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Walking Pneumonia

Pneumonia Basics


Updated April 10, 2014

A cough is a common symptom that children have when they get sick.

Fortunately, it is more common for the cough to be caused by a viral infection, like a cold or bronchitis, instead of pneumonia, even though many parents do seem to worry that their kids may have pneumonia when they are coughing.

Even when kids do have pneumonia, they often have viral pneumonia or a more mild walking pneumonia, and not more serious bacterial causes of pneumonia.

Walking Pneumonia

Walking pneumonia, a type of atypical pneumonia, is caused by the Mycoplasma pneumoniae bacteria. Although it is usually a milder form of pneumonia than other bacterial forms of pneumonia, the symptoms can be bothersome, can linger for a month or more, and although rare, some cases can be serious and even life-threatening.

Walking pneumonia got its name because even as these children are discovered to have pneumonia, most of their other symptoms, including their fever, have gone away, so they are often 'walking around' with pneumonia.

Walking Pneumonia Symptoms

The first symptoms of walking pneumonia can be similar to a cold or the flu, and usually begin gradually with decreased activity, fever, sore throat, and a headache.

Children then develop a dry cough, which can be worse at night. Unlike the cough from a cold, which you would expect to start getting better after 5 to 7 days, children with walking pneumonia will often cough more as time goes on, even as the fever and other symptoms are going away. Their cough will likely even become productive, may become streaked with blood, and the cough may linger for 3 or 4 weeks.

Other signs and symptoms might include:

  • a skin rash, including erythema multiforme
  • crackles and wheezes in the chest
  • muscle aches
  • diarrhea
  • chest pain
  • chills
  • enlarged lymph glands
  • trouble breathing

Walking Pneumonia Diagnosis

The diagnosis of walking pneumonia is usually made based on the pattern of the child's symptoms, but a chest x-ray can also be helpful, which may show diffuse infiltrates. This finding isn't specific for walking pneumonia though, and just means that your child has pneumonia. It is still the pattern of the symptoms that suggests it is walking pneumonia.

Cultures are sometimes done, but are impractical, because they take a long time to grow, and some people can test positive for weeks or months after an infection.

Other tests that are sometimes done include the cold agglutinin test, complement-fixing (CF) antibody, and Mycoplasma pneumoniae antibody tests, although none is used routinely in children with uncomplicated walking pneumonia.

Walking Pneumonia Treatments

The main treatments for walking pneumonia are supportive, including rest and fluids, and antibiotics, including:
  • erythromycin
  • azithromycin (Zithromax)
  • clarithromycin (Biaxin)
  • tetracyline (only for kids over age 8 though)
Other antibiotics, such as Amoxil and cephalosporins, do not work against walking pneumonia, but they can treat other common causes of bacterial pneumonia, which can make it difficult for pediatricians to choose antibiotics for these children.

Keep in mind that kids with walking pneumonia can still be contagious after they have been treated with an antibiotic, and very often other family members get sick too. Antibiotics do help most when they are started early in the course of the illness.

What You Need To Know

  • Walking pneumonia is more common in school age children, and in fact, it is the most common cause of pneumonia in older children and teens. Infants, toddlers, and preschool age children more commonly have viral pneumonia, like from RSV, although some experts think that Mycoplasma pneumoniae also causes many infections in younger children too.

  • After being exposed to someone with a Mycoplasma pneumoniae infection, it can take 1 to 4 weeks until your child gets sick (the incubation period).
  • In addition to walking pneumonia, Mycoplasma pneumoniae can cause ear infections, sinus infections, bronchitis, croup, and other infections.

  • Epidemics of Mycoplasma pneumoniae are thought to occur every 4 to 7 years.

  • Unlike other infections that are more common during certain times of the year, like RSV, rotavirus, and flu during the winter, kids can get walking pneumonia almost any time of the year.

1Long: Principles and Practice of Pediatric Infectious Diseases, 2nd ed., Copyright © 2003 Churchill Livingstone, An Imprint of Elsevier
2Community-acquired pneumonia. Diagnostic and therapeutic approach. Cunha BA - Med Clin North Am - 01-JAN-2001; 85(1): 43-77
3Emerging role of Mycoplasma pneumoniae and Chlamydia pneumoniae in paediatric respiratory-tract infections. Principi N - Lancet Infect Dis - 01-DEC-2001; 1(5): 334-44
4Infectious triggers of asthma. MacDowell AL - Immunol Allergy Clin North Am - 01-FEB-2005; 25(1): 45-66

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