Walking Pneumonia Is on the Rise. Here Are the Symptoms to Look Out For

Erica Sloan
·9 min read

Mina De La O/Getty Images

You might know this time of year as cold and flu season, but that’s just the headline—respiratory infections of all sorts often spike in the chilly months. In recent years, surges in COVID-19 and RSV (respiratory syncytial virus) have added to that story. And this year, there’s another plot twist: Infections with a type of bacteria known as Mycoplasma pneumoniae (M. pneumoniae), which can be a common cause of walking pneumonia, have been on the rise.

As its name implies, walking pneumonia is a kind of pneumonia (an infection where the air sacs in the lungs fill with fluid or pus) that is milder than what you’d typically expect—so you’re not bedridden and you’re able to go about your daily tasks, Lauren Pischel, MD, MSc, an infectious disease specialist and instructor at Yale School of Medicine, tells SELF. Whereas the symptoms of a classic case of pneumonia—usually caused by other types of bacteria (like Streptococcus pneumoniae) or a virus—can include fever, shortness of breath, nausea, confusion, and stabbing chest pain so severe that you wind up in the hospital, the “walking” or “atypical” variety of pneumonia presents more like a bad, lingering chest cold.

Though M. pneumoniae is estimated to infect as much as 1% of the US population each year, the CDC issued an alert this fall noting that infections increased in late spring (across all age groups but especially in young children) and have stayed at unusually high levels since. That intel is mainly from emergency room visits and some lab test data, but since doctors aren’t required to report M. pneumoniae and plenty of folks may not seek care for milder symptoms, walking pneumonia may be more prevalent than the numbers show. (Plus, viruses and other bacteria besides M. pneumoniae can trigger the condition, too.)

Walking pneumonia tends to peak every three to seven years, Dr. Pischel says, but the reason for this pattern—and why it’s surging this year, in particular—isn’t totally clear. Doctors have some theories, though. Like other respiratory bugs, walking pneumonia spreads via droplets (the spray that happens when you cough or sneeze). During the COVID pandemic, we avoided a lot of these pathogens by simply distancing from others and wearing masks—but that lack of exposure may have limited our ability to develop some immunity to them, too. Now that we’re spending more time in close quarters again, we may be less prepared to fend off M. pneumoniae and other microbes, Jorge Mercado, MD, a pulmonologist and critical care medicine specialist at NYU Langone Hospital - Brooklyn, tells SELF. It is also possible that the current strain of M. pneumoniae is just more damaging or contagious than other recent ones, Dr. Pischel says.

In any case, it’s worth getting acquainted with the latest respiratory offender making waves so you can steer clear of its wrath. Below, experts share the typical signs of walking pneumonia and how it’s diagnosed, plus what treatment and prevention look like.

What are the symptoms of walking pneumonia?

As noted above, the thing about walking pneumonia that distinguishes it from traditional pneumonia is the relative mildness of the symptoms. But both illnesses exist on a spectrum, Dr. Pischel notes, meaning that cases of walking pneumonia can still range in severity, and different people can respond to similar symptoms in distinct ways.

Generally, the common symptoms of walking pneumonia include:

  • Cough

  • Low-grade fever

  • Sore throat

  • Headache

  • Chest pain

  • Fatigue

As a result, it’s tricky to differentiate it from a cold, the flu, or any other respiratory tract infection, like COVID or RSV. One thing to look out for? A wet or productive cough, where you’re hacking up a lot sputum, Purvi Parikh, MD, MD, FACAAI, FACP, a New York-based allergist and immunologist and a member of the medical advisory council of the Allergy & Asthma Network, tells SELF.

There’s also the duration of these symptoms to consider, Dr. Mercado says. He notes that many of his patients blame a nagging cough or sore throat on allergies—but if it’s not letting up for several days, even after taking an allergy medication or avoiding the allergen, a pathogen like M. pneumoniae could be the culprit. Walking pneumonia symptoms also tend to come on gradually and outlast those of the common cold or flu. (Some, like a cough, can even linger for months.)

In young kids, walking pneumonia can also trigger an array of gastrointestinal woes, like diarrhea, nausea, and vomiting, Dr. Pischel says. And she adds that less commonly, both children and adults can develop a skin rash from the bug, too, that shows up as blisters or target-like lesions (think: concentric circles) as well as swelling of the lips and mouth.

Because none of the above symptoms are specific to just walking pneumonia, it’s important to see a doctor who knows what to look for and can do the appropriate testing if they think it’s necessary.

How is walking pneumonia diagnosed?

