2023 年底和 2024 年初,维多利亚州的两个主要检测实验室检测到肺炎支原体呼吸道感染病例上升。

IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Medical Journal of Australia Pub Date : 2024-09-06 DOI:10.5694/mja2.52433
Maryza Graham, Thomas Tran, Changxu Zhang, Michelle Sam, Andrew Daley, Kathy Jackson, Chuan Kok Lim
{"title":"2023 年底和 2024 年初,维多利亚州的两个主要检测实验室检测到肺炎支原体呼吸道感染病例上升。","authors":"Maryza Graham,&nbsp;Thomas Tran,&nbsp;Changxu Zhang,&nbsp;Michelle Sam,&nbsp;Andrew Daley,&nbsp;Kathy Jackson,&nbsp;Chuan Kok Lim","doi":"10.5694/mja2.52433","DOIUrl":null,"url":null,"abstract":"<p>In November 2023, the World Health Organization noted that the numbers of outpatient consultations and hospital admissions for children with pneumonia caused by <i>Mycoplasma pneumoniae</i> had increased in China since May 2023.<span><sup>1</sup></span> In Denmark, a surge in <i>M. pneumoniae</i> infections since October 2023 was reported, most in children or adolescents, but the impact on hospital capacity was limited; 446 of 3195 people (14%), primarily adults, required hospitalisation.<span><sup>2</sup></span></p><p>The most frequent manifestation of <i>M. pneumoniae</i> infection in school-aged children, pneumonia, is generally mild. However, people of all ages can require hospitalisation because of severe community-acquired pneumonia (CAP) or extrapulmonary manifestations (including haemolysis and central nervous system disease).<span><sup>3</sup></span> <i>M. pneumoniae</i> is the most frequently detected bacterial pathogen in children hospitalised with CAP.<span><sup>4</sup></span> Infections are most frequent during summer and early autumn, but can develop at any time of year. The cumulative attack rate in families approaches 90%, and immunity is not long lasting.<span><sup>2</sup></span> <i>M. pneumoniae</i> is resistant to β-lactam antibiotics, the mainstay of the empiric treatment of CAP. Recommended treatments for <i>M. pneumoniae</i> include macrolide, tetracycline, and fluoroquinolone antibiotics, the prescribing of which requires clinical suspicion of this infection.</p><p>We reviewed the results of polymerase chain reaction (PCR) testing for <i>M. pneumoniae</i> in the laboratory information systems of the Victorian Infectious Diseases Reference Laboratory (VIDRL; 1 January 2016 – 30 April 2024) and the Royal Children's Hospital (RCH; 1 January 2018 – 31 January 2024). At VIDRL, only samples for which <i>M. pneumoniae</i> testing is specifically requested by the ordering clinician are tested (targeted testing). At RCH, targeted testing was undertaken prior to 2020; from January 2020, a syndromic multiplex PCR panel was used that included <i>M. pneumoniae</i> targets (Respiratory Pathogens 16-well REF 20620; AusDiagnostics), and all samples submitted for respiratory pathogen testing were therefore tested for <i>M. pneumoniae</i> (untargeted testing). Reporting by VIDRL of information on currently circulating pathogens, including outbreak or transmission investigations, is approved by the Office for Research Ethics and Governance of the Royal Melbourne Hospital (QA2022085); the analysis of RCH data for public health surveillance has local governance approval from the hospital legal services and human research ethics committee.</p><p>The <i>M. pneumoniae</i> positivity rate at RCH was 4% (five of 124 samples) in 2018 and 8% (12 of 148 samples) in 2019 (targeted testing). At VIDRL, 5.9% (five of 85 samples) were positive in 2016; during 2016–2022 the positivity rate was 1.3% (15 of 1148 samples; targeted testing). Three of 14 837 RCH and VIDRL samples were PCR-positive during July 2020 – December 2022; during January–October 2023, the positivity rate was 0.2% at RCH (21 of 8873 samples; untargeted testing) and 1.5% at VIDRL (11 of 734 samples; targeted testing). <i>M. pneumoniae</i> positivity rates began to rise in October 2023, reaching their highest levels since 2016: 6.8% at RCH (43 of 627 samples; untargeted testing) in January 2024, and 21.6% at VIDRL (33 of 153 samples; targeted testing) in January 2024 and 19.7% (57 of 289; targeted testing) in April 2024 (Box 1; Supporting Information).</p><p>During August 2023 – January 2024, 80 people were PCR-positive for <i>M. pneumoniae</i> at RCH (Box 2). None required intensive care, and the proportions of positive sample types indicating invasive disease (eg, cerebrospinal fluid, lower respiratory tract samples) did not increase (data not shown). A total of 4251 nasopharyngeal swabs or aspirates, ten throat swabs, 47 sputum samples, 142 bronchoalveolar lavage samples, and 78 miscellaneous sample types were tested at RCH during this period; 695 upper respiratory tract swabs, 146 sputum samples, 23 bronchoalveolar lavage samples, 12 cerebrospinal fluid samples, and 16 miscellaneous sample types were tested at VIDRL.</p><p>In conclusion, we detected a rise in the number of <i>M. pneumoniae</i> infections in Victoria beginning in October 2023. This rise was later than rises reported in other parts of the world, delayed until after the relaxation of COVID-19-related restrictions in Victoria. The higher rates have continued until April 2024, the proportion of positive test results reaching the highest sustained level since 2016. No signals for greater disease severity during the peak were detected. A higher index of suspicion for this pathogen is needed, as specific requesting for <i>M. pneumoniae</i> testing may be required.</p><p>Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.</p><p>No relevant disclosures.</p><p>We had full access to all of the data (including statistical reports and tables) in the study. Individual-level data are not publicly available for sharing.