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Microbes & Immunity

LETTER TO EDITOR
The re-emergence of Mycoplasma pneumoniae

in the post-COVID-19 era: Challenges
in diagnosis and treatment in low- and

middle-income countries

Mohamad S. Hakim*
Postgraduate School of Molecular Medicine, Erasmus MC-University Medical Center, Rotterdam,
the Netherlands

Dear Editor,
Mycoplasmas are cell wall-deficient prokaryotes and known as the smallest self-
replicating microorganisms, both in the cellular dimension and genome size. Mycoplasma
(Mycoplasmoides) pneumoniae is a notable human pathogen that is strongly associated
with significant health problems in the society, mainly including lower respiratory
tract infections of (atypical) pneumonia. It is characterized by a slow generation time
in culture (~6 h), a relatively long period of incubation time in the infected patients
(from 1 up to 3 weeks), and a low transmission rate. 1
The coronavirus disease 2019 (COVID-19) pandemic has resulted in considerable
epidemiologic shift of M. pneumoniae. Data from laboratories and national or regional
surveillance systems in Europe, Asia, and the Americas showed that the overall
*Corresponding author:
Mohamad S. Hakim detection rate of M. pneumoniae was 8.61% of all tested samples during the period
(ms.hakim@outlook.com) between April 2017 and March 2020, which preceded the start of the COVID-19
2
Citation: Hakim MS. The pandemic. However, after the implementation of non-pharmaceutical interventions
re-emergence of Mycoplasma (NPIs) due to the COVID-19 pandemic, including social distancing and closure, the
pneumoniae in the post-COVID-19 detection rate decreased significantly to 1.69% during April 2020 to March 2021.
2
era: Challenges in diagnosis and 3
treatment in low- and middle- Continuous surveillance from April 1, 2021, to March 31, 2022, and April 1, 2022, to
4
income countries. Microbes & March 31, 2023, still found very low detection rates of 0.70% and 0.82%, respectively.
Immunity. 2024;1(1):3599. These data demonstrated that during the 1 and 2 year after NPI implementation, the
st
nd
doi: 10.36922/mi.3599
burden of M. pneumoniae was consistently reduced. This phenomenon is in apparent
Received: May 7, 2024 contrast with earlier resurgence of other bacterial pathogens shortly after relaxation
5
Accepted: May 28, 2024 or discontinuation of NPIs, such as Group A Streptococci. Surprisingly, the same
surveillance system reported a resurgence of M. pneumoniae, with the detection rate
Published Online: June 4, 2024
rising significantly to 4.12% between April and September 2023. 6
Copyright: © 2024 Author(s).
This is an Open-Access article This alarming situation worsened, as the World Health Organization reported
distributed under the terms of the an increase in pneumonia cases caused by M. pneumoniae in children in China since
Creative Commons Attribution mid-October 2023, including those requiring hospital admissions. In line with this
7
License, permitting distribution,
and reproduction in any medium, report, a notably increased incidence of M. pneumoniae was also reported from a local
8
provided the original work is hospital in the Netherlands and from national surveillance system in Denmark since
properly cited. October 2023. The increased incidence of M. pneumoniae infections has also been
9
Publisher’s Note: AccScience documented in a French hospital, reporting a surge from 8.5 (2019 – 2022) to 110 cases
Publishing remains neutral with (January – November 2023) per 100,000 hospital admissions. Some severe pneumonia
regard to jurisdictional claims in 10
published maps and institutional cases requiring oxygen support and intensive care unit admission were also reported.
affiliations. In the United States, the positivity rate of M. pneumoniae testing increased during the
Volume 1 Issue 1 (2024) 121 doi: 10.36922/mi.3599