‘Walking pneumonia’: Mycoplasma infections on the rise bringing cough that lasts ‘weeks or months’
If you’ve had a persistent cough lasting weeks, it may not be the flu or Covid but a little-known infection doctors say is on the rise again.
Illness
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If it seems like everyone is sick at the moment, it’s not your imagination.
NSW is swimming in a “respiratory bug soup” that is putting “unprecedented” strain on hospital emergency departments, driven by a monster flu outbreak and high levels of Covid.
But a little-known infection that causes a persistent cough that can last for months is also on the rise, causing many children in particular to get sick again after contracting other viruses.
Mycoplasma pneumoniae, a bacterial infection, is most common in children and young adults and while usually mild, it can be serious for people who are recovering from another respiratory viral illness, already have a lung disease, or have a weakened immune system.
There is no vaccine for mycoplasma and people can be infected more than once. Occasionally infections can be severe and may need antibiotics.
Sometimes called “walking pneumonia” because of its generally mild symptoms, mycoplasma pneumoniae can cause sore throat, headache, fever, tiredness and shortness of breath.
But its key feature is a persistent, dry cough that “may last for weeks or months”, according to a NSW Health fact sheet.
“In some cases it can lead to severe pneumonia needing admission to hospital,” it said.
In children under five, other symptoms may include sneezing, a stuffy or runny nose, watery eyes, wheezing, vomiting or diarrhoea.
Royal Australian College of GPs (RACGP) president Dr Nicole Higgins said there was “a lot of it around at the moment”.
“We’ve got a respiratory bug soup at the moment, it’s multiple bugs that are impacting especially our children,” Dr Higgins said.
“Mycoplasma is one of them. At the same time we’re seeing increasing cases of influenza, Covid and RSV. We’re also seeing increasing cases of whooping cough, just to confuse things.”
Dr Higgins said in many cases people were being infected with one of the viral illnesses “and then they get sick again” with mycoplasma.
“With mycoplasma it tends to develop over time and especially kids, they just don’t get better,” she said.
“The general rule of thumb is if your child’s not getting better, get them checked out [for mycoplasma]. Our initial swabs are the respiratory viruses because we know they’re the most common … then we go back and do a re-swab and it’s coming back as mycoplasma, which has to be treated differently.”
Making things more difficult is the fact that the antibiotics used to treat mycoplasma in children, azithromycin and clarithromycin, are both in short supply due to the medicines shortage.
“It’s been very challenging to get the right treatment, but we also have guidelines around how to manage it with medication alternatives,” Dr Higgins said.
Since April, NSW hospitals have seen high numbers of presentations to ED for children and young adults with pneumonia, particularly in the five to 16 age group, with the ones that show up to hospital likely representing “only a proportion of cases in the community”, a NSW Health spokeswoman said.
“Many pathogens can cause pneumonia, including bacteria, viruses, and fungi,” the spokeswoman said.
“There is some indication that increases in pneumonia are likely contributed to by infection with mycoplasma pneumoniae. High rates of influenza, RSV, Covid-19 and pertussis (whooping cough) may also contribute to the rise in pneumonia ED presentations.”
NSW Health was unable to provide more detailed data on current mycoplasma pneumoniae case numbers.
While mycoplasma infection occurs throughout the year, there are spikes in cases every three to seven years as population immunity wanes. The last epidemic in NSW was before Covid.
“There has been an increase in cases of mycoplasma pneumoniae in children in several other countries,” the spokeswoman said.
Symptoms usually appear from one to four weeks after the person is infected with the bacteria, which spreads by droplets from coughing or sneezing.
“Someone can be infected with mycoplasma and show no symptoms, but still be able to spread it to others,” according to NSW Health’s fact sheet.
“People with mycoplasma can be infectious for about 20 days.”
Living in the same house as someone with mycoplasma infection puts you at higher risk of getting infected.
“Living and working in a crowded setting can increase the risk of getting mycoplasma infection,” it warned.
“Crowded settings include schools, colleges, and dormitory facilities.”
In its most recent respiratory surveillance report for the week ending July 6, NSW Health noted there had been “unseasonably high” pneumonia presentations to emergency departments.
“Within the ED, most pneumonia presentations are classified as unspecified pneumonia, that is, a specific cause of the pneumonia has not yet been identified,” the report published on Thursday said.
“This information may become available later in the admission or following discharge from hospital. There is some indication, from a number of different data sources, that increases in pneumonia are likely contributed to by infection with mycoplasma pneumoniae.”
NSW Health urged the public to “help reduce the spread of these pathogens through simple measures such as staying home if unwell and wearing a mask if you need to go out, staying up-to-date with recommended vaccinations and practising good hygiene, including regular handwashing and covering your coughs and sneezes”.
Mycoplasma infection is diagnosed by a nose and throat swab, and sometimes a doctor may also do a blood test or a chest X-ray to check for lung infection.
But it can be hard to distinguish from other types of pneumonia, and doctors usually don’t recommend lab tests for mild cases.
“The symptoms of mycoplasma pneumoniae infection can be more subtle than those of other forms of lung infection,” Medical News Today notes.
“For example, the doctor may not hear any unusual sound from the lungs. This can make it harder to diagnose. In addition, since mycoplasma pneumoniae has similar symptoms to other conditions, it can be hard to identify. The doctor will need to rule out other conditions. A clear diagnosis might only be possible if the symptoms do not respond to the usual treatments for upper respiratory infections, which involve other types of bacteria.”
In rare instances mycoplasma pneumoniae symptoms can affect other parts of the body, leading to life-threatening neurological diseases such as encephalitis, among the most serious complications.
The NSW Health surveillance report also revealed 17,431 people tested positive for influenza in the week ending July 6, including 3299 in the 10 to 19 age group, 3058 aged five to nine and 2514 aged four and under.
So far this year there have been a staggering 96,750 total positive flu tests.
NSW Health Minister Ryan Park said on Monday the rise in influenza cases was contributing to increased pressure on emergency departments.
“Our emergency departments are under unprecedented demand … we’re seeing about a 30 per cent increase in influenza cases,” Mr Park said.
“We are starting to track towards the peak of influenza across the system. We’re probably about a week or so away from that, but that is putting unprecedented demand on our emergency departments.”
Mr Park urged people to get vaccinated if they hadn’t already.
NSW Health executive director of health protection Jeremy McAnulty said the data was “concerning”.
“The high level of flu activity is concerning, and we expect this to continue in the coming weeks,” he said.
“Influenza is more serious than the common cold. It can cause pneumonia, make chronic underlying medical conditions like diabetes, lung and heart disease much worse, requiring hospital admission and causing death. Complications can occur in anyone but are most likely in those at higher risk of severe illness.”
Dr McAnulty also urged Australians to get vaccinated.
“Vaccination is the best protection against infection and severe disease,” he said.
“Everyone, but particularly those at higher risk of severe disease, is urged to get their influenza vaccination now — it’s not too late to get vaccinated. By getting vaccinated you also help protect those around you.”
Experts have also warned three highly transmissible Covid subvariants are taking off in Australia — FLiRT, FLuQE and most recently de-FLiRT.
“Due to this mutation, as well as fluctuating community immunity, we are witnessing more than one wave each year,” Queensland chief health officer John Gerrard told The Courier-Mail last week.
“Covid-19 has not yet developed a clear seasonal pattern.”
— with NCA NewsWire
Originally published as ‘Walking pneumonia’: Mycoplasma infections on the rise bringing cough that lasts ‘weeks or months’
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