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":null,"pages":null},"PeriodicalIF":6.7000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52433","citationCount":"0","resultStr":"{\"title\":\"A rise in Mycoplasma pneumoniae respiratory infections in Victoria in late 2023 and early 2024 detected at two major testing laboratories\",\"authors\":\"Maryza Graham,&nbsp;Thomas Tran,&nbsp;Changxu Zhang,&nbsp;Michelle Sam,&nbsp;Andrew Daley,&nbsp;Kathy Jackson,&nbsp;Chuan Kok Lim\",\"doi\":\"10.5694/mja2.52433\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>In November 2023, the World Health Organization noted that the numbers of outpatient consultations and hospital admissions for children with pneumonia caused by <i>Mycoplasma pneumoniae</i> had increased in China since May 2023.<span><sup>1</sup></span> In Denmark, a surge in <i>M. pneumoniae</i> infections since October 2023 was reported, most in children or adolescents, but the impact on hospital capacity was limited; 446 of 3195 people (14%), primarily adults, required hospitalisation.<span><sup>2</sup></span></p><p>The most frequent manifestation of <i>M. pneumoniae</i> infection in school-aged children, pneumonia, is generally mild. However, people of all ages can require hospitalisation because of severe community-acquired pneumonia (CAP) or extrapulmonary manifestations (including haemolysis and central nervous system disease).<span><sup>3</sup></span> <i>M. pneumoniae</i> is the most frequently detected bacterial pathogen in children hospitalised with CAP.<span><sup>4</sup></span> Infections are most frequent during summer and early autumn, but can develop at any time of year. The cumulative attack rate in families approaches 90%, and immunity is not long lasting.<span><sup>2</sup></span> <i>M. pneumoniae</i> is resistant to β-lactam antibiotics, the mainstay of the empiric treatment of CAP. Recommended treatments for <i>M. pneumoniae</i> include macrolide, tetracycline, and fluoroquinolone antibiotics, the prescribing of which requires clinical suspicion of this infection.</p><p>We reviewed the results of polymerase chain reaction (PCR) testing for <i>M. pneumoniae</i> in the laboratory information systems of the Victorian Infectious Diseases Reference Laboratory (VIDRL; 1 January 2016 – 30 April 2024) and the Royal Children's Hospital (RCH; 1 January 2018 – 31 January 2024). At VIDRL, only samples for which <i>M. pneumoniae</i> testing is specifically requested by the ordering clinician are tested (targeted testing). At RCH, targeted testing was undertaken prior to 2020; from January 2020, a syndromic multiplex PCR panel was used that included <i>M. pneumoniae</i> targets (Respiratory Pathogens 16-well REF 20620; AusDiagnostics), and all samples submitted for respiratory pathogen testing were therefore tested for <i>M. pneumoniae</i> (untargeted testing). Reporting by VIDRL of information on currently circulating pathogens, including outbreak or transmission investigations, is approved by the Office for Research Ethics and Governance of the Royal Melbourne Hospital (QA2022085); the analysis of RCH data for public health surveillance has local governance approval from the hospital legal services and human research ethics committee.</p><p>The <i>M. pneumoniae</i> positivity rate at RCH was 4% (five of 124 samples) in 2018 and 8% (12 of 148 samples) in 2019 (targeted testing). At VIDRL, 5.9% (five of 85 samples) were positive in 2016; during 2016–2022 the positivity rate was 1.3% (15 of 1148 samples; targeted testing). Three of 14 837 RCH and VIDRL samples were PCR-positive during July 2020 – December 2022; during January–October 2023, the positivity rate was 0.2% at RCH (21 of 8873 samples; untargeted testing) and 1.5% at VIDRL (11 of 734 samples; targeted testing). <i>M. pneumoniae</i> positivity rates began to rise in October 2023, reaching their highest levels since 2016: 6.8% at RCH (43 of 627 samples; untargeted testing) in January 2024, and 21.6% at VIDRL (33 of 153 samples; targeted testing) in January 2024 and 19.7% (57 of 289; targeted testing) in April 2024 (Box 1; Supporting Information).</p><p>During August 2023 – January 2024, 80 people were PCR-positive for <i>M. pneumoniae</i> at RCH (Box 2). None required intensive care, and the proportions of positive sample types indicating invasive disease (eg, cerebrospinal fluid, lower respiratory tract samples) did not increase (data not shown). A total of 4251 nasopharyngeal swabs or aspirates, ten throat swabs, 47 sputum samples, 142 bronchoalveolar lavage samples, and 78 miscellaneous sample types were tested at RCH during this period; 695 upper respiratory tract swabs, 146 sputum samples, 23 bronchoalveolar lavage samples, 12 cerebrospinal fluid samples, and 16 miscellaneous sample types were tested at VIDRL.</p><p>In conclusion, we detected a rise in the number of <i>M. pneumoniae</i> infections in Victoria beginning in October 2023. This rise was later than rises reported in other parts of the world, delayed until after the relaxation of COVID-19-related restrictions in Victoria. The higher rates have continued until April 2024, the proportion of positive test results reaching the highest sustained level since 2016. No signals for greater disease severity during the peak were detected. A higher index of suspicion for this pathogen is needed, as specific requesting for <i>M. pneumoniae</i> testing may be required.</p><p>Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.</p><p>No relevant disclosures.</p><p>We had full access to all of the data (including statistical reports and tables) in the study. Individual-level data are not publicly available for sharing.</p>\",\"PeriodicalId\":18214,\"journal\":{\"name\":\"Medical Journal of Australia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":6.7000,\"publicationDate\":\"2024-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52433\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medical Journal of Australia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.5694/mja2.52433\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Journal of Australia","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.5694/mja2.52433","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

