The CDC says most people who spend a short time with someone infected with walking pneumonia don’t get sick, but the longer the exposure, the higher the chances are of getting sick.Tijana Martin/The Canadian Press
Walking pneumonia began to re-emerge globally last year after remaining largely subdued during the COVID-19 pandemic, according to the U.S. Centers for Disease Control and Prevention.
Now, doctors say they are seeing an unusual spike in cases of the respiratory tract infection in parts of Canada, particularly in kids. But they urge parents not to worry, as treatment options are available.
“The message is not to panic. It’s just more raising awareness about what’s happening,” said Dr. Allan Grill, chief of family medicine at Markham Stouffville Hospital.
“If you think that your child or your relative might be one of the people that’s coming down with this, this is why you go and see your primary-care provider so we can help you out.”
What is walking pneumonia and how do you get it?
Walking pneumonia, or mycoplasma pneumoniae, is caused by mycoplasma bacteria. In most cases it’s a mild illness that feels like a chest cold, otherwise known as tracheobronchitis, but it can also turn into a lung infection, otherwise known as pneumonia, the CDC says. The mycoplasma bacteria can infect different parts of the body and can damage the respiratory tract lining, including the throat, windpipe and lungs.
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You can get walking pneumonia by breathing in air droplets of an infected person who coughs or sneezes. Most people who spend a short time with someone infected with walking pneumonia don’t get sick, but the longer the exposure, the higher the chances are of getting sick, the CDC says.
What are the symptoms of walking pneumonia?
Symptoms include a sore throat, headache, coughing, fatigue and fever, but a small subset of severe cases can develop into pneumonia and leave patients short of breath, in need of oxygen or with high fevers that won’t break.
While serious complications are rare, the infection could cause or make the following conditions worse, requiring a person to go to the hospital:
- Asthma attacks or new asthma symptoms
- Encephalitis (brain swelling)
- Hemolytic anemia (too few red blood cells delivering oxygen)
- Renal dysfunction (kidney problems)
- Serious pneumonia
- Skin disorders such as Stevens-Johnson syndrome (SJS) or mycoplasma-induced rash and mucositis (MIRM)
Walking pneumonia symptoms can present differently in children under five years old, who may experience:
- Diarrhea
- Sneezing
- Sore throat
- Stuffy or runny nose
- Vomiting
- Watery eyes
- Wheezing
Why is it called walking pneumonia and should you be worried?
Because illness from the infection is usually mild, people seem to be better than one would typically expect of a person with a lung infection, the CDC says, so a person could be well enough to be out rather than staying home and in bed, hence “walking pneumonia.”
Dr. Warren Thirsk, an emergency medicine physician in Edmonton and president of Alberta Medical Association’s emergency medicine section, said “COVID-19 and influenza are guaranteed to be more serious,” while walking pneumonia is a “drop in the ocean” of the respiratory season and that most people can recover at home without intervention.
It’s when a person has a fever for more than five days, has symptoms that have persisted for more than three weeks or needs oxygen that they should seek medical attention, he said.
Who is most vulnerable to infection?
Infectious disease division director Dr. Earl Rubin of Montreal Children’s Hospital said he’s noticed more cases in toddlers, which is younger than the typical school-age and young adult demographic the bacterial infection usually impacts.
“The numbers are increasing and we’re seeing more severe cases where people need to be admitted to hospital and have some complications,” said Dr. Rubin, who has been observing this since late spring and early summer.
Those who are high risk, such as immunocompromised individuals or people recovering from a respiratory infection, are more susceptible to contracting walking pneumonia if exposed.
Outbreaks occur typically in crowded places, such as schools, nursing homes and university residences, and can be prolonged because:
- Walking pneumonia has a long incubation period of one to four weeks
- The bacteria that causes the infection can remain in the respiratory tract for months
- Symptoms, such as coughing, can last for a prolonged period
Why are walking pneumonia cases increasing?
The “unusual” increase could be because of people’s lowered immunity since the pandemic: As there were fewer people who had contracted the illness at that time, more could be now susceptible to it. It’s also highly contagious – infecting one in three people in a household – and has an incubation period that can last a month, along with no vaccine to prevent it, Dr. Rubin said.
In October, the CDC reported it noticed an increase of walking pneumonia cases, particularly among children, in the U.S. around spring. Cases in the country peaked in August and have since remained high.
How is walking pneumonia treated?
Doctors can test for walking pneumonia with a nasal or throat swab, which is then sent to a lab.
Dr. Camille Lemieux, chief of family medicine at Toronto’s University Health Network, said physicians need to be aware of this increase – the first she’s observed in her 30 years of practice – because it requires a different antibiotic than regular pneumonia, and patients won’t get better without it.
“I’ve never seen a distinct uptick like this so quickly and suddenly,” Dr. Lemieux said.
Normally, if a child has a chest X-ray that shows signs of pneumonia, doctors prescribe amoxicillin or a relative of the drug that stops the growth of bacteria causing the infection.
However, mycoplasma is atypical and doesn’t have a cell wall, making that medication ineffective. But another class of antibiotics, such as macrolides, would treat it.
How many cases of walking pneumonia are there in Canada?
Although public-health agencies don’t track walking pneumonia in Canada, health care providers in Ontario, Quebec and British Columbia say they’re seeing more cases.
While there is no formal laboratory-based surveillance for this pathogen, the Canadian Public Health Laboratory Network is on the lookout for unusual activity with mycoplasma, the bacteria that causes walking pneumonia, the Public Health Agency of Canada says.
BC Children’s Hospital said it’s recorded an increase in children with walking pneumonia in the emergency department since August, but that it would take a significant time to compile corresponding data and release numbers.
A couple months earlier, in May and June, McMaster Children’s Hospital started seeing rates of walking pneumonia grow and peak in September after seeing no cases for the past couple years, said Dr. Jeffrey Pernica, an infectious disease specialist at the hospital.
“These may well decrease as winter approaches,” he said.
This unusual increase hasn’t been seen in Alberta at this point in time, said Dr. Thirsk.
With reports from The Canadian Press.