As schools have reopened and colder weather has begun, respiratory infections in school-aged children are becoming more common. However, a recent trend is emerging in pediatric care: cases of "walking pneumonia" are on the rise.
Bacterial infections caused by Mycoplasma pneumoniae can occur at any age but are most often diagnosed in children aged 5-17. Currently, cases are surging for all ages, but most notably among toddlers and preschoolers ages 2-4, causing concern for parents and healthcare providers alike. This noteworthy increase draws expert's attention as, historically, Mycoplasma pneumoniae has not been the typical cause of pneumonia in this age group.
"Mycoplasma pneumoniae is an atypical bacterial infection that can cause pneumonia, but it is also known for causing upper respiratory or even skin infections," said Dr. Alyssa King, CEUfast Nurse Planner & Author, who is a board-certified primary care pediatric nurse practitioner (PNP). "It is important to know that anyone can get infected, but the pediatric world most commonly sees this in children aged 5 to 17."
With symptoms that mimic a cold, like a persistent cough and mild fever, "walking pneumonia" can go unnoticed, yet it's spreading rapidly in schools and daycare centers, creating a heightened need for awareness and early detection. The Centers for Disease Control and Prevention (CDC) has issued warnings about the increased number of infections, urging clinicians to remain vigilant and prepared as cases spread.
What Is "Walking Pneumonia" & Why Are Cases Rising?
"Walking pneumonia," often used interchangeably with Mycoplasma pneumoniae (a commonly known bacterial culprit of pneumonia), atypical pneumonia, or even as a type of Community-Acquired Pneumonia (CAP), generally presents with milder symptoms than traditional bacterial types of pneumonia, making it challenging to identify.
"Pneumonia is most often a secondary infection. This illness typically starts as a viral infection that then a couple of days later can lead to pneumonia," Dr. King said.
The phrase "walking pneumonia" originated from comparing two patients with pneumonia, one with a severe case and one with a milder one. With more mild symptoms, patients generally do not feel as sick and are more often still going about their everyday lives, attending school and work. Therefore, the patient who can walk around and go about their lives with their mild case of pneumonia was said to have "walking pneumonia."
Children with "walking pneumonia" may have a persistent cough, fatigue, headache, sore throat, and mild fever symptoms that can easily be mistaken for a cold or seasonal allergies. As mentioned above, because the illness is less severe, many children continue their daily routines, attending daycare or school and unknowingly spreading the infection.
This year, however, an unusual spike in cases has captured national attention, particularly among children under five, a group not typically affected by this illness. According to the CDC, hospitals across the country are reporting more cases of young children than usual, raising questions about the causes of this surge.
Mycoplasma pneumoniae spreads through respiratory droplets, making close-contact environments such as schools and daycare centers ideal places for the infection to spread from one child to another. Even if symptoms are mild, children can unknowingly transmit the illness to others by coughing, sneezing, or just being in the same space.
Although symptoms may be mild, according to the Cleveland Clinic, the close-contact environments of schools increase the potential for transmission. This trend, combined with the onset of flu season, creates a perfect storm for respiratory illnesses to circulate, making vigilance and awareness essential for parents and caregivers.
Symptoms of "Walking Pneumonia"
Children infected with Mycoplasma pneumoniae may exhibit symptoms that often start subtly and become more pronounced over time. According to the CDC, this respiratory infection can resemble a mild cold initially, making it challenging to recognize in its early stages. Symptoms typically include:
- Persistent Cough: Often dry and prolonged, this is the most common symptom and can last for weeks.
- Low-Grade Fever: Children may experience a mild fever that can persist or occasionally spike, but it's generally lower than other pneumonia types.
- Fatigue and Weakness: An ongoing sense of tiredness and low energy, which can be unusual for typically active children.
- Sore Throat and Nasal Congestion: These symptoms may mimic common colds, leading to misidentification.
- Chest Discomfort: Some children might report mild chest pain or discomfort, especially when coughing.