2023 年 11 月,世界卫生组织(WHO)指出,自 2023 年 5 月以来,中国因肺炎支原体引起的肺炎而就诊和入院的儿童人数有所增加。1 丹麦报告称,自 2023 年 10 月以来,肺炎支原体感染人数激增,其中大部分为儿童或青少年,但对医院收治能力的影响有限;3195 人中有 446 人(14%)需要住院治疗,主要是成年人。2 学龄儿童感染肺炎霉菌后最常见的表现是肺炎,一般病情较轻,但由于严重的社区获得性肺炎(CAP)或肺外表现(包括溶血和中枢神经系统疾病),所有年龄段的人都可能需要住院治疗。2 肺炎 M 型菌对β-内酰胺类抗生素有耐药性,而β-内酰胺类抗生素是 CAP 经验性治疗的主要药物。肺炎双球菌的推荐治疗方法包括大环内酯类、四环素类和氟喹诺酮类抗生素,在开具处方时需要临床怀疑该感染。我们回顾了维多利亚传染病参考实验室(Victorian Infectious Diseases Reference Laboratory,VIDRL;2016 年 1 月 1 日至 2024 年 4 月 30 日)和皇家儿童医院(Royal Children's Hospital,RCH;2018 年 1 月 1 日至 2024 年 1 月 31 日)实验室信息系统中肺炎双球菌的聚合酶链反应(PCR)检测结果。在VIDRL,只有下单的临床医生特别要求进行肺炎链球菌检测的样本才会进行检测(定向检测)。在 RCH,2020 年前进行的是有针对性的检测;从 2020 年 1 月起,使用的是包括肺炎双球菌靶标(Respiratory Pathogens 16-well REF 20620; AusDiagnostics)的综合多重 PCR 面板,因此所有提交进行呼吸道病原体检测的样本都要进行肺炎双球菌检测(非针对性检测)。VIDRL对当前流行病原体信息的报告,包括疫情或传播调查,得到了墨尔本皇家医院研究伦理与治理办公室(QA2022085)的批准;RCH用于公共卫生监测的数据分析得到了医院法律服务和人类研究伦理委员会的地方治理批准。2018年,RCH的肺炎链球菌阳性率为4%(124个样本中的5个),2019年为8%(148个样本中的12个)(定向检测)。在 VIDRL,2016 年的阳性率为 5.9%(85 个样本中的 5 个);2016-2022 年期间的阳性率为 1.3%(1148 个样本中的 15 个;定向检测)。在 2020 年 7 月至 2022 年 12 月期间,仁爱医院和 VIDRL 的 14 837 个样本中有 3 个 PCR 阳性;在 2023 年 1 月至 10 月期间,仁爱医院的阳性率为 0.2%(8873 个样本中的 21 个;非目标检测),VIDRL 的阳性率为 1.5%(734 个样本中的 11 个;目标检测)。肺炎霉菌阳性率从2023年10月开始上升,达到2016年以来的最高水平:2024年1月,瑞金医院的阳性率为6.8%(627份样本中的43份;非目标检测);2024年1月,VIDRL的阳性率为21.6%(153份样本中的33份;目标检测);2024年4月,VIDRL的阳性率为19.7%(289份样本中的57份;目标检测)(方框1;佐证资料)。2023年8月至2024年1月期间,瑞金医院有80人的肺炎链球菌PCR检测呈阳性(方框2)。没有人需要接受重症监护,表明存在侵袭性疾病的阳性样本类型(如脑脊液、下呼吸道样本)的比例没有增加(数据未显示)。在此期间,仁济医院共检测了 4251 份鼻咽拭子或吸出物、10 份喉咙拭子、47 份痰液样本、142 份支气管肺泡灌洗液样本和 78 份其他类型样本;VIDRL 共检测了 695 份上呼吸道拭子、146 份痰液样本、23 份支气管肺泡灌洗液样本、12 份脑脊液样本和 16 份其他类型样本。总之,从 2023 年 10 月开始,我们检测到维多利亚州的肺炎霉菌感染数量有所上升。这种上升比世界其他地区报告的上升要晚,一直延迟到维多利亚州放宽 COVID-19 相关限制之后。较高的感染率一直持续到 2024 年 4 月,检测结果呈阳性的比例达到了 2016 年以来的最高持续水平。在高峰期没有发现疾病严重程度加剧的信号。莫纳什大学通过澳大利亚大学图书馆员理事会(Council of Australian University Librarians)签署了 Wiley - 莫纳什大学协议,作为协议的一部分,莫纳什大学为开放存取出版提供了便利。我们可以完全访问研究中的所有数据(包括统计报告和表格)。个人层面的数据不公开共享。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

