pneumonia

Montreal TB cases rose in 2024

by Dan Laxer
The Suburban

In the fall doctors were concerned about the rise in the number of cases of walking pneumonia, particularly among small children. Now, with flu season in full swing, with the usual warnings and vaccine recommendations, doctors are worried about the rise, albeit slight, in tuberculosis.

The incidence of TB in Canada and Quebec is generally low. The average number of cases in Montreal each year is around 120. But in 2024 there were a reported 200 cases of the disease, or 9.4 for every 100,000 people. That’s an increase of 54 percent, prompting the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal – the city’s public health authority – to issue an Appel à la vigilance, warning doctors to be on the lookout.

According to Dr. Mitch Shulman, in Montreal if a patient presents with symptoms like a cough, a low-grade fever, a bit of weight loss, tuberculosis would not be the obvious diagnosis. Shulman, a regular contributor to The Suburban, is an Associate Professor in the Department of Emergency Medicine at McGill Medical School as well as an Attending Physician in the Emergency Department of the McGill University Health Centre. For the most part, he explains, TB is brought in by those coming from, or having travelled to, countries with a high incidence of untreated TB, like Southeast Asia or Africa.

In Quebec reporting and treating the disease is mandatory. In fact, it is the only disease in the province that carries that requirement. Shulman says the advisory is to suggest that it might be appropriate, where symptoms warrant, to get a patient’s travel history and to test for TB.

There are fundamentally two forms of the disease. Latent TB, which stays in the lungs, won’t necessarily cause symptoms. The problem is when it becomes active either through travel, stress, or a change in health status. Then it becomes transmissible.

“It really is a function of poor living conditions, unsanitary living conditions, malnutrition,” says Shulman. “And under those circumstances, if you’re living close to someone with TB for prolonged periods of time TB can be spread.”

TB is treatable, though, “with the right antibiotics, in the right sequence, taken for the right amount of time.” What is worrisome, says Shulman, are the cases of treatment-resistant TB which, if they becomes the dominant strain could lead to a health crisis, which is why global health organizations keep a close watch on the bacteria.

For most people living on the island of Montreal TB is not a concern. Where it does become a concern, Shulman says, is in First Nations communities. “Because of living conditions like crowding, poor housing, and in some cases malnutrition and poor access to healthcare, we do know that the rate of tuberculosis in some First Nations communities is much higher. That’s a clear sign of a failure on our part to take care of people properly, to make certain that they receive adequate nutrition, water, and housing.”

More kids coming down with walking pneumonia

Local Journalism Initiative / The Suburban / August 4, 2025 / Dan Laxer, Dr. Earl Rubin, Montreal Children’s Hospital, pneumonia

By Dan Laxer
The Suburban

There has been an uptick in the number of children coming down with walking pneumonia, not just in Montreal, but across North America. But doctors say that parents needn’t worry.

Dr. Earl Rubin, a pediatric infectious disease specialist at the Montreal Children’s Hospital, says there have been “a lot more” cases since the last spring / early summer. But specific numbers are not available. As of yet walking pneumonia is not tracked the way that other illnesses are, so it is a difficult thing to monitor. So the rise in cases, which is corroborated all across Canada, and in the U.S., is anecdotal, but significant.

Walking pneumonia is a milder form of the lung infection, brought on by the bacteria mycoplasma pneumoniae, the number 1 cause of pneumonia in school-aged kids, adolescents, and young adults. And although it is quite contagious, it is less of a cause for concern than full-blown pneumonia. “it’s called ‘walking pneumonia’,” Rubin explained, “because you’re not wiped out and hospitalized and really sick. You’re still functional.”

Rubin and others have said that it is plausible that the surge in the number of cases may be due to the Covid-19 pandemic; masking, distancing, and isolating led to fewer instances of cold, flu, or anything from one another, leading to a lower immunity. “There’s no science or proof of that,” says Rubin, “but that’s the working hypothesis for almost anything post-pandemic.”

The disease has been affecting a higher number of kids, of late, and younger kids at that, some as young as two to four years old. Rubin has been a summer camp doctor for more than 30 years. He says that all the summer camps had outbreaks this past summer.

Since walking pneumonia doesn’t lead to an immune response, it is possible for those who have had it to catch it again. And it is very infectious, Rubin says. “If it gets introduced into a household, about one third of the people in the household will get it.” And it is difficult, because of the incubation period, to know where you caught it.

Diagnosis of walking pneumonia requires clinicians to be aware that the illness is out there to know to look for it, and to know what type of antibiotic to prescribe. Symptoms include low energy, cough, low-grade fever, and it comes on gradually. There may be some wheezing, and some heaviness in the chest.

Only about 25% of kids who are infected with the bacteria will actually develop pneumonia (inflammation of the lung tissue), as opposed to a simple upper respiratory condition, which generally gets better without treatment. Those who do present symptoms can see their physician (if they have one) and don’t need to go to the ER.

As communicable as it is, a child with walking pneumonia is usually not contagious after a five-day course of antibiotics, says Rubin. But that doesn’t mean you should send them to school if they’re not feeling up to it. n

More kids coming down with walking pneumonia Read More »