China has recently reported an outbreak of an enigmatic influenza-like illness, primarily affecting children. Without any other symptoms, children are presenting with high-grade fever, and additional radiological investigations have shown lung lesions. A few patients were admitted to the hospital for additional care. Such symptoms can be caused by a variety of viruses, including the Covid virus, Adenovirus, influenza virus, enterovirus, rhinovirus, and RSV. It’s important to remember that not all viral infections result in the full range of symptoms that we typically associate with the common flu. Any viral infection often manifests as fever, chills, or both. According to Dr. Tushar Tayal, Consultant in Internal Medicine at CK Birla Hospital in Gurugram, there may be accompanying symptoms such as running nose, cough, SOB, vomiting, and loose motions, but these are not always required.

Pneumonia cases in children have increased recently, especially in some parts of northern China, raising concerns reminiscent of what happened in November and December of 2019. However, a World Health Organization (WHO) report indicates that there is some relief. According to the Chinese government, these cases—which include the influenza virus, respiratory syncytial virus, some COVID cases, and some mycoplasma cases—are linked to known pathogens like bacteria and viruses. It is hoped that this surge is seasonal because pneumonia incidence usually rises during the winter. The Chinese government has determined the causes of these pneumonia cases, according to the WHO report, ruling out the possibility of the presence of any novel viruses or bacteria. As a result, there is no current danger that the situation will spread internationally or make its way to India. Although there is comfort, vigilance is still necessary, According to Dr. Sushila Kataria, holding the position of Senior Director in the Internal Medicine department at Medanta, Gurugram, the following information is presented.

In a press meeting in November 13, delegates for China’s National Health Commission revealed a worrying amount of instances of respiratory diseases in the country, according to the WHO. Respiratory diseases such as influenza, respiratory syncytial virus (RSV), mycoplasma pneumoniae (a common bacterial infection that usually affects younger children), and SARS-CoV-2 (the virus that causes COVID-19) are most likely the cause of these infections. The timing of the lift of lockdown restrictions and the arrival of winter, when these respiratory infections are more common, is thought to be connected to the rise in childhood infections. Clusters of pneumonia cases in children in northern China that go undiagnosed were reported by the media and ProMED, a division of the International Society for Infectious Diseases, on November 21. It is unclear if these cases are related to distinct incidents or the general rise in respiratory infections that Chinese authorities had previously reported. As of mid-October, there has been a rise in influenza-like illnesses in northern China when compared to the preceding three years, according to Dr. Gurmeet Singh Chabbra, Director of Pulmonary at Marengo Asia Hospitals in Faridabad.

What are the symptoms of this mysterious pneumonia?

Mycoplasma pneumonia is a bacterial variant known for triggering lung infections, encompassing RSV (respiratory syncytial virus), Adenovirus, Influenza, Rhinovirus, and COVID. Pneumonia can affect one or both of the lungs and cause fluid or pus to fill the alveoli.” Cough, difficulty breathing, fever additive symptoms (loose stool, vomiting in children), chest X-ray, and other symptoms are used to make the diagnosis. Children from Beijing and Liaoning Province in China have recently shown an increase in influenza-like illness cases. These cases have been dubbed “mysterious pneumonia” because the exact cause of the illness is still unknown. Any of the pre-existing bacteria, viruses, or atypical bacteria, such as Mycoplasma, could be the cause. According to Dr. Dhirendra Pratap Singh, a PICU Consultant at Amrita Hospital in Faridabad, identifies this enigmatic pneumonia as displaying symptoms of high-grade fever and unusual chest X-ray findings, frequently occurring without or with minimal coughing.

The origin of the illness is attributed to mycoplasma pneumonia and the respiratory syncytial virus (RSV). Usually, they are referred to as atypical pneumonia. This kind of pneumonia produces less severe symptoms, such as fever, headache, intense fatigue, sore throat, runny nose, and coughing up little phlegm. For this is why it’s occasionally referred to as “standing the illness.” On the other hand, a case of regular bacterial pneumonia can cause severe illness, including fever, hypotension, and dyspnea. This variation results from the distinct bacteria that cause each of these kinds of pneumonia. According to Dr. Rupkatha Sen, Chief Intensivist at SRV Hospitals in Chembur, “it’s crucial to prevent the quick spread of any infection by keeping hands clean, avoiding public transportation and crowded places if you have symptoms, and getting prompt medical attention for early diagnosis and the right antibiotics for a speedy recovery.”

Fever presents as a symptom of this particular pneumonia; however, notably, there is an absence of both coughing and difficulty in breathing. The fact that this illness differs from common respiratory infections adds to its mystique. The medical authorities are looking into these cases very carefully in an effort to determine which pathogen is to blame and to put in place efficient management plans. As the situation develops, ongoing research and monitoring are crucial to understanding the type of pneumonia and putting in place the necessary public health precautions, according to At the Indraprastha Apollo Hospital, Dr. Rajesh Chawla holds a distinguished position as a senior consultant specializing in pulmonology and critical care.

The reason could a pneumonia epidemic in China lack the traditional signs?

Depending on the child’s age, comorbid conditions, and the source of the infection, not every child will experience all of the symptoms of classical pneumonia, according to Singh.

