By Children who have coughs that go on for weeks may have a type of walking pneumonia that’s been surging in the US this year, and they may need a different antibiotic regimen to treat it, infectious disease experts say.
“It’s very much been on our radar since early summer, when we started to see a remarkable increase in the number of kids with pneumonia who seemed to have this particular type of pneumonia,” said Dr. Buddy Creech, a pediatric infectious disease specialist at Vanderbilt University Medical Center. Creech says that on the same day in August, four Nashville-area pediatricians reached out to him to ask why so many kids were coughing in the summertime. These doctors wanted advice, he says, because their go-to antibiotic for pneumonia – amoxicillin – didn’t seem to be working in these cases.
The pneumonia is caused by tiny Mycoplasma pneumoniae bacteria and cases are spiking this year, particularly among preschool-age children, according to the US Centers for Disease Control and Prevention (CDC), which sent a bulletin alerting parents and doctors to the uptick last week.
This Mycoplasma pneumonia surge is the latest entry on a growing list of lung infections keeping doctors on their toes this fall. Pertussis (whooping cough) cases, which also cause a prolonged cough – are five times higher than they were at this time last year, and respiratory syncytial virus (RSV) is also on the rise in parts of the U.S.
More than 7 of emergency room visits with pneumonia in the age group of 2-4 years were diagnosed with the bacteria throughout the last month.
In the past, it’s been difficult to test for Mycoplasma. It’s not a germ that likes to grow in a Petri dish, which is the standard, if slow, way to test for bacterial infections. Now, Creech says, better diagnostic tests are making it easier to detect these bacteria more quickly and reliably. With so many germs making kids cough this fall, it’s crucial that doctors use these new tests to get the right diagnosis, he said.
“This is the exact time where we need to be using these diagnostic tests that can guide treatment,” he said. Awareness of the Mycoplasma trend is important, the CDC says, since first-line antibiotics for kids such as amoxicillin and penicillin don’t kill this type of bacteria. The infection is usually easily treated with other antibiotics, however, such as azithromycin.
According to the CDC, which monitors discharge data from a network of hospitals as well as test results from commercial laboratories, the number of children ages 2 through 4 who were seen in the ERs for pneumonia and who tested positive for Mycoplasma increased from 1% in April 2024 to 7.2% in early October, a sevenfold increase. Diagnoses in older kids doubled over the same time frame, increasing from 3.6% to 7.4%.
The CDC said Mycoplasma cases seem to have peaked in mid-August, but they remain high. Creech said he expects they will continue to be high for another month or so, then should begin to taper off later into the fall.
On an X-rays, Mycoplasma infections can give lungs a cloudy or “white lung” appearance.
Children experiencing prolonged coughs for several weeks might be suffering from a type of walking pneumonia that has seen a notable increase in the United States this year, necessitating a different antibiotic treatment, according to experts in infectious diseases.
Last year, China, Denmark and France all reported increases of this kind of pneumonia in children.
The rise in cases is probably due to at least three factors, said Dr. Geoffrey Weinberg, a pediatric infectious disease specialist at the University of Rochester Medical Center. The first is that rates of Mycoplasma infections are returning to where they were before the Covid-19 pandemic.
“It may seem very dramatic now, but this is largely because, during the peak of the COVID pandemic, nearly every other infection dropped off,” Weinberg explained. “However, the current nationwide rates are quite similar to what we saw before 2019.”
The second reason, he noted, is that many infections have cyclical patterns, with some years being worse than others. Mycoplasma pneumonia tends to surge every 3 to 7 years as immunity wanes, according to Creech.
Walking pneumonia is a mild form of pneumonia that starts off with symptoms of a cold but then lasts longer than a typical cold.
“Sometimes you just have a bad year, combined with not noticing it for a while, now we’re getting it more,” Weinberg said. Having a lot of cases after not having many at all can make the spike feel even bigger, he added.
The third reason is that doctors have more advanced tests – called multiplex tests – that can check for multiple types of viruses and bacteria at the same time, so it could be that this infection is just getting picked up more often.
Mycoplasma pneumoniae are bacteria that travel through respiratory droplets. People catch them when they’re near another person’s coughs and sneezes, the CDC said. For that reason, this type of pneumonia easily spreads through crowded settings like schools, college residence halls and nursing homes.
These bacteria are tricky too because they hang around for a while – from one to four weeks in the body – before they make a person sick. By the time symptoms start, a person usually has little memory of what they may have been exposed to. Mycoplasma infections start off pretty generically, with a headache, a sore throat, a low fever and chills. People often feel crummy but can still get around, hence the term “walking pneumonia.”
The cough is typically a dry cough, without phlegm. It starts gradually and slowly increases over a period of two to three weeks, becoming almost constant.
Walking pneumonia is joining whooping cough and RSV on the list of lung infections making children sick this fall. Imgorthand/E+/Getty Images.
Rarely, these germs can travel outside the lungs. In the central nervous system, they can infect the lining of the brain and spinal cord. The bacteria can also infect the nerves of the eyes, as well as the ones that control the legs and bladder. These patients may not ever develop a cough.