摘要图片

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
A rise in Mycoplasma pneumoniae respiratory infections in Victoria in late 2023 and early 2024 detected at two major testing laboratories

In November 2023, the World Health Organization noted that the numbers of outpatient consultations and hospital admissions for children with pneumonia caused by Mycoplasma pneumoniae had increased in China since May 2023.1 In Denmark, a surge in M. pneumoniae infections since October 2023 was reported, most in children or adolescents, but the impact on hospital capacity was limited; 446 of 3195 people (14%), primarily adults, required hospitalisation.2

The most frequent manifestation of M. pneumoniae infection in school-aged children, pneumonia, is generally mild. However, people of all ages can require hospitalisation because of severe community-acquired pneumonia (CAP) or extrapulmonary manifestations (including haemolysis and central nervous system disease).3 M. pneumoniae is the most frequently detected bacterial pathogen in children hospitalised with CAP.4 Infections are most frequent during summer and early autumn, but can develop at any time of year. The cumulative attack rate in families approaches 90%, and immunity is not long lasting.2 M. pneumoniae is resistant to β-lactam antibiotics, the mainstay of the empiric treatment of CAP. Recommended treatments for M. pneumoniae include macrolide, tetracycline, and fluoroquinolone antibiotics, the prescribing of which requires clinical suspicion of this infection.

We reviewed the results of polymerase chain reaction (PCR) testing for M. pneumoniae in the laboratory information systems of the Victorian Infectious Diseases Reference Laboratory (VIDRL; 1 January 2016 – 30 April 2024) and the Royal Children's Hospital (RCH; 1 January 2018 – 31 January 2024). At VIDRL, only samples for which M. pneumoniae testing is specifically requested by the ordering clinician are tested (targeted testing). At RCH, targeted testing was undertaken prior to 2020; from January 2020, a syndromic multiplex PCR panel was used that included M. pneumoniae targets (Respiratory Pathogens 16-well REF 20620; AusDiagnostics), and all samples submitted for respiratory pathogen testing were therefore tested for M. pneumoniae (untargeted testing). Reporting by VIDRL of information on currently circulating pathogens, including outbreak or transmission investigations, is approved by the Office for Research Ethics and Governance of the Royal Melbourne Hospital (QA2022085); the analysis of RCH data for public health surveillance has local governance approval from the hospital legal services and human research ethics committee.

The M. pneumoniae positivity rate at RCH was 4% (five of 124 samples) in 2018 and 8% (12 of 148 samples) in 2019 (targeted testing). At VIDRL, 5.9% (five of 85 samples) were positive in 2016; during 2016–2022 the positivity rate was 1.3% (15 of 1148 samples; targeted testing). Three of 14 837 RCH and VIDRL samples were PCR-positive during July 2020 – December 2022; during January–October 2023, the positivity rate was 0.2% at RCH (21 of 8873 samples; untargeted testing) and 1.5% at VIDRL (11 of 734 samples; targeted testing). M. pneumoniae positivity rates began to rise in October 2023, reaching their highest levels since 2016: 6.8% at RCH (43 of 627 samples; untargeted testing) in January 2024, and 21.6% at VIDRL (33 of 153 samples; targeted testing) in January 2024 and 19.7% (57 of 289; targeted testing) in April 2024 (Box 1; Supporting Information).

During August 2023 – January 2024, 80 people were PCR-positive for M. pneumoniae at RCH (Box 2). None required intensive care, and the proportions of positive sample types indicating invasive disease (eg, cerebrospinal fluid, lower respiratory tract samples) did not increase (data not shown). A total of 4251 nasopharyngeal swabs or aspirates, ten throat swabs, 47 sputum samples, 142 bronchoalveolar lavage samples, and 78 miscellaneous sample types were tested at RCH during this period; 695 upper respiratory tract swabs, 146 sputum samples, 23 bronchoalveolar lavage samples, 12 cerebrospinal fluid samples, and 16 miscellaneous sample types were tested at VIDRL.

In conclusion, we detected a rise in the number of M. pneumoniae infections in Victoria beginning in October 2023. This rise was later than rises reported in other parts of the world, delayed until after the relaxation of COVID-19-related restrictions in Victoria. The higher rates have continued until April 2024, the proportion of positive test results reaching the highest sustained level since 2016. No signals for greater disease severity during the peak were detected. A higher index of suspicion for this pathogen is needed, as specific requesting for M. pneumoniae testing may be required.

Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.

No relevant disclosures.

We had full access to all of the data (including statistical reports and tables) in the study. Individual-level data are not publicly available for sharing.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Medical Journal of Australia
Medical Journal of Australia 医学-医学:内科
CiteScore
9.40
自引率
5.30%
发文量
410
审稿时长
3-8 weeks
期刊介绍: The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.
期刊最新文献
Inequity of access to voluntary assisted dying for New Zealand citizens residing permanently in Australia. Issue Information Issue Information The crux of modern health care challenges Five decades of debate on burnout.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1