There has been an increase in pneumonia cases over the past several weeks in our community. Pneumonia is an infection in the air sacs of one or both lungs, causing symptoms such as fever, coughing, difficulty breathing, wheezing, and fatigue. There are several different causes of pneumonia. Viruses account for the majority of pneumonia in children (RSV, influenza, adenovirus, to name a few). There are also bacterial causes, which we often divide into typical bacteria, such as Streptococcus pneumoniae, and atypical bacteria, or “walking pneumonia,” which is typically caused by Mycoplasma pneumoniae. While all of these pathogens can cause very similar symptoms, subtle findings in the patient’s history or exam can help physicians determine the most likely cause and best course of treatment.
What is Atypical Pneumonia?
In the past few months, we’ve seen more atypical pneumonia cases compared to previous years. So what exactly is it? Atypical pneumonia is most commonly caused by a bacterium called Mycoplasma pneumoniae. Mycoplasma is considered atypical because it does not have a cell wall like most bacterial pathogens and does not respond to the same antibiotics as typical bacteria. This distinction is important when your doctor is deciding on a treatment plan.
Mycoplasma pneumoniae causes 10-40% of community-acquired pneumonia in children and young adults. Most people will recover on their own without antibiotics, though it is estimated that about 10-20% of cases require antibiotics to clear the infection. Hospitalizations and serious complications are rare but can occur. This infection can occur throughout the year but is more prevalent in summer and fall.
Who Gets Mycoplasma Pneumonia and How Contagious Is It?
This form of pneumonia most commonly affects school-age children, teenagers, and young adults. It is not as contagious as viral illnesses such as the flu, but outbreaks can still occur in settings where people spend prolonged time in close contact, such as homes, schools, or dorms. The incubation period can be anywhere from 1-4 weeks, so you may not always know where your exposure came from. People are often contagious before their symptoms become more severe and the disease is spread through respiratory droplets from coughing and sneezing. Practicing good hand hygiene and reminding your children to cover their mouth when coughing or sneezing is important way to help protect themselves and prevent the spread of infection.
What are the Symptoms?
Mycoplasma infections often look very similar to other common viral respiratory infections, especially early in the illness. It got the nickname “walking pneumonia” because symptoms tend to be milder, with a gradual onset, and those affected can often continue their regular activities. Symptoms often begin with a headache, sore throat, mild fatigue, and a dry cough. They may also include congestion, stomach pain, nausea, vomiting, diarrhea, decreased appetite, and muscle or joint pain. People often see a doctor when the cough lingers or worsens and may be associated with wheezing, chest tightness, or shortness of breath.
Non-Lung Symptoms and Complications of Mycoplasma
Serious complications from Mycoplasma pneumoniae are rare, but they can occur, such as:
Skin: Mild rash, or more rarely, a serious rash known as Stevens-Johnson Syndrome.
Neurological: Encephalitis, Guillain-Barré Syndrome, ataxia, transverse myelitis.
Gastrointestinal: Splenomegaly, intussusception, pancreatitis, hepatomegaly.
Cardiac: Myocarditis, pericardial effusion.
Hematologic: Hemolysis, which may become severe in patients with underlying conditions such as sickle cell disease.
How Is It Diagnosed?
Most often, the diagnosis is made clinically by your doctor based on the history and physical exam. We consider this diagnosis when someone has a persistent or worsening cough for more than 1-2 weeks. There may be wheezing or “crackles” heard on the lung exam. The patient may be breathing faster than normal or have a mildly lowered oxygen saturation level. A chest X-ray may be performed on a case-by-case basis but is often not required to diagnose or begin treatment. Chest X-rays are also not always useful in differentiating between the causes of pneumonia (viral, typical bacteria, or atypical bacteria), which is another reason they are not typically done initially. Unless the patient appears very ill and needs hospitalization, further lab work is also unlikely to be necessary.
How Do You Treat Mycoplasma?
More mild cases are treated with supportive care rather than antibiotics. Some effective tools include rest, increased fluids, acetaminophen or ibuprofen for pain or fever, honey for cough and sore throat, and nasal saline rinses or sprays for congestion. In cases requiring antibiotics, we typically use a medication called azithromycin. Antibiotics like amoxicillin, penicillin, and cephalosporins are not effective against mycoplasma. In patients with asthma or significant wheezing, breathing treatments with albuterol or similar medications may also be used. Even with appropriate treatment, the cough can take several weeks to fully resolve.
When to Call the Doctor?
If you are concerned about your child’s symptoms, it is always a good idea to schedule an appointment with the pediatrician. Coughs can be caused by many things, and the treatment of each can be very different, so it is important to discuss the details with your doctor and have a thorough exam. Medical illnesses can evolve and change over time, and your pediatrician can help guide you through the different stages and escalate care when appropriate. If your child is experiencing acute respiratory distress, they should be evaluated in the Emergency Room.
Conclusion
While mycoplasma pneumonia is generally less severe than some other types of pneumonia, it’s still important to watch for symptoms and seek treatment when necessary—especially as we’re seeing more cases in the community. Please don’t hesitate to reach out to your pediatrician with any concerns.
Every person is unique, and while there are basic strategies to follow, it is essential to involve your doctor in developing a treatment plan that is individualized for your child and family.
-Dr. Christina Piron
Board Certified Pediatrician
MamaDoc NJ
