What is Walking Pneumonia?

Dear Dr. Greene, Thanks for this wonderful service!!! My daughter’s friend has been diagnosed with “walking pneumonia.” What is it? How serious is it? Is my daughter likely to get it?
Redwood City, California

What is Walking Pneumonia?

Dr. Greene’s Answer:

The word pneumonia sounds alarm bells in many parents. It is understandably disturbing, because some pneumonias are quite serious, particularly in those whose immune system is vulnerable (newborns, the elderly, and people with AIDS). The good news is that the great majority of pneumonias in children and adolescents are easily treatable.

Pneumonia simply means inflammation in the lung. It can be caused by microorganisms, viruses, chemical irritants, or foreign bodies. The phrase “walking pneumonia” refers to a group of pneumonias that, even if untreated, would not usually need bed rest or hospitalization. They can, however, make someone feel miserable with a severe cough, fever, chills, headache, and abdominal pain and they can last a long time.

When physicians diagnose someone with walking pneumonia, they are usually referring to an infection with an organism called Mycoplasma pneumoniae. (Apart from being a pain, mycoplasmas are kind of cool. They are the smallest self-replicating biologic systems known.) Mycoplasma is a major cause of respiratory infections in school-aged children and young adults. It is most common between the ages of 5 and 15, accounting for 70% of pneumonias in children aged 9 to 15.

Mycoplasma can be contagious with close contact. It usually requires prolonged contact to catch the disease. Epidemics have been reported in situations such as summer camps and boarding schools. The disease spreads through breathing air coughed by someone who is infected. Since the cough is often worse at night, people sleeping in the same room are most vulnerable. If your daughter has been spending a lot of time with her friend, chances are high that she will get it.

She will probably begin to get ill 1 to 3 weeks after her friend, but the onset is often so gradual that she may not notice it at first. A decrease in her energy level may be the earliest sign, followed by cold symptoms . She may have a headache, runny nose, and sore throat, sometimes accompanied by a fever. Unlike a cold, however, she will gradually get worse over about 2 weeks, with an increasing moist cough (and perhaps hoarseness) as the disease settles into her chest. Without treatment she will likely remain sick for a month or more.

Even after she is well, she may have a dry cough lasting for 6 more weeks. Mycoplasma attacks the ciliated cells of the respiratory tract – those with little hairs on the surface. As new cells grow in to replace the damaged ones, there is a ‘tickle’ in the chest, causing a sporadic deep, dry cough.

Thankfully, mycoplasma infections are easy to treat – with the right medicine. The most common antibiotics in children are no help at all! Mycoplasma is exceptionally sensitive, however, to erythromycin, clarithromycin (Biaxin), azithromycin (Zithromax or Z-pak), and tetracyclines (usually only used over age 8). Your daughter will usually start to feel better within about a week of taking any of these medicines.

Should she take other medicines to help relieve her symptoms? Perhaps. Many of the symptoms in walking pneumonia are part of her body’s attempt to heal. The invading organisms don’t reproduce as well when she has a fever. The runny nose is an attempt to expel the invaders. The tiredness is a plea from her body to get some rest.

The cough keeps the infection from settling too deeply in her lungs. I would not recommend cough medicine except when the cough is disturbing her sleep – it is when she sleeps that her body is most actively repairing itself. Do keep in mind is that over-the-counter cough and cold medications are no longer available for children under 2 years old, and their use is discouraged in children under 6 years old.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. palash

    Biaxin seems to work well. my cough is gone after 10 days of biaxin treatment 500mg twice a day

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  2. Sak

    My three year old daughter had cough for 2 months finally diagnosed with myc pneumonia. She had clarithromycin for 7 days which gave a tremendous relief , almost no cough.now after 3 rd day since medicine stopped she is getting her cough worse.please reply me