You can link the current pneumonia epidemic to “immunity financial obligation” after lifting China’s lengthy restrictions throughout the height of respiratory illness, which significantly reduced security to breathing bugs that is typically achieved by exposure. Reports have indicated an increase in Mycoplasma pneumonia, commonly referred to as “walking pneumonia,” in China. While most cases of this illness seem benign, some patients may experience breathing difficulties. Antibiotics called macrolides are used to treat it, but the general public is increasingly becoming resistant to these drugs as a result of needless overuse during cold cough episodes. Until more data is obtained, it is premature to make judgments about whether undiagnosed pneumonia represents a new pandemic or an increase in an already-existing infection, according to Dr. Singh.

After the extended lockdown was lifted, there’s a likelihood that the Chinese populace experienced various respiratory infections due to the relaxation of restrictions. Their immunity to fight off these respiratory infections may have waned from prolonged lack of exposure, even though some infections, such as mycoplasma pneumoniae and antigenically variable corona viruses, do not produce long-lasting immunity. Despite the absence of symptoms such as cough, children are experiencing elevated fever and inflammation of the lungs. According to Dr. Chhabra, the symptoms of these winter-related infections typically include a sore throat, nasal discharge, sneezing, body ache, headache, chills with fever, dry cough, dyspnea, wheezing, confusion, etc.

Despite the fever in the children, the pneumonia shows no signs of a cough or typical respiratory symptoms, prompting curious questions about the nature of the organism causing the illness. Fever is a common symptom of many infections, and different bacteria or viruses may present with different sets of symptoms. This is important to keep in mind. It’s not completely out of the ordinary that the organism causing this pneumonia might not cause a cough. There are many different ways that infections can manifest, and it is not unusual for people to get infections without exhibiting some of the more common symptoms, like coughing. This highlights how crucial it is to take into account a wide variety of clinical presentations when looking into infectious diseases, according to Dr. Chawla.

Preventive measures

Dr. Chhabra suggests that in order to prevent the spread of these diseases, which are contracted through close contact with infected respiratory droplets, precautions should be taken such as avoiding sick people, staying at home when sick, getting tested and medical attention when necessary, wearing masks when necessary, making sure there is adequate ventilation, washing your hands frequently, and getting vaccinated.

Just as precautions are crucial against any contagious ailment, employing masks, practicing frequent hand hygiene, steering clear of social gatherings, and staying home when feeling unwell all play vital roles in curbing the spread of this specific disease. It is advised to ensure medical care, adequate ventilation, and testing for the disease in addition to receiving the recommended vaccination. Another suggestion, according to Dr. Singh, is to avoid using antibiotics without first consulting a pediatrician.

Enforcing crucial directives like minimizing nonessential travel, stressing the importance of personal hygiene, and upholding cleanliness standards in the surroundings constitute preventive steps aimed at curbing the spread of pneumonia across China. In order to reduce the risk of infection, it is crucial to emphasize the importance of frequently washing your hands and maintaining good respiratory hygiene. Notably, these prophylactic actions, such as influenza vaccination, are essential in halting the spread of respiratory infections. Being proactive in implementing these measures is still crucial for protecting public health, even though the situation might not be as severe in India, according to Dr. Chawla.

Should India worry about this mystery pneumonia spread?

Amidst the present pandemic, it’s possible that there will be a surge in influenza instances within our nation. In order to reduce risks, it is therefore advised to give vaccination against influenza top priority and to always cough politely. Despite our current understanding of the situation, vigilance is still essential, according to Dr. Kataria.

It is plausible to infer that an unknown virus or an unconventional bacterial strain might be responsible for the infection observed in Chinese children. Appropriate research will be required to identify the culprit organism so that it can be contained and effective strategies put in place. It is too soon to tell if the current infection will spread to India and if it has the potential to become a pandemic. WHO has already become involved, is investigating the situation, and has requested that the Chinese government do the same. The most crucial thing is to continue using personal protection measures like three-ply masks, frequent hand sanitization, and social distancing, according to Dr. Tayal.

At present, the existing information does not provide enough evidence to suggest that the pneumonia outbreak in northern China could deteriorate and extend its reach to India. Despite the fact that subgroups of the pneumonia have been spreading, we must keep in mind that this is the Northern Hemisphere’s winter. Worldwide, the number of cases has consistently increased during the winter. We need to investigate the cause of the winter cases and determine whether or not there is a real reason for the rise in cases. In winter, it’s common to just report cases of pneumonia or flu. We are genuinely unsure if this is a common pneumonia or an enigmatic case. There is currently no objective evidence, so we need more specific information before we can classify it as one,” says Dr. Rahul Pandit, chair of the critical care department at the Sir HN Reliance Foundation Hospital in Mumbai.

China is facing its initial winter season after the easing of lockdown measures. Pneumonia cases have suddenly increased recently, mostly affecting groups of kids, which has resulted in a notable drop in student attendance. It is premature to make assumptions about potential additional risks of infection spread that could result in a pandemic-like situation at this time, as there is currently no identified novel virus as the cause, according to Dr. Sen.