4 key things to know about lung infections caused by fungi

Walking Pneumonia Is On The Rise. Here Are The Symptoms To Look Out For

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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:

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

A Prospective Study Of Antibiotic Use And Clinical Factors In Patients With Suspected Pneumonia

This study explored how chest X-ray results influence antibiotic initiation by general practitioners in France when managing patients with suspected pneumonia.

Study approach

A prospective cross-sectional study was conducted with adult patients with suspected pneumonia who received chest X-rays as part of their evaluation. To analyze factors associated with antibiotic initiation, patients' characteristics were compared at inclusion and at 28 days between patients with positive chest X-rays (indicating pneumonia) and patients with negative chest X-ray results.

Main results

The sample included 259 adult patients. The median age was 58 years, 120 (46.3%) were male, 249 (96.1%) had not received antibiotics prior to inclusion, and 69 (26.7%) had at least one risk factor for pneumococcal disease.

Most of the general practitioners who included patients were women (55.2 %; n = 153), with a median age of 39 years. 76.1% (n = 210) were general practitioner trainers.

55.6% of patients (144 out of 259) had positive chest X-ray results.

Patients with positive chest X-ray results had higher body temperature, faster heart rate, faster breathing rate, more difficulty breathing, and more frequent unilateral chest pain than patients with negative X-ray results, and their symptoms lasted for a longer time.

99.3% of patients with positive chest X-ray results received antibiotics. Despite fewer symptoms and negative chest X-ray results, a significant portion (68.75%) of patients with negative chest X-ray results were prescribed antibiotics (79/115 patients).

Why it matters

The findings of this study show that many general practitioners prescribe antibiotics for suspected community-acquired pneumonia even when chest X-ray results are negative, highlighting a gap between guidelines and actual practice. 

What To Know About Pneumonia As Queen Camilla Recovers From Chest Infection

Queen Camilla has been recovering from pneumonia over the last few weeks. (Getty Images)

Being struck down by a chest infection can be very unpleasant and, in some cases, dangerous - particularly if it turns out to be pneumonia.

The condition, usually caused by a viral or bacterial infection, isn't swift. Recovery can take up to four weeks, even for a healthy person. Babies, older people and those with heart or lung conditions are at risk of getting seriously ill from it.

Recently, Queen Camilla revealed that the chest infection she had been suffering from over the last few weeks was pneumonia. She fell ill after the royal tour of Australia and Samoa that she embarked on with King Charles III, and was forced to pull out of a series of engagements, including the Remembrance Day service at the Cenotaph on Sunday 10 November.

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According to The Telegraph, the Queen's condition was viral, not bacterial, and she has recovered from the illness but is still dealing with bouts of fatigue.

Queen Camilla was recovered enough from her bout of pneumonia to attend part of the Qatari State Visit alongside King Charles III. (Getty Images)

Pneumonia is common in the UK, with between five to 11 adults in every 1,000 getting it each year.

What is pneumonia and what are the symptoms?

Pneumonia is an inflammation of the lungs, usually caused by an infection that can either be viral or bacterial. It can also sometimes be caused by a fungal infection, but this is rare in healthy people, the NHS says.

It may also be caused by something getting into your lungs, such as water or food. This is known as aspiration pneumonia.

Symptoms of pneumonia are quite similar to other chest infections, such as bronchitis and chronic obstructive pulmonary disease flare-ups. They include:

Coughing up yellow or green phlegm

Feeling very tired (fatigue)

Making wheezing noises when you breathe - babies may make grunting noises

Feeling confused (common in older people)

Symptoms of pneumonia can include a cough and coughing up green or yellow phlegm. (Getty Images)

Dr Donald Grant, GP and senior clinical adviser at The Independent Pharmacy, also warns that pneumonia symptoms can be commonly mistaken for symptoms related to the cold winter weather.

He says: "Coughing, cold chills and shortness of breath can all be overlapping symptoms of the weather and this harmful illness. Untreated pneumonia can prove extremely risky to health - particularly towards older individuals and those with a compromised immune system. As a result, people suffering from pneumonia should seek antibiotic treatment from their GP."

Is pneumonia contagious?

Only bacterial and viral pneumonia are contagious. You cannot catch pneumonia from someone who has it because of a fungal infection.

Pneumonia can be spread when an infected person coughs, sneezes or talks, and a healthy person inhales the droplets.

There is also a milder form of pneumonia called 'walking pneumonia', which can be caused by a bacterial infection. It usually resembles a cold and is more common in children aged five to 15 years of age and adults below the age of 40.

How is pneumonia treated?

Many people can recover from pneumonia at home but if you belong to a vulnerable group, you may be at higher risk of severe pneumonia. (Getty Images)

Pneumonia is usually treated with antibiotics, and clears up in most people within two to four weeks.

But certain groups of vulnerable people are more at risk of becoming seriously ill. These include babies, older people, and people with heart or lung conditions.

You may need to go to the hospital to get treatment for pneumonia if you belong to one of these groups, or if you are very unwell and have been coughing for three weeks or more.

In hospital, you may be given fluids and antibiotics, as well as oxygen to help you breathe. The doctor may send you to get an X-ray of your chest and order blood tests to check for other conditions.

If you are recovering from pneumonia at home, there are a number of things you can do to help with your recovery and avoid spreading it to others:

Stay at home and rest until you feel better

Avoid contact with other people if you have a high temperature

Take paracetamol or ibuprofen to help with pain or a high temperature

Cover your mouth and nose with a tissue when you cough or sneeze

Put used tissues in the bin as quickly as possible

Wash your hands regularly with water and soap

What vaccines are available to reduce the risk of pneumonia?

There are several vaccines that can help you avoid catching an infection that can lead to pneumonia. (Getty Images)

There are four vaccines that can help protect you and your family from infections that can cause pneumonia.

These include:

Pneumococcal vaccine

This is recommended for babies, adults over 65, and people at higher risk of pneumococcal infections. It is available from the NHS, and your GP surgery will usually contact you if you or your child are eligible.

Flu vaccine

This is recommended during pregnancy, for adults over 65, people with certain long-term health conditions, and those at high risk of catching or passing on flu. It's offered on the NHS every year in autumn or early winter to people at higher risk of getting seriously ill from flu.

RSV vaccine

This is recommended for adults aged 75 to 79 and during pregnancy (from 28 weeks onwards). Your GP surgery will usually contact you about getting the RSV vaccine, if you are between 75 to 79 years old. If you are pregnant, you should be offered the RSV vaccine around the time of your 28-week antenatal appointment.

COVID-19 vaccines

This is a seasonal vaccine recommended for people at increased risk from COVID-19. You may be offered a COVID-19 vaccine if you:

are aged 6 months to 64 years and have an increased risk of getting seriously ill from COVID-19 because of a health condition or treatment

live in a care home for older adults

are a frontline health or social care worker

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