Recognizing these signs early can help parents seek appropriate care and prevent further transmission. Younger children might exhibit slightly different symptoms, including vomiting, diarrhea, and wheezing.
While most cases of "walking pneumonia" in children are mild and can be managed at home with rest and fluids, some may require medical evaluation. Health experts advise consulting a healthcare provider if symptoms persist beyond a few days, if a cough worsens or becomes painful, or if a child starts experiencing difficulty breathing. Rapid breathing or wheezing could indicate that the infection is spreading to the lower respiratory tract, where complications can arise.
"If the child is experiencing shortness of breath or difficulty breathing, has decreased urine output, or seems to be demonstrating a change in their level of consciousness, please seek care in the emergency room as soon as possible," Dr. King said.
Recommendations for Healthcare Professionals
With "walking pneumonia" cases rising, healthcare professionals should be vigilant, especially if they work in pediatric care settings. Early recognition of symptoms, according to the CDC, such as persistent cough, low-grade fever, and fatigue, is crucial for timely diagnosis and management. Testing for Mycoplasma pneumoniae should be considered when children present with these symptoms, particularly in regions where cases are increasing.
Testing can be performed in outpatient settings, pediatric offices, or emergency departments to diagnose Mycoplasma pneumoniae. Diagnostic tests most commonly consist of a nasal or throat swab as part of a respiratory panel that also tests for other bacteria and viruses, such as flu, respiratory syncytial virus (RSV), COVID-19, and Bordetella pertussis. Per the CDC, it is recommended that both the nasopharynx and throat be swabbed to improve the chances of detecting a case of Mycoplasma pneumoniae. For children with a persistent cough for a few weeks or difficulty breathing, a chest X-ray is often indicated. Even though lung sounds are more commonly present as crackling sounds on auscultation, sometimes the lungs might actually sound clear. Therefore, it is possible to identify pneumonia for the first time clinically on the chest X-ray as lung consolidation.
Healthcare providers are advised to educate parents about symptom monitoring, particularly if children attend school or daycare, where transmission risk is high. Most children will recover with only over-the-counter medicines treating discomfort. However, antibiotics might be indicated. Because Mycoplasma pneumoniae is naturally resistant to beta-lactams, including amoxicillin, macrolides are the preferable first-line treatment for Mycoplasma pneumoniae infection. Since antibiotics like azithromycin are effective for treating Mycoplasma pneumoniae, healthcare professionals should consider antibiotic treatment for laboratory-confirmed cases to do their part in minimizing the risk of antibiotic resistance. In cases where patients are not improving on their prescribed macrolide, a second-line consideration of a fluoroquinolone or tetracycline antibiotic is recommended. In these cases, however, make sure to consider the potential adverse effects that these second-line medications potentially might have.
Regarding prevention methods, it is essential to remind families of the importance of washing hands, covering sneezes and coughs, and keeping affected children at home to prevent further spread. In addition, while no vaccine is available to prevent Mycoplasma pneumoniae specifically, children can be vaccinated against the flu and bacterial pneumonia, both of which are made to protect against many different strains of these illnesses.
In addition, the CDC recommends staying informed about local infection rates and coordinating with public health authorities to track and manage outbreaks effectively. By following these guidelines, healthcare providers can help reduce transmission rates and support the health and safety of young patients during this uptick in cases.
As cases of Mycoplasma pneumoniae continue to rise among younger children, awareness and early intervention are crucial to managing the spread of this infection. Understanding the symptoms and taking preventive measures can make a meaningful difference for parents, particularly in group settings like schools and daycare centers where transmission is most common.
Healthcare providers are crucial in educating families, diagnosing cases early, and implementing effective treatment. By staying informed and vigilant, caregivers and medical professionals can work together to mitigate the impact of "walking pneumonia," helping protect our youngest and most vulnerable as they navigate a challenging season for respiratory health.
