White Lung Syndrome outbreak in Ohio

Warren County, Ohio, has seen a spike in hospitalizations after children reported suffering from a mysterious form of pneumonia known as “white lung syndrome” since August. Warren County health officials say there have been 142 cases of the disease in children.

Officials said Wednesday, “This is not only above the statewide average, but also meets the Ohio Department of Health’s definition of an outbreak.” Meanwhile, doctors in western Massachusetts are seeing “a lot” of walking pneumonia, a milder form of lung disease caused by a mix of bacterial and viral infections. The average age of the affected children is eight, the youngest of whom is three years old.

Health officials reported that the most common symptoms associated with an outbreak of “white lung syndrome” are cough, fever and fatigue. Officials said no outbreak is caused by a new pathogen and that not all cases of pneumonia are caused by the same infection. Experts say a mix of several seasonal bacterial and viral diseases is about to break out, putting more pressure on hospitals.

What is White Lung Syndrome ?

White lung syndrome is a severe form of pneumonia that can cause scarring and discoloration of the lungs. The exact cause of the disease is still unknown, but it is believed to be caused by a combination of bacteria, viruses and environmental factors.

This disease mainly affects children from 3 to 8 years old. The disease is spread by coughing, sneezing, talking, singing and breathing, and is transmitted by small respiratory droplets. White lung syndrome is on the rise in children in Ohio and Massachusetts in the United States. It is the same strain of pneumonia that caused an outbreak in China, causing hospitals and medical facilities to overflow.

Image: The Economic Times

‘White lung syndrome’ outbreak

Before the United States, the Netherlands and Denmark also reported mysterious spikes in pneumonia cases, many of which are partly caused by mycoplasma. Last week, 80 out of 100,000 children between the ages of 5 and 15 were treated for pneumonia, according to the Netherlands Institute for Health Services Research (NIVEL). Similarly, cases among those years and younger increased, jumping from 124 to 145 per 100,000.

Danish health chiefs also noted that cases of pneumonia had reached “epidemic” levels. Denmark’s Statens Serum Institut (SSI) revealed that the number had tripled in the last five weeks and warned that more children will be killed this winter. More than 100 cases were also reported in Sweden, Switzerland and Singapore between April and September, according to a study published in The Lancet Microbe last week. China’s neighbouring countries, such as Taiwan, Nepal and India, have also warned of cases of pneumonia and authorities have stepped up vigilance.

White lung syndrome
Image: CNN News18

Treatment and Drug Resistance

Most Mycoplasma pneumoniae infections resolve on their own; however, doctors routinely treat pneumonia caused by M. pneumoniae with antibiotics. All mycoplasmas lack a cell wall and are therefore naturally resistant to beta-lactam antibiotics such as penicillin. Doctors treat the disease with macrolides, tetracyclines or fluoroquinolone antibiotics, taking into account the age of the patient and local antibiotic resistance patterns.

  • Macrolides (e.g., azithromycin): Children and adults
  • Tetracyclines (e.g., doxycycline): Older children and adults
  • Fluoroquinolones: Adults

 Doctors should not normally prescribe tetracyclines and fluoroquinolones for young children. Macrolides are generally considered first-line therapy. However, physicians should use macrolide drugs with caution because macrolide-resistant strains of M. pneumoniae have emerged.

Source CDC (https://www.cdc.gov/pneumonia/atypical/mycoplasma/hcp/antibiotic-treatment-resistance.html)

Since the 21st century, M. pneumoniae has developed resistance to macrolides. This problem is of particular concern in Asia, where resistance has been up to 90%. Macrolide resistance has also been reported in the United States and Europe. Current data indicate that the prevalence of macrolide resistance in M. pneumoniae in the United States, with a regional variation of approximately 10%. 

Studies have shown that patients with infections caused by macrolide-resistant strains may have a fever and cough longer than patients infected with macrolide-susceptible strains. Professionals need to learn more about the extent of macrolide resistance and its clinical implications for prescribing decisions.

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