Symptoms of Illness
Their illness this time developed quite differently from a typical cold or flu. First, after Dingding (my older son) got sick, it took two or three weeks for Dangdang (my younger son) to start showing symptoms, indicating a long incubation period for the pathogen. Second, the low-grade fever lasted for a long time; Dingding had a fever for 4 days, while Dangdang had one for 7 days. Additionally, there was a severe cough, especially in the mornings and at night, which persisted for about 2 weeks.
Usually, if Dingding catches a cold, he hardly ever runs a fever or has one for just 2 days at most. Although I found it suspicious that he had a fever for 4 days, I didn’t suspect mycoplasma at that point. However, when Dangdang started experiencing low fever and coughing with the same symptoms two weeks later, I began to have my doubts.
Doctor's Diagnosis
On the fifth day of Dangdang's fever, we took him to the pediatric hospital. The doctor performed a standard examination and diagnosed it as a viral cold. I asked if it could possibly be a mycoplasma infection, and he said it was unlikely, as mycoplasma infections are very rare in the U.S., especially in 5-year-olds. Additionally, he listened to his lungs and found them to be very clear with no abnormalities, which reassured us not to worry.
（Dangdang at the pediatric hospital in the U.S.）
I felt something was off at that moment. First of all, mycoplasma infections are not as rare in the U.S. as he suggested. A statistical study of over 2,200 hospitalized children in the U.S. diagnosed through radiology (ages <18) found that 8% of cases tested positive for mycoplasma, making it one of the most common bacterial pathogens.
Additionally, according to a 2019 study, among 353 pediatric cases that tested positive for mycoplasma, 51.3% of the children were under 6 years old, with a median age of 5.7 years.
So saying that 5-year-olds rarely get mycoplasma infections is overly subjective. Moreover, even if mycoplasma infection progresses to pneumonia, chest auscultation can still sound normal, so just because it sounds clear doesn’t mean we should dismiss it.
After expressing our concerns, we asked the doctor to prescribe azithromycin, but he refused, stating that antibiotics could only be prescribed if the fever lasted over 7 days. However, after our insistence, he finally agreed to order a panel of tests that included mycoplasma. When I asked what method would be used, he said it was a culture test. I inquired about PCR testing, and he said they didn’t have that.
Hearing that made me uneasy, as mycoplasma culture is quite difficult. Not only does it require special media and methods, but even experienced personnel can take one to two weeks to get results. If it really is a mycoplasma infection, that would be quite a delay. Nevertheless, we proceeded with the sample collection.
By the seventh day, Dangdang was still feverish. On the morning of the eighth day, the pediatrician listened to his lungs again and still said they sounded clear. Fortunately, this time he finally ordered a chest X-ray and, after we insisted again, prescribed azithromycin.
That night, the pediatrician called us to say that a nodule was found in the lower right lobe of the lungs, and he prescribed amoxicillin to be taken along with azithromycin.
On the same day, the doctor informed us that due to the previous nurse’s lack of experience, nothing had grown from the initial sample, so we needed to collect another sample. This time, an experienced nurse came with the previous nurse to perform the nasal swab on Dangdang. I knew that even if we got the results, he would probably be better by then, but I wanted to validate my concerns, so we went ahead with the test.
Ironically, from the moment we received the azithromycin, Dangdang stopped running a fever and his cough improved. In the end, this hard-won azithromycin went unused.
Follow-up Analysis
After our first visit to the hospital, on the fifth day of his fever when the doctor refused to prescribe antibiotics, I started crushing glucan and dissolving it in honey water for Dangdang to drink, since he was extremely picky and refused to take lozenges. I’m not sure if this had any effect or if the child truly managed to fight it off on his own.
Thus, Dangdang’s cough persisted for another week, accompanied by noticeable fatigue and sleepiness, before gradually improving. Now, two weeks later, he has almost fully returned to normal.
Besides Dingding and Dangdang, many of their classmates are experiencing similar symptoms. The symptoms are almost identical, and doctors often cannot determine a clear diagnosis at the hospital; they simply say the lungs sound clear and are reluctant to prescribe antibiotics. Only those with issues found on X-rays or fevers lasting over 7 days are given amoxicillin. However, as far as I know, Dingding's classmates who took amoxicillin did not show any improvement in their symptoms.
One child quickly recovered after his mother administered azithromycin brought from China on the second day of his fever, while others who were left to fend for themselves often endured discomfort for 2 to 3 weeks.
Although we never received a definitive diagnosis of mycoplasma infection, we exhibited very typical clinical symptoms of it, such as a slow onset of illness, preceded by headaches, discomfort, and low-grade fever, followed by severe coughing and the discovery of lung nodules on the chest X-ray. The timeline of the entire illness closely resembles that of "untreated mycoplasma pneumonia" described in the literature.
The course of untreated mycoplasma pneumonia
Adding to this, the quick recovery of other children who were treated with azithromycin, contrasted with those who showed no improvement after amoxicillin treatment, makes me highly suspicious that this wave of infections is caused by mycoplasma.
However, among these children, only Dangdang underwent a bacterial culture, which yielded no results, and none of the other children had pathogen testing done. This is because it’s very difficult to find a facility here that can perform mycoplasma PCR testing, and even if one is available, results cannot be obtained the same day; it typically takes two to three days.
Current Progress
Additionally, doctors are very cautious about prescribing antibiotics; they usually start with amoxicillin and will only switch if there’s no improvement. As far as I know, among the children in this wave, only Dangdang was prescribed azithromycin, while others with lung nodules were given amoxicillin.
Therefore, it can be said that if mycoplasma infection does occur, I don't know how it is in other parts of the U.S., but in our area, it's highly likely that you’ll have to tough it out on your own.
I fully support the cautious approach that doctors take toward antibiotics, and I have always opposed their overuse and overtreatment. However, the immaturity of pathogen testing and the lack of experience among some doctors here also worries me.
While mycoplasma infections can self-resolve for most people, they can also lead to severe complications like lung consolidation, pleural effusion, and pericarditis, especially in children and the elderly. Given that Dangdang had heart surgery and has always been somewhat weak, I feel quite anxious about this. If similar symptoms arise next time, I will immediately request testing and treatment to minimize the risks.
That’s why I asked Uncle Kong to help me prepare a mycoplasma PCR testing kit so I can test at home; results can be obtained in just two hours.
Moreover, during peak cold seasons, I will strictly encourage the whole family to increase their intake of glucan, consume more zinc and vitamin-rich foods, and get plenty of sunlight or supplement with vitamins D and K. Boosting our immune system is the most important thing.
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