During the fall and winter months, a cough or runny nose could mean any number of things—a cold, the flu, COVID-19, RSV, fall allergies.
Now, you might add so-called “walking pneumonia” to your list of concerns.
In October, the Centers for Disease Control and Prevention (CDC) issued an alert that cases of walking pneumonia, an atypical pneumonia caused by the bacteria Mycoplasma pneumoniae, are on the rise. The increase is happening in people of all ages, but the CDC considers the rates of walking pneumonia in children 2 to 4 years old to be notable, as this age group isn’t typically affected.
We asked UNC Health family medicine physician Sarah Ruff, MD, about what to watch for in the coming months.
What is walking pneumonia, and why are cases on the rise?
Pneumonia is a lung infection that can be caused by bacteria, viruses or fungi, resulting in inflammation in the lungs or a buildup of fluid or pus in the lungs. Sometimes, pneumonia follows another illness, such as a cold, RSV, flu, strep throat or an ear infection.
Symptoms include fever, cough, congestion, fatigue, body aches and headache.
Pneumonia can be severe enough to require hospitalization. Walking pneumonia has the same symptoms, but for most, it doesn’t have the same severity.
“With walking pneumonia, people are usually less sick,” Dr. Ruff says. “They’re able to be up and walking around, and not in the hospital. It can feel like a cold that doesn’t get better.”
As with other respiratory infections, some groups are at increased risk of more severe disease or outcomes, including babies younger than 2 and adults 65 and older; people who are immunocompromised due to treatment for cancer, HIV or autoimmune conditions; and people with lung issues.
The CDC estimates that there are about 2 million infections each year in the United States, though cases aren’t tracked, and many people may think they have just a cold. Mycoplasma pneumoniae spreads through airborne respiratory droplets, such as those produced through coughing, sneezing and speaking, which is why child care centers and schools can be hot spots for transmission.
It’s not yet clear why cases of walking pneumonia are on the rise, though there are theories: According to the CDC, cases of walking pneumonia had been low since the start of the COVID-19 pandemic, so the current rise may be due to many children being exposed to this type of bacteria for the first time, instead of years ago during lockdowns.
The increase could also be thanks to more widespread and precise testing that allows providers to see the presence of Mycoplasma pneumoniae.
How is walking pneumonia diagnosed?
The symptoms of walking pneumonia resemble many other respiratory infections, so unless you have a known exposure to Mycoplasma pneumoniae, your primary care provider may rule out other concerns first.
“The typical respiratory nasal swab in urgent care or a doctor’s office is going to test for flu, COVID-19 and RSV,” Dr. Ruff says. “If you have symptoms that don’t get better, your provider might do a second swab that tests for 19 respiratory issues, including Mycoplasma pneumoniae.”
Walking pneumonia can sometimes be diagnosed with a chest X-ray.
“With traditional pneumonia, there’s a big infiltrate, or a bacterial chunk, that you can see on an X-ray,” Dr. Ruff says. “Walking pneumonia is an atypical pneumonia because you don’t see that infiltrate. You might see something that’s hazier or nonspecific.”
Dr. Ruff says that the presence of a fever may also be a clue to your provider.
“Colds don’t typically have fevers, but people with Mycoplasma pneumoniae infections do,” she says. “If it’s not COVID-19 or flu, but there is a fever, and you’ve had other symptoms for a length of time, your doctor may treat based on clinical suspicion.”
If your symptoms are mild, it’s not necessary to see a provider, but Dr. Ruff says to call your doctor if symptoms persist or worsen.
“Talk to your doctor if you’ve had symptoms for longer than 14 days, if your symptoms seem to get better and then get worse, or if you have any difficulty breathing,” she says. “If your child has a fever for longer than five days, they should be seen.”
What’s the treatment for walking pneumonia?
Walking pneumonia can clear up on its own in about seven to 10 days without treatment. If symptoms persist, your provider might prescribe antibiotics. Most commonly, a five-day course of azithromycin, also known as a Z-Pak, is used.
Even with treatment, Dr. Ruff says to plan on plenty of rest.
“I always tell people, it will take a while to feel better if you’re diagnosed with any pneumonia,” she says. “Even once symptoms like fever and cough are gone, it’s common to have low energy or feel really tired. You’ve had an infection in your lungs, so it can take up to a month to feel better. Be patient.”
Is there anything I can do to reduce my risk of walking pneumonia?
There are several steps you can take to keep yourself healthy against respiratory diseases, including those that can develop into pneumonia. Start by getting a flu shot and a COVID-19 vaccine. It’s recommended that you get an RSV vaccine if you’re pregnant, older than 75 or older than 60 and at increased risk of severe disease. An RSV antibody is recommended for all babies younger than 8 months whose mothers were not vaccinated during pregnancy.
In October, the CDC also recommended that people 50 and older get a vaccine against pneumonia (the previous recommendation was for adults 65 and older, in addition to children younger than 5 and people at risk for severe disease). Dr. Ruff says it’s important to note that while this vaccine will protect against traditional pneumonia, it does not protect against infections caused by Mycoplasma pneumoniae. This is currently no vaccine for Mycoplasma pneumoniae.
As with all respiratory infections, frequent hand-washing is important to reducing the spread of disease.
Otherwise, “stay home and wear a mask when you’re sick,” Dr. Ruff says. “Be alert to your symptoms and call your doctor if you don’t get better.”
Questions about respiratory symptoms? Talk to your doctor. Need a doctor? Find one near you.