A cough that has not settled after a week, or is even getting worse, in a child who keeps going to school and playing... The name "walking pneumonia" comes from exactly this picture: the illness often does not put the child to bed. Behind this diagnosis, which is often heard during the school term, there is usually a bacterium called Mycoplasma pneumoniae. In this article we explain the symptoms of walking pneumonia, how it spreads, how it gets better and when to see a doctor without waiting.

What is walking pneumonia?

According to the US Centers for Disease Control and Prevention (CDC), Mycoplasma pneumoniae is a bacterium that infects the respiratory tract. Its most common form is tracheobronchitis, also called a "chest cold"; less often it causes pneumonia. Because the symptoms are often not severe enough to keep a person at home or in bed, this type of pneumonia is called "walking pneumonia". The CDC states that among children admitted to hospital with pneumonia, Mycoplasma is the most common bacterial cause.

Who gets it more often?

According to the CDC, the infection most commonly affects children, both school-age and younger, but it can occur at any age. People who spend a lot of time together, especially those living in the same home, are at higher risk, and outbreaks are common in crowded places such as schools, residence halls and hospitals. The same person can have a Mycoplasma infection more than once.

What are the symptoms?

The CDC lists the symptoms according to the type of illness:

  • Chest cold (tracheobronchitis): tiredness, fever, headache, sore throat and a slowly worsening cough
  • Pneumonia: cough, tiredness, fever and chills, shortness of breath
  • Children younger than 5: diarrhoea, sneezing, sore throat, a stuffy or runny nose, vomiting, watery eyes and wheezing

Symptoms can start 1 to 4 weeks after exposure and can last several weeks; some people have no symptoms at all. In young children the illness often cannot be told apart from an ordinary common cold. Nemours KidsHealth stresses that walking pneumonia should be considered when "a cold lasts longer than 7 to 10 days", especially if the cough is getting worse.

How does it spread and how can it be prevented?

The bacterium spreads when small droplets produced by coughing and sneezing are breathed in. According to the CDC, the best way to prevent it is to wash hands often; covering the mouth with a tissue or the elbow when coughing or sneezing also reduces spread. There is no vaccine against Mycoplasma, and preventive antibiotics after exposure are generally not recommended.

How is it diagnosed?

According to the CDC, there is no quick test for Mycoplasma like those available for some other respiratory illnesses. The doctor usually decides based on the examination and may request a chest X-ray if pneumonia is suspected. In mild to moderate illness a test is often not needed; when it is, a swab is taken from the nose or throat. We describe the general signs of pneumonia in our article on pneumonia in children.

Treatment and home care

According to the CDC, most mild infections get better without medicine, while pneumonia caused by Mycoplasma is treated with antibiotics. Because this bacterium has no cell wall, some antibiotics that target the cell wall do not work against it. The doctor decides after the examination which medicine is given and for how long (antibiotic use in children).

  • Offer fluids often and let your child rest.
  • Use a fever reducer only as advised by the doctor.
  • Do not start cough syrup or an expectorant without asking the doctor.
  • If an antibiotic has been started, complete the recommended course even if your child feels better.

KidsHealth advises that a child who has started antibiotics should stay at home for a few days until the treatment takes effect and the symptoms improve.

When to see a doctor

  • Fast or laboured breathing, the skin pulling in below the ribs
  • Bluish lips or face
  • Inability to keep fluids down, clearly less urine, unusual drowsiness
  • Sores in the mouth and on the lips together with blisters on the skin (a rare but serious complication listed by the CDC)

Book an appointment: a cough that lasts longer than 7–10 days or is getting worse, a fever lasting more than a few days, wheezing. According to the CDC, Mycoplasma can trigger attacks in children with asthma or cause new asthma symptoms; if wheezing keeps coming back, see our article on asthma in children and consider a paediatric allergy and asthma assessment. For viruses that cause similar symptoms, our articles on HMPV and bronchitis can help. You can book an appointment at Özel Düztepe Yaşam Hospital in Şahinbey, Gaziantep.