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China - Tianjin: Children's Hospital daily outpatient and emergency room surges - wave of respiratory infections - November 20, 2023

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  • China - Tianjin: Children's Hospital daily outpatient and emergency room surges - wave of respiratory infections - November 20, 2023

    Children’s Hospital’s daily outpatient and emergency volume surges! This wave of respiratory infections is at its peak, doctors say this
    Netcom Tianjin2023-11-20 01:53

    From cold dew to frost to the beginning of winter
    The peak of respiratory tract infections is coming
    Compared with previous flu peaks
    Come earlier

    Since October this year
    Mycoplasma pneumoniae infection becomes a hot topic
    "Azithromycin", "Three-piece Medication Set" and "Lung Cleansing"
    Hot words are accompanied by public anxiety
    disseminated in different media

    Found during the interview
    In sharp contrast to the popularity of communication,
    Specialist on Mycoplasma pneumoniae infection
    show calmness
    They analyzed it from a professional perspective
    The ins and outs of this wave of infection peak——

    Outpatient and emergency volume in a single day in the first half of the year
    Breakthrough historical extreme value

    "Since the Spring Festival this year, the number of children with respiratory infections in our hospital has been at a high level. The new coronavirus, influenza virus, respiratory syncytial virus, norovirus, adenovirus, etc. have brought wave after wave of infection peaks, and there are many more It is a mixed infection. Since mid-February, the daily diagnosis and treatment volume of our hospital has been between 9,000 and 10,000 for more than 100 consecutive days. In the first half of the year, the single-day outpatient and emergency volume of the two hospital districts has exceeded the historical extreme, reaching 12,252. Recently , the daily number of outpatient and emergency consultations has once again climbed to 9,500-12,000." Zou Yingxue, director and chief physician of the Department of Comprehensive Internal Medicine (Respiratory Infection) at the Machang Campus of Tianjin Children's Hospital, said: "We do not understand the epidemiology of mycoplasma pneumonia infection in children in society. Data can be used to infer the Mycoplasma pneumoniae infection status from the proportion of Mycoplasma pneumonia in hospitalized patients with pneumonia." Zou Yingxue said: “The proportion of mycoplasma pneumonia among children with pneumonia increased from 2% to 3% at the beginning of the year to 5% to 6% at the end of September, to 10% to 20% in early October, and to 40% in mid-October. 50%, showing a peak prevalence trend. Currently, this proportion has basically remained at this level and has not increased. It can be said that it has reached the peak, but the number of severe cases of mycoplasma pneumonia is still increasing, which is related to the lag in the development of severe disease."    Xu Yongsheng, director and chief physician of the Respiratory Department of Beichen Longyan Campus of Tianjin Children's Hospital, said that Mycoplasma pneumoniae is not an unfamiliar pathogen. Mycoplasma pneumoniae infection is a common respiratory infection. Mycoplasma pneumoniae is one of the important causes of pneumonia in children. There was a high epidemic a few years ago, but the public did not pay much attention to it at that time. Talking about the sudden increase in patients with mycoplasma pneumonia Both Zou Yingxue and Xu Yongsheng believe that It is related to three factors↓ First, Mycoplasma pneumoniae infection is a global disease that can continue to be sporadic or epidemic from time to time, but generally there will be a cyclical pandemic every 3 to 7 years. In layman’s terms, epidemics have “big and small years”. The last time Mycoplasma pneumoniae infection was prevalent was around 2018, and the previous one was in 2012, and this year it has caught up with the epidemic cycle again. Mycoplasma pneumoniae infections are concentrated in the age group of 5 to 40 years old, and children with weak immunity are the main group of people with severe infections.    Second, various pathogens have their active periods within a year, and the same is true for Mycoplasma pneumoniae. The seasonal manifestations of Mycoplasma pneumoniae infection in southern China are not as obvious as those in the north. Mycoplasma pneumoniae infection is most active in autumn and winter in the north. The peak of infection is earlier in the south than in the north.    The transition from autumn to winter is the season of high incidence of various respiratory diseases. At present, Mycoplasma pneumoniae infection is the "main force" in the peak of respiratory tract infections, but it cannot be completely blamed. Influenza, respiratory syncytial virus, adenovirus and other viral infections are also involved. Next, we must be vigilant about secondary bacteria after viral infection. The problem of increasing infection rates.    Third, due to the need for prevention and control of the new coronavirus epidemic, children spend more time at home, which reduces group gatherings and the probability of infectious diseases such as respiratory infections is significantly reduced. However, because the opportunities for exposure to various pathogens are reduced, the antibodies produced by the body also increase. decrease. Children are more likely to become infected after being exposed to various pathogens such as influenza virus, respiratory syncytial virus, adenovirus, and Mycoplasma pneumoniae.

