trends in the country thanks to the network established with the Regions with the support of the Ministry of Health which involves family doctors and paediatricians. In the event of anomalous increases – explains the ISS – it is able to detect them and, if a new virus emerges that needs to be taken into account, the system is able to do so. The trend in this period is an increase in flu-like syndromes, as is normal as the cold season advances.”
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November 23, 2023 (modified November 23, 2023 | 7:14 pm)
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