Walking Pneumonia Cases In India: Docs Share Symptoms You Should Know

The sudden surge of walking pneumonia cases in China led to widespread global panic. When news broke of 7 cases at Delhi’s AIIMS, people feared a repeat of COVID experiences – where few cases will go on to become many, before it turns into a global pandemic. However, AIIMS was quick to clarify that the cases were unrelated to the pneumonia cases in China and urged the public not to panic.

Pneumonia is an infection of lungs which may be caused by bacteria, virus or fungus. It may become severe especially in extremes of ages i.e. elderly and young children or in immunocompromised patients where patients need to be hospitalised. Dr Sandeep Nayar, Principal Director & HOD, Chest & Respiratory Diseases, BLK Max Super Speciality Hospital explains, “With the advent of antibiotics and better understanding of the disease, we are able to treat most of the patients on OPD bases."

Dr Maninder Dhaliwal, Senior Consultant, PICU, Amrita Hospital, Faridabad adds, "The prevalence of walking pneumonia is widely underestimated, largely because disease presentation is usually mild, self-limiting and many patients do not always seek medical attention. Furthermore, the lack of easy, cheap and accurate diagnostic modalities for walking pneumonia makes definite diagnosis difficult in day today practice."

‘Walking Pneumonia’ is the name given to patients who develop lung infection but can be treated without admitting them. They are relatively stable where oxygen saturation, respiratory rates as well as other vitals are maintained. Patients may have symptoms like fever, cough, sore throat, runny nose which appear gradually over 2 to 3 weeks and may be milder than typical pneumonia. In view of milder symptoms, patients get treatment at home without hospitalisation, hence it is termed as “Walking Pneumonia”. Presently the reports from China indicate it could be usual winter infections. It could be a mixture of infections like influenza, adenovirus and respiratory syncytial virus (RSV). There are also reports of increase in Mycoplasma pneumonia infections which are known to cause “atypical” pneumonia. As of now it does not look like any new pathogen which could be the causal agent. One of the viruses known as H9N2, a subtype of the Influenza A virus which primarily affects bird is also suspected to be the culprit.”

Dr Dhaliwal answers, "Rates of M. pneumoniae vary annually, yet cyclic epidemic patterns have been observed every three to five years. Nothing unusual to have a spurt now and then. Mycoplasma pneumoniae has a diminutive size, which allows it to spread from person to person through droplet infection during close contact. Following a coughing event, contaminated droplets disperse through the air. Also, immunity after infection is not long lasting; the bacteria and its associated disease can relapse in patients even after adherence to an effective antibiotic regimen. Pneumonia due to M. pneumonia usually increases with age (2-5% in children <2 years, 5-10% in age group 2–4 years, 120% in the age group 5–9 years, and 23-30% in the age group 10–17 years), so more commonly seen in adolescent children."

Dr Sandeep clarifies, “We should not be alarmed at present but we must be cautious about it and continue to take all the precautions to prevent its spread. We must continue to take precautions, whatever causal agent may be as these respiratory infection spread via droplets through air only. We must continue to wear masks and maintain social distance as far as possible. It is also a good idea to practice hand hygiene and get out annual Flu shots. I would also recommend anyone having respiratory symptoms to consult their doctor and avoid going into a crowded area or school or office as it may spread to others.”

Mostly these patients are managed by antibiotics and other conservative treatment. As most patients suffer from mild disease, they don’t even require hospitalisation or intravenous antibiotics. Oral medication for 7 to 10 days (about 1 and a half weeks) takes care of the problem. However, some of the patients develop more serious forms of disease where they require hospital care and some even Intensive Care admission. Some of these patients may even develop extrapulmonary involvement like brain etc. where the patients may become critical and are even put on supportive care like ventilator.

Dr Dhaliwal adds, "Mycoplasma species are the smallest free living organisms that can survive alone in nature and they usually target the lungs, ears, throat, but can rarely involve other systems like blood, brain and skin too. Most of the children initially have mild upper respiratory symptoms, which are usually self-limiting. Its onset is gradual starting with cough, fever, headache, malaise, sore throat, and is self-limiting mostly. There are 2 ways this walking pneumonia can become worrisome:

First, when it seems that a cold is lasting longer than 7 to 10 days, especially if a cough is getting worse or not going away, it could be walking pneumonia. Cough continues without relief. To differentiate walking pneumonia cough from allergic / irritant (pollution related) related cough becomes important, as treatment is different.

Second, like any disease walking pneumonia can become severe pneumonia over time with high fever, laboured breathing, fall in oxygen levels, refusal to feed, vomiting, rash, arthritis. At this stage admission becomes important.

Dr Dhaliwal shares macrolide antibiotics, after diagnosis by a doctor, is an effective treatment for walking pneumonia caused by Mycoplasma pneumoniae. A 5- to 10-day course of oral antibiotics is usually recommended. If your doctor prescribes antibiotics, make sure your child takes them on schedule for as long as directed to recover more quickly. In addition, nebulization & anti-pyretic may be given. Hydration is important, as small frequent sips. Cough suppressants stop the lungs from clearing mucus, which might not be helpful for lung infections like walking pneumonia, so don’t give cough syrups blindly. Follow doctor’s prescription.

After starting on antibiotics, your child is less likely to pass the illness to other family members. But encourage everyone in household to wash their hands well and often. Don't let your child share drinking glasses, eating utensils, towels, or toothbrushes. Mycoplasma pneumonia remains contagious for a long time even after the antibiotic therapy, which should be explained to the parents.

Elderly, young children as well as immunocompromised people are more at risk of catching these infection. People going into crowded places and not taking protective measures are likely to catch these infections as well as pass onto others.

"It’s important that we seek medical attention in children/adults having cough and do not self-medicate children blindly with antibiotics out of panic/anxiety, as resistance to antibiotics is a major concern. And we will soon have a mega-bug, who we can’t kill with antibiotics. So its essential to seek medical attention as early as possible," adds Dr Dhaliwal.