    The busiest year yet!
    Her director number was "instantly killed"
    At 8:15 pm on November 8, the racecourse campus of Tianjin Children’s Hospital was brightly lit. In order to allow more children to seek treatment in a timely manner, Ji Yanhui, the head nurse of the emergency room, not only diagnoses children at the emergency diagnosis office, but also patrols the emergency area every once in a while . To 20,000 to 30,000 steps!”    In Internal Medicine Clinic 109, parents and their children kept walking in and out. The most impressive thing about Liu Li, director of the Department of General Internal Medicine (Immunology) with 23 years of experience, is that she maintains professionalism and quick thinking. Her director number was "instantly killed" by her parents, and young doctors would subconsciously bow politely when communicating with her. Talking about how difficult this year has been, she said without hesitation that this year is undoubtedly the busiest year since she started working in the industry.    Parents who seek medical treatment have read more or less popular medical science articles, but many of them have been "sold" by self-media marketing accounts to make them anxious. In Liu Li's view, the medical knowledge promoted on the Internet is one-sided, and it is easy for parents without professional knowledge background to understand it. Liu Li remembers that she once treated a 5-year-old girl who looked very cute. When her parents took her to the emergency room, she was holding a brown teddy bear in her hand. After she developed symptoms such as coughing, the parents decided to take it for 5 days . of azithromycin. When he was sent to the hospital, the child was gasping for breath and was in a state of severe hypoxia. Treatment was almost delayed because of the parents' blind confidence.    "Pediatric diseases develop and change rapidly, making diagnosis and treatment difficult. In addition, some children have 10 fevers in six months!" Liu Li, who specializes in children's immunity, analyzed that children's immune systems have not yet matured before they are 6 years old. At this stage, the only option is to " "Exercise Questions" allows immune cells to recognize the enemy and have memory, so that they can have the function of fighting. But these young children have been exposed to too many pathogens in the past six months to a year. For example, a child might be infected with Mycoplasma pneumoniae in the first half of the year and suffer from influenza in the second half of the year, but now he is infected with Mycoplasma pneumonia in the first half of the month and suffers from influenza in the second half of the month. If the density of repeated infections is too high, the body's immune system will collapse. Especially after infection with certain pathogens, there will be a temporary decline in immunity. At present, the prevalence of mycoplasma pneumonia is very high, but the proportion of patients who develop severe cases is actually lower than that of other types of pneumonia. Most non-severe children can relieve their condition through oral medications according to the doctor's judgment, but the child's treatment response must be closely observed.    "If the child is picked up and rushed to the hospital as soon as he has a fever, ready for a blood test or chest X-ray, the indicators may not reflect the full picture of the disease at this time. If the child is in good condition, you can first take antipyretics and other symptomatic treatment at home, and observe 24 Hours to 48 hours if the fever persists, seek medical attention promptly." "Azithromycin is not a 'miracle drug', and taking it without following the doctor's advice may cause serious adverse reactions." " In addition to the popular Mycoplasma pneumoniae, there are also Streptococcus pneumoniae and influenza viruses . , adenovirus and other epidemic pathogens, all can cause lung infections in children.” “Help children cure diseases with the least medicine and least pain, and give children the opportunity to fight infections with their own immunity.”… As a pediatrician, In addition to diagnosing and prescribing medicines for children, Liu Li also spends a lot of his energy on educating the parents of children with medical science over and over again, trying his best to alleviate the parents' anxiety, explain the condition, and teach nursing methods... Don’t be too anxious, let alone panic
    "We should pay attention to Mycoplasma pneumoniae infection, but don't be too anxious, let alone panic." This is what experts emphasized many times during the interview. In Zou Yingxue's view, Mycoplasma pneumoniae is a mild, inert pathogen, and the proportion of developing severe cases is much lower than that of influenza virus, respiratory syncytial virus, adenovirus, etc. The vast majority of children have mild symptoms, mainly upper respiratory tract infections . Manifested as colds, bronchitis, etc. Among them, 10%-30% develop lower respiratory tract infections, and only a small part of them develop into severe cases. Zou Yingxue said that some social media, especially medical self-media, pay too much attention to mycoplasma pneumonia, which has contributed to the anxiety of parents of children. Parents' anxiety may affect the treatment of doctors. The physical condition of each child is different. The diagnosis and severity of the disease after infection with Mycoplasma pneumoniae are individual differences, and there is a certain clinical process from infection to recovery. Some parents are very anxious after their children become ill. They either take medication blindly or hope for a speedy recovery. They mistakenly believe that infusion (intravenous injection) will help the child's recovery and request infusion treatment in outpatient or inpatient settings as soon as possible. In fact, over-treatment and under-treatment It also endangers the physical and mental health of children.   She specifically reminded that for upper respiratory tract infections caused by Mycoplasma pneumoniae, including mild pneumonia, oral macrolide drugs are sufficient. Azithromycin is not suitable for intravenous injection in young children. Some hospitals intravenously inject other drugs or oral azithromycin. From the perspective of anti-infection, intravenous injection is sufficient. There is no point anymore. Because children are underweight and many organ functions are not yet fully developed, intravenous injection will increase many unpredictable risks. The principle adhered to by Tianjin Children’s Hospital is “you can take medicine without injections, you can get injections without infusions”. If it is a severe case of mycoplasma pneumonia that requires hospitalization, when intravenous azithromycin is required, strict clinical industry standards must be implemented, and parents will be informed of informed consent. Moreover, the treatment of severe cases is not limited to simple anti-infection, and may also require glucocorticoids. , bronchoscopy and many other treatment methods, which vary from person to person.   Zou Yingxue also reminded parents not to focus only on mycoplasma pneumonia and ignore influenza. In late autumn and early winter every year, influenza will gradually reach its epidemic peak. Analysis of respiratory infection cases admitted to Tianjin Children's Hospital shows that infections caused by influenza have been on the rise, mixed with Mycoplasma pneumoniae infections. The course of influenza progresses faster and causes more severe illness or complications than Mycoplasma pneumoniae. Influenza is not only harmful to the health of children, but also harmful to the elderly and patients with underlying diseases. There is currently no vaccine for Mycoplasma pneumoniae infection, but there is vaccination for influenza. Scientific vaccination of influenza vaccine can prevent 50% of severe cases. Therefore, she hopes that the public will not only focus on mycoplasma pneumonia and ignore influenza prevention.

    What is Mycoplasma pneumoniae

    Mycoplasma pneumoniae is neither a bacterium nor a virus. It is a common clinical pathogenic microorganism with a size between bacteria and viruses. It is a common atypical pathogenic microorganism that causes respiratory tract infections. It can colonize in human respiratory mucosal epithelial cells. Children of all age groups can be infected, most commonly children over 5 years old. Mycoplasma pneumoniae infection mainly affects the respiratory tract and can cause a variety of diseases, including common colds, pharyngitis, Tonsillitis, rhinitis and sinusitis, otitis media, bronchitis, pneumonia, etc. can cause complications inside and outside the lungs. Mycoplasma pneumoniae can survive independently and has no cell wall. Common antibiotics, such as cephalosporins, amoxicillin and other beta-lactam antibiotics, are ineffective against Mycoplasma pneumoniae.

    source: z