What is Walking Pneumonia?

Walking pneumonia has been on the rise this fall, and it has parents and caregivers everywhere scratching their heads. Walking pneumonia? That's still a thing in the modern age of antibiotics?

According to the CDC, doctors and hospitals have observed an unusual increase in cases of Mycoplasma pneumonia (M. pneumoniae), particularly among young children. M. pneumoniae is a bacterium that likes to settle in the lungs, leading to pneumonia or bronchitis.

The infections caused by M. pneumoniae are usually mild, allowing kids to continue their normal activities (albeit with a fever and a cough), hence the term "walking pneumonia." The uptick in pediatric cases started in the spring and continues through the fall.

The Recent Surge

The CDC and health experts are investigating the reasons behind this unusual surge in Mycoplasma pneumonia cases among young children. Historically, this bacterial pneumonia mostly infected school-age children and teenagers, while viruses are the most significant cause of pneumonia and lower respiratory infections in young children.

However, the rate of lower respiratory bacterial infections in young children has been up this year. According to the CDC, some theories suggest that reduced exposure to common pathogens during the COVID-19 pandemic might have left children more susceptible to infections as social interactions normalized.

Symptoms to Watch For

If you suspect your child has pneumonia or bronchitis, you should take them to the doctor for evaluation and treatment. Some common symptoms include:

A persistent cough that can last for weeks
Fever
Fatigue
Headache
Sore throat
Mild chest pain
Young children may also experience vomiting

As I reviewed this list, I acknowledged to myself how difficult it is for parents to tell the difference between the common cold and pneumonia, which is far more serious. All of these symptoms could suggest the common cold or many other viruses.

Always consult your pediatrician for guidance, but one general rule of thumb is that with walking pneumonia or bronchitis caused by a bacteria such as M. pneumoniae, symptoms will persist and likely gradually worsen. Coughing, trouble breathing, and tightness in the chest may be predominant features. If your child gets progressively worse, it's time to call and set up an appointment!

If any of the above symptoms are severe, or if your child has very fast or difficult breathing, wheezing, discoloration, or severe pain, that is an urgent situation that needs prompt treatment.

How It Spreads

M. pneumoniae spreads through respiratory droplets when an infected person coughs or sneezes. Your child can contract the infection by being in close proximity to someone who has it. This explains why outbreaks often occur in places where people are in close contact, such as schools, daycare centers, and households.

In my neighborhood, many kids go to the same school and daycare. At the bus stop, we have almost daily discussions of "who's got what this week," and a cough with mild fever is almost always on the list! Teaching good hygiene is important, but it won't completely stop those daycare germs.

Diagnosis and Treatment

If you suspect your child might have M. pneumoniae, consult your pediatrician. They can diagnose the infection through:

A physical examination (listening to breath sounds in the lungs)
A nasal swab test (to screen for the bacteria)
A chest X-ray in some cases (to visualize a pneumonia infection)

While mild cases might resolve on their own, with bacterial pneumonia, doctors may need to prescribe antibiotics. Unfortunately, trusty old amoxicillin doesn't work so well for M. pneumoniae, so expect to see an Rx for a macrolide antibiotic (azithromycin, clarithromycin, or erythromycin) to treat the infection. Azithromycin is the preferred choice for treating M. pneumoniae infections.

It's also important to note that other germs, like viruses or different classes of bacteria, can also cause pneumonia. Based on the exam and history, your doctor will be able to make a diagnosis and prescribe the correct medicine or supportive care.

What Should I Know About Azithromycin?

Azithromycin is the preferred drug for treating M. pneumoniae. Adults or older kids usually get a handy Z-Pak, which is an entire course of azithromycin tablets in one convenient card. The patient takes a big (loading) dose on day one and then completes therapy for four more days.

For younger kids, expect a prescription for azithromycin liquid. Like the tablets, the dose (in milliliters) will differ on day 1 than on days 2 through 5 of treatment. Completing the entire course of antibiotics as prescribed is essential, even if your child feels better.

Some quick tips for azithromycin:

Finish the entire course of antibiotics, even if your child starts to feel better
Diarrhea and nausea are the most common side effects
Vomiting and rash can also occur
Shake the bottle well before use
Store at room temperature or as instructed on the package
Use an oral syringe with markings in milliliters (mL) to measure doses
Can be taken with or without food

Rarely, azithromycin can cause serious side effects. If your child experiences severe rash, jaundice, signs of an allergic reaction, severe stomach pain, bloody stools, or anything else that concerns you, reach out to your pediatrician immediately. Azithromycin is usually used in patients aged 6 months and older. Contact your doctor if your infant is prescribed azithromycin and shows signs of irritability or discomfort with feeding.

Preventing Walking Pneumonia

While there's no vaccine for M. pneumoniae, you can take steps to reduce your child's risk of infection:

Encourage good hygiene practices, especially frequent handwashing. Make it a habit to sing a song while handwashing to make it long enough!
Teach your child to cover their mouth and nose when coughing or sneezing.
Keep your child home when they're sick to prevent spreading the infection.
Ensure your home is well-ventilated and clean.

When to Seek Medical Attention

While M. pneumoniae is usually mild, closely monitoring your child's symptoms is important. Seek immediate medical care if your child:

Has difficulty breathing
Shows signs of dehydration
Has a persistent high fever
Experiences chest pain
Has a worsening cough

Conclusion

The increase in M. pneumoniae cases among young children is concerning. Thankfully with proper care and treatment, most children recover just fine!

It can be tricky to tell the difference between a bacterial infection like walking pneumonia caused by M. pneumoniae and a viral respiratory infection, especially as we head into winter. Keep an eye on your child's fever, severity of cough, length of symptoms, and work of breathing, and reach out to your doctor if you suspect it's more than just a cold.

Stay well!

The following references were used to compile this information:

Bradley, J. S., Byington, C. L., Shah, S. S., Alverson, B., Carter, E. R., Harrison, C., Kaplan, S. L., Mace, S. E., McCracken, G. H., Jr, Moore, M. R., St Peter, S. D., Stockwell, J. A., & Swanson, J. T. (2011). The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical Infectious Diseases, 53(7), e25–e76. https://doi.org/10.1093/cid/cir531

CDC. (2024, October 18). Mycoplasma Pneumoniae Infections Have Been Increasing. National Center for Immunization and Respiratory Diseases. https://www.cdc.gov/ncird/whats-new/mycoplasma-pneumoniae-infections-have-been-increasing.html

DailyMed—AZITHROMYCIN- azithromycin monohydrate suspension. (n.d.). Retrieved December 5, 2024, from https://www.dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=071e71b8-bb53-4075-9bda-2ec48affa018#section-2.2

Mycoplasma Pneumoniae Infection & Walking Pneumonia. (2006, January 1). HealthyChildren.Org. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Mycoplasma-pneumoniae-Infections.aspx

This article has been reviewed by Andrea Morrissey, PharmD, Board Certified Pediatric Pharmacy Specialist, and Chief Content Officer of Kids Med Guide. The content is for educational and entertainment purposes only and does not replace professional medical advice. Always consult your healthcare provider for medical guidance, and call 911 in an emergency.

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