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  3. Robert Damian

    Been working in Northern California for 4 months now…developed what started as a chest cold back in February…went to urgent care and was diagnosed with bronchitis…was given sulfameththoxazole/trimethoprim 800-160mg…after running through that…went back home to northern cal…coughing got worse and sleep less…finally went to emergency room last week after serious breathing issues at work…took chest X-rays and diagnosed with bacterial pneumonia…was given zpac…felt better for a few days…now I am back finishing job in Palo Alto…have no medication and still after almost two months of this cant sleep all night…have congestion which won’t leave…nose drips and dry cough…what is the next phase of nightmare I can expect?…I’m about running out of options in the money category…need to work to keep family going… This is horrible..any advice would be great..thanks

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    • JJS

      Kind of a shot in the dark, but have you had a patchy red rash on your legs, by any chance? My brother thought he had pneumonia for a long time, but it turned out to be Valley Fever, a fungal infection: http://www.cdc.gov/features/valleyfever/ Especially if you have been in the southern Central Valley, or if your job involves digging, I would look into this.

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  4. Keistine

    Diagnosed finally with pneumonia lower left lobe and fluid lower right lobe on March 4. I was having severe pressure right rib and cough expelling dark green phlegm and felt horrible for 3 full weeks. Then felt as if someone was sitting on my chest. Dr kept saying upper respiratory infection. I went to dr every week then he finally ordered chest X-ray. I had to go to a different dr because that dr said my xray was normal however it showed pneumonia as I stated above. Prescribed levaquin 10 days. It has been 2.5 weeks a little over and now I’m struggling with post nasal drip and fatigue. Chest X-ray last week showed it cleared. I hope I start feeling a lot better soon.

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  5. Nancy Hartley

    I have RLL pneumonia . This is day 4.5 of treatment with one twice/day. Amox TR-K CLV 875-125, Symbicort 160/4.5 2 puffs twice/day, MucinexDM. I also take synthroid .100mcg, I use a netty pot. I’m a yoga crazy 56 yr, 104, 4’10” felt fine but this cough then fever led to Pnemonia, I do cough up green, and blow green from my nose. Feeling moderately better, but question the inhaler and see you do not list my antibiotic. Is this all normal?

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  6. MBC

    I am an adult in my 40s. I was diagnosed with Walking Pneumonia 3 weeks ago. went on Z-Pak. started feeling better for a few days then cough got worse and chest started hurting. 3 weeks later I am on day 5 of 10 day course of Doxycycline..chest still hurts as it did when I started the course. do I go back for chest X-rays or wait till the course is done.

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  7. Suzie

    I was diagnosed with pneumonia in my right lung last July. I have had chest x-rays confirming it did go away. However it’s now March of the next year and I still have coughing spasms and they are worse at night when I am worn down. I’ve been to an allergist who told me I’m not allergic to much and he stopped my inhalers and fenofexadine allegra otc. I have had a spirometer test that came back well. They are sending me to an ENT to rule out reflux disease. I get frequent sinus infections as well so in the meantime I have been on several antibiotics and I start to feel a little better and then it all relapses again. Any suggestions? TY!

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    • Rick

      I can relate to your symptoms, i have been battling walking pneumonia since March 10th. Now it is already April 5th and i still feel lack of energy.

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  8. jason

    I went to the ER the other night because I was coughing severely and my lungs were majorly congested. They told me it was just a severe case of bronchitis, they gave me a z-pak to clear up my lungs and it worked. Today I took the last pill I had from it. All the sudden I’m trying to sleep and my heart, lung and neck start throbbing badly, like a very sharp pain. I’m just a little worried considering I’ve had pneumonia 7 times and I’m only 18, someone help please. Thank you.

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    • J.D. Contreras

      The same crap happened to me last week bro! At first my doctor said it was bronchitis and then he gave me the “Z” pack with an inhaler. I’m on my last pill and my body feels like it’s getting worse! Then I hear about “Walking Pneumonia??” that’s going around where I live in California. My stomach hurts, I’ve lost TEN pounds, have NO appetite, muscle spasms, back aches, itching and cold/hot flashes! I’ve never had pneumonia before and I’m scared to death! My doctor just sent me home with a diagnosis of bronchitis. Whatever! It’s more than that if I’m losing weight and I keep forgetting things. I’m in college, too.

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      • Concerned mom

        Sounds like Mycoplasma infection or communal pneumonia. There are some nasty strains around and docs are not all properly diagnosing it. My 12 yr. old has been sick for 8 weeks and bed ridden still no resolution of symptoms. Finally resorted to Doctor of Naturopathy. Have you been exposed to a sick cat? If so look up Feline Mycoplasma Infection scary stuff best of luck!

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      • Dave

        I have the exact same symptoms you described and I also live in Cali. What as the outcome of your condition? Thanks

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  9. Hyder

    My wife was diagnosed pneumonia about one month ago. We took the treatment and now she is better, but the dry cough is still there. She can’t sleep at night, Through out the day she suffers from dry cough. We also tried home remedies, but it seems useless. Kindly advice what to do.

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    • charise

      Try getting an old asthma medication called zaditen or ketotifen to dry up excess fluids in lungs. It takes away the need to cough need a Drs prescription.

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  10. Mrs.PK

    After an urgent care visit, and two doctors apt.’s my kids were diagnosed with pneumonia (after two months of copping) . They were given amoxicillin and it has been 2 days with no improvement. It’s -35 *F here and I’d like to see them get better soon. Any help would be great! :)

    They are using musinex and a nebulizer also.

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    • Sam

      Amoxicillin does not do anything for atypical bacteria like Mycoplasma. Your Dr is an idiot if that’s really what they prescribed.

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  11. KaSandra

    My 18 month old was just diagnosed with this as well. We hav d been to the Dr so many times in the last few months and they always said cold until today and a 2 hour appointment with xrays. He scared me with his breathing last night is what made me take him again. He has heart issues so breathing is a big deal and they want to rule out infections and viruses first. I was so worried we were going to the hospital again. But as long as the medicine works they said we don’t have to! So day 1 meds are down and he only has to take it 3 days. This momma and her boy needs some sleep so hopefully this medicine works!

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  12. amanda

    Hi just been told I have this.but I’ve had a cough same as this on and off for the past 2 years.I was seen by an ENT. They told me prolonged use of inhalers made my voice croaky. We are visiting the US and saw the doctor last night as I was having problems with asthma due to the coughing, etc. Surely it can’t go on that long. At home they say my chest is clear. It’s just viral it will go when it’s ready…..

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  13. Amanda

    Hi and thanks for the info in this post. I’m 32years old and have had walking pneumonia for 2 weeks now. It started just like you said like a bad head cold be for settling in my chest. I just finished a 5 day z-pack and only now starting to feel a little better. My cough is still bad especially at night. Really hope I quit coughing and my body aches go away soon.

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    • Unknown

      Ugh u sound irritating

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  14. Chandana

    Hi my daughter is 12 and she got microplasma and was treated with antibiotics ,but her cough is still their after one month anything that can be recomanded .

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  15. amysc

    Even though I’m an adult, you are the first doctor to explain it this way – the aftermath of mycoplasma! Thank you. I feel great, energy back – but the dry cough and lingering symptoms made me wonder if it was gone. But it’s the body just getting rid of things and building back up. You totally get it–this makes all the sense in the world. Thank you thank you. My night cough keeps me so hoarse – I haven’t had a voice since I got infected! So I may take a night cough medicine just to sleep and wake up with a normal voice!

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  16. yani

    Hi there, my 2 yr old currently has walking pneumonia and I am worried my other baby might catch it -he is only four months old and exclusively breastfed. Does this type of pneumonic affect young babies?

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  17. Janae Smith

    This was a great article. Good detail and presented well. Easy to understand with great advice. Thank you.

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