There are two main paths toward a walking pneumonia diagnosis: lab testing and a physical exam—and sometimes, just one of these may be sufficient.

The best way to officially confirm walking pneumonia is with a nasal or throat swab and PCR test that detects a microbe’s genetic material (much like a COVID test). In some cases, your provider may run a “multiplex” respiratory panel that tests for a bunch of pathogens, including M. pneumoniae, with a single swab, Dr. Pischel says. But because these tests can be expensive and inaccessible outside of a hospital setting, they may start by ruling out other more common respiratory infections, like COVID, RSV, and influenza. If all those tests turn up negative and they’re still suspicious of walking pneumonia, then they might test you for M. pneumoniae in particular (or send you to a lab that can).

There’s also a blood test that can check for antibodies your body may have made to the bacteria, though it can take some time for your immune system to develop those (so you might not get a positive result in the early stages of an infection). Another option is a sputum culture: You cough into a container, and the test scouts for M. pneumoniae in your phlegm—but these bacteria don't always stick around in the sample. (Because neither of these methods is as accurate as the PCR test, they aren’t used as frequently as they used to be, but may still be cheaper and more accessible in some settings.)

Given the challenges and costs associated with testing—and the fact that mild cases are treated simply with rest (more on that in a minute)—your doc may instead simply assess your symptoms, examine your throat, and listen to your lungs with a stethoscope to check for crackling sounds as you breathe. They might also do an X-ray of your chest to look for signs of inflammation typical with this type of pneumonia, Dr. Pischel says. And depending on the exam findings, they may be able to diagnose you without any lab testing.

What is the treatment for walking pneumonia?

Many people recover from walking pneumonia sans treatment, Dr. Pischel says—though you should expect for it to take longer than if you had a cold or the flu. Cases tend to linger for up to four to six weeks, with that chest-y cough being the thing that sticks around longest. In the meantime, OTC pain relievers, cough suppressants, and fever reducers can help you deal with the symptoms. You’ll also want to rest and drink plenty of fluids to lend your immune system a hand.

In some cases, your doctor may prescribe you an antibiotic to knock out the M. pneumoniae infection (if testing definitively shows you have it), which could help you feel better sooner, Dr. Pischel says. Macrolides like azithromycin (a.k.a. a Z-pack) are the most commonly used option, but if you live in an area known for high rates of antibiotic resistance to macrolides (or microbes that have evolved to thwart this treatment), your doctor may opt for fluoroquinolones like moxifloxacin or levofloxacin, she adds. Though these are all generally well-tolerated drugs, any antibiotic can mess with your GI tract, potentially causing diarrhea, Dr. Parikh says. Azithromycin has also been linked with arrhythmia (an off-kilter heartbeat) and other cardiac issues especially in older people and folks with existing heart conditions, Dr. Mercado says.

It’s important to stay in touch with your doctor if your symptoms get worse or you’re experiencing any new ones, whether you’re taking an antibiotic or not. Though it’s rare, the condition can morph into a more serious form of pneumonia (potentially requiring oxygen support) and cause or worsen asthma, among other complications.

How can I avoid getting walking pneumonia?

The people most at risk are the ones “in intense contact settings,” Dr. Pischel says. Think: anywhere that involves frequently sharing airspace with a bunch of other people, like daycares, schools, and college dorms—which are especially susceptible to outbreaks. That’s because the condition has a long incubation period (the time from when someone gets exposed to when they have symptoms), meaning people can catch it and then pass it around to several others in their vicinity over days or even weeks before feeling sick, Dr. Pischel explains.

While spending a brief time in a crowded area is less likely to result in infection, if you’ll be surrounded by people, you can lower your chances by wearing a mask, Dr. Parikh says. All the things you’ve already heard about preventing the spread of respiratory illness also apply here, Dr. Pischel says: Wash your hands regularly, avoid touching your face, and put some space between you and anyone who’s coughing or otherwise spewing droplets.

Another helpful tactic? Make sure to stay up to date on your vaccines, Dr. Parikh says, including COVID and flu, as well as RSV (if you’re 75 or older, or over 60 and at increased risk) and the pneumococcal vaccine (if you’re 50 or older, or at increased risk), which helps prevent infection with Streptococcus pneumoniae (the bacteria that causes the classic variety of pneumonia along with ear and sinus infections and meningitis, among other things). The reason to be sure you’re fully immunized is to “reduce your chances of everything else [besides walking pneumonia] that you could get,” Dr. Parikh says. Ultimately, the less strain on your immune system, the more prepared you’ll be to fend off walking pneumonia should you cross paths with it.

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Originally Appeared on Self

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