Government says no Mycoplasma pneumonia cases detected so far, amid global concerns over resurgence

The central government affirmed on Thursday that no cases of Mycoplasma pneumonia were found in 611 samples recently examined at the All India Institute of Medical Sciences (AIIMS) Delhi. 

Addressing recent concerns, the government clarified that seven cases identified during an ongoing study at AIIMS Delhi, spanning the April to September period, hold no connection to the recent increase in respiratory infections observed among children in various parts of the world, including China.  

The thorough examination at the Department of Microbiology, the government said, was part of the Indian Council of Medical Research's (ICMR) comprehensive surveillance initiative targeting multiple respiratory pathogens. The surveillance primarily concentrated on severe acute respiratory illness (SARI), encompassing approximately 95% of the cases, utilising advanced real-time PCR technology, the union health ministry said in a statement. 

These cases, identified within the study's framework, pose no cause for worry and have been deemed unrelated to the global trend, said the Union Health Ministry in a statement. Terming Mycoplasma pneumonia as “the commonest bacterial cause of community-acquired pneumonia," the government said, it typically contributes to around 15–30% of such infections. “There has been no reported surge in Mycoplasma pneumonia cases from any region in India,” the government statement said. 

The Union Health Ministry further said that it has taken proactive measures, closely collaborating with state health authorities and maintaining a vigilant daily watch on the situation.  

“There's been a recent surge in interest surrounding Mycoplasma pneumonia, particularly in light of reported cases of childhood pneumonia in China. While India has an ongoing project meticulously analysing acute and severe respiratory illnesses, there has been no significant rise in Mycoplasma pneumonia cases in recent months. The cases currently observed are likely typical occurrences,” said Dr. Poonam Sidana, Director of Neonatology & Paediatrics at the CK Birla Hospital, Delhi. 

Typically referred to as "walking pneumonia," Mycoplasma pneumonia most commonly affects children over five years old. While symptoms are generally mild, the characteristic lingering cough can be frustratingly persistent and unresponsive to treatment. Children under five may experience flu-like symptoms, including malaise and a general feeling of exhaustion. 

”The government is actively monitoring the situation, and all paediatricians and physicians have been instructed to be vigilant regarding any unusual cases. As always, practicing good hand hygiene, following proper coughing and sneezing etiquette, and avoiding crowded places are essential preventive measures,” she said. 

“There is currently no vaccination available for Mycoplasma pneumonia. However, the basic hand hygiene and protective practices we've learned during the COVID-19 pandemic remain our most effective defence,” she added.

Why the global concern?

Government’s response comes at a time when a recent Lancet paper highlighted the re-emergence of Mycoplasma pneumonia in Europe and Asia more than three years after the introduction of COVID-19 pandemic restrictions.  

The study, part of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC), and the ESGMAC Mycoplasma pneumoniae Surveillance (MAPS) study, revealed a sustained low incidence of M pneumoniae from April 2022 to March 2023. However, a notable increase in case numbers was observed in some countries in the last months of the third year (January to March 2023), prompting increased vigilance.  

Mycoplasma pneumoniae is notorious for causing atypical pneumonia and is distinct in its characteristics, including a small genome and lack of a cell wall, according to the doctors. The study pointed out that after the implementation of non-pharmaceutical interventions (NPIs) to combat COVID-19 in March 2020, Mycoplasma pneumoniae cases globally witnessed a marked decline. This decline persisted through the first and second years after NPIs, with a significant reduction in incidence compared to pre-pandemic levels. 

However, in the third year, the Lancet paper said, some countries reported a gradual increase in Mycoplasma pneumoniae cases during the months of January to March 2023, more than three years after the introduction of pandemic restrictions. This atypical re-emergence has become a subject of intense scrutiny, as it defies conventional expectations, it said. 

The ESGMAC MAPS study, initiated in April 2022, involved 45 sites across 24 countries in Europe, Asia, the Americas, and Oceania. The study revealed a sustained, very low incidence of Mycoplasma pneumoniae in the third year (April 2022–March 2023), but a subsequent increase in some regions during the last months of the same year. 

Researchers said that they are exploring potential factors for this delayed resurgence, considering the unique characteristics of Mycoplasma pneumoniae, such as its slow generation time and relatively low transmission rate. The study further highlighted that this phenomenon is unprecedented and appears to be exclusive to this particular pathogen. 

The study emphasised the importance of ongoing monitoring to assess whether the re-emergence will escalate to epidemic levels. The unpredictable nature of the progression and severity of the re-emergence underscores the need for global prospective surveillance to provide timely alerts for clinicians. 

India scenario 

Indian healthcare experts have said that Mycoplasma pneumoniae infections are an underreported health problem. A study published in the American Society for Microbiology in July 2022, conducted at AIIMS New Delhi, studied these infections among hospitalised patients with acute respiratory tract infections (ARI) in India.  

The study, led by Dr. K. Sreenath and Dr. Randeep Guleria, former director of AIIMS, aimed to identify the prevalence of Mycoplasma pneumoniae in a large set of patients and assess the demographic, clinical, and laboratory characteristics associated with Mycoplasma pneumoniae infections. 

The study, conducted between 2015 and 2020, revealed that 5% of the 1,098 tested samples were positive for Mycoplasma pneumoniae by PCR, indicating a relatively low prevalence. However, the impact on patients, especially those with underlying conditions, was notable. School-aged children and young adults represented a significant portion of Mycoplasma pneumoniae-positive cases, accounting for 36%. Additionally, 47.3% of the cases were registered during the summer and monsoon seasons. 

Among the Mycoplasma pneumoniae-positive patients, 61.8% had underlying conditions, with malignancy (21.8%) and hypertension (10.9%) being the most common. Fever (98.2%) and pharyngitis (27.3%) were significantly more common in the Mycoplasma Pneumoniae-positive group compared to the Mycoplasma Pneumoniae-negative group. 

Among the Mycoplasma pneumoniae-positive group, 20% were admitted to an intensive care unit, and 12.7% received ventilatory support. The mortality rate in the Mycoplasma pneumoniae-positive cohort was 13.3%, emphasising the potential severity of Mycoplasma pneumoniae infections. 

The findings of this study suggested the need for increased awareness among clinicians regarding Mycoplasma pneumoniae as a significant respiratory pathogen in India. The researchers emphasise the importance of large-scale studies to avoid the underdiagnosis of Mycoplasma pneumoniae infections and address research gaps, including macrolide resistance and molecular typing. 

The application of timely and accurate diagnostic tools, as suggested by the study, could play a crucial role in improving patient management decisions and outcomes. Furthermore, understanding the prevalence of macrolide resistance and genotypic variations of Mycoplasma pneumoniae in the Indian population is identified as a key area for future research.