From @MD Puffer:
”Mycoplasmal pneumonia, aka "walking pneumonia" is a very common community acquired pneumonia. M. pneumoniae is highly fastidious- that's why it took the lab 2 weeks to culture. Cigars/tobacco are not a a feasible substrate for it to grow upon, let alone survive.
The most likely and reasonable explanation is someone in your vicinity had it, coughed, and you breathed in the same air. Your attending physician ordered lab testing because you had to be stabilized in the ICU, apparently were not responding to antibiotic treatment, and needed to show he ordered all reasonable tests in case you died and someone sued him. Your vitals had to have been in the crapper or at least trending there for them to have put you in the ICU, unless you're really old or immunocompromised and you were admitted there as a precautionary measure (but seriously, even then you would have been admitted to a gen med ward if you were otherwise stable).
Most people survive these infections without any treatment because the symptoms are frequently mild and easily mistaken for seasonal allergies. The absence of a cell wall just makes them resistant to a few classes of antibiotics but they're highly susceptible to a wide range of other and they don't show the prevalence of antibiotic resistance seen with other bacteria (most likely owing to their longer generation times). So it's not like there's a paucity of antibiotic treatment available. A ten dollar Z-pack typically suffices in most cases. Cultures are almost never obtained and the treatment is almost always empirical.
If you were my patient in residency, I would have presented your case in grand rounds because almost everybody who gets walking pneumonia either is satisfactorily treated with common antibiotics or just weathers the storm. Also, you don't have interstitial lung disease from a mycoplasmal infection. Mycoplasma is no tough cookie- it's easily treated (most often).
Since I have some time to kill, I will digress.
What other bacterial pathogens might be lurking about on your CCs?
Staph. It's in everyone's noses. These guys are breathing dust all day, and smoke, and sneezing (as above). Someone's gonna pick their nose then roll a piramide. I bet you staph could be easily cultured from a cigar. Threat? Realistically? Next to nil. Staph is on everyone. It's already in your nose and oropharynx. Good survival rate outside of the host. But unless your immunocompromised I don't see it infecting a cigar smoker- it's not like Cuban staph is more pathogenic than American staph.
E. Coli (and other coliforms). Hah. Nasty. Someone didn't wash their hands after their government sanctioned potty break. And you wondered why that HDM Ep 1 looked like a maduro wrapper. Tsk tsk. Threat? Realistically? Next to nil. It doesn't have as great a survival rate outside their host for one. This fact makes one wonder how much crap exactly is on one's Romaine lettuce. The answer is not enough because Caesar salad is fucking delicious and I'm going to continue to eat it. Plus, it's also already in your gut and you'd need to ingest a minimum inoculum for infection with one of the strains that are known to be pathogenic. Hypothetically, it could be the opposite. You could be sick with "bad" E. coli and ingesting good coliforms from your torcedor. Sort of a de facto fecal transplant. Yeah, those are real. When I was an intern my chief and attending were talking about a patient with C. diff who was crumping. The former proposed a fecal transplant. Despite both of them trying to convince me that they weren't pulling my leg I refused to believe it until I read some journal articles on it. True story. I shit you not.
Honorable mention: Tuberculosis. Now this guy is a tough cookie. You see, outside of his cell wall he makes a waxy-like coating which makes it difficult to ID under a microscope, difficult to culture, and difficult to get the antibiotics across this