I have been sick with what I thought was the cold for over a month now. It's almost impossible to walk up Mt. Everest (what we call the hill to the dorms) three times a day, and I'm out of tissues already. I sleep way too much, which would explain why I'm failing all of my midterms. After a week or so of this unexplained bout of illness, I began to think that maybe I was coming down with mono again. But I didnt have a lot of the symptoms, just fatigue and sore throat, so I talked to the cool custodian Rodney who seems to know everything and he told me that I could have walking pneumonia. I just toughed it out because I was too scared to go to a doctor, but I'm pretty sure that walking pneumonia is what I had.

Here are the facts to support my suspicions:

Mycoplasma Infection: (walking pneumonia, atypical pneumonia)

Mycoplasma infection mostly infects older children and younger adults, and is most common during the late summer and fall. It is spread through contact with droplets from the nose and throat of infected people when they cough and sneeze. Transmission is thought to require prolonged close contact with an infected person. The contagious period is probably fewer than 10 days and occasionally longer.

Typical symptoms include fever, cough, bronchitis, sore throat, headache and malaise. A common result of mycoplasma infection is pneumonia (sometimes called ³walking pneumonia² because it is usually mild and rarely requires hospitalization). Infections of the middle ear (otitis) also can result. Symptoms may persist for a few days to more than a month. They generally begin 15-25 days after exposure, and generally develop slowly, over a period of two to four days.

Immunity after mycoplasma infection does occur, but is not life-long. Second infections are known to occur, although they may be milder. The duration of immunity is unknown.

Antibiotics such as erythromycin or tetracycline are effective treatments. However, because mycoplasma infection usually resolves on its own, antibiotic treatment of mild symptoms is not essential.

Source: New York State Department of Health

Walking pneumonia is changing.

The classic bugs are four "atypical bacteria":

mycoplasma pneumonia
chlamydia pneumonia (this is not the STD chlamydia. Different one.)
legionella
pertussis(whooping cough)

However, streptococcus pneumonia can also be a walking pneumonia OR a lobar pneumonia. In a lobar pneumonia the person usually is short of breath, running a fever of 102-104, and they point to where it is: hurts in the right upper chest. On chest xray there will be consolidation: whited out from fluid or swelling instead of nice ribs and dark air. They are often tachycardic and hypoxic.

In walking pneumonia the person often has no or minimal fever, they just feel tired or short of breath when they do things, and the chest xray can be "clear". It isn't really "normal", it's just that the bacteria or virus affects the entire lungs and causes some swelling throughout and doesn't white it out.

"Double" pneumonia is when the chest film is whiting out on both sides. We also see the lungs whiting out with ARDS -- acute respiratory distress syndrome. So after trauma in a car wreck and lots of broken ribs, the lungs can be bruised too and white out. Ow. Influenza virus can cause lung swelling and in the 1917-1918 flu infected military recruits lungs were swelling shut. They would turn blue and die.

"My" strep that I've been writing about is streptococcus A, not strep pneumonia. It causes strep throat mostly though it can invade and cause sepsis or pneumonia or cellulitis. There are currently 4000+ known strains of strep A, and some are resistant to antibiotics or can cause kidney damage or do all sorts of nasty things. I think that "my" strep is resistant to azithromycin.

The current guidelines say to treat walking pneumonia with azithromycin. However, a paper came out this year saying that resistance to azithromycin is rising among streptococcus pneumonia and that nearly 50% of strains tested were resistant. Uh-oh. That means that azithomycin doesn't work and the person can get sicker and may die. I talked to a pulmonologist in Seattle when I needed help with someone. He said that he would have said there weren't any resistant strep pneumo strains here in Washington except that he had one intubated and in the ICU right then. "I'm convinced now, " he said.

A lobar pneumonia is easier to diagnose. Abnormal chest xray, reasonably healthy people run a high white blood cell count (so my frail folks, immunosupressed folks and 90 year olds don't), and a fever (ditto) and look sick. The walking pneumonia people come in saying they have been coughing for 3 weeks or 4 weeks or two months. I am doing more lab testing because of the resistance.

This winter I have seen 6 different causes of walking pneumonia here: influenza A, respiratory syncytial virus (In more than one person over 60. That is NOT who the books say it should affect. It's supposed to mostly cause bronchiolitis in babies and premies), pertussis, strep pneumococcus, strep A and none of the above. All looking pretty much the same, but with different treatment.

https://wwwnc.cdc.gov/eid/article/15/8/08-1187_article
https://www.cdc.gov/pneumonia/atypical/mycoplasma/index.html
http://www.medscape.com/viewarticle/820736
https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=79
RSV: http://kidshealth.org/en/parents/rsv.html
Mycoplasma resistance to azithromycin has been reported too: http://erj.ersjournals.com/content/36/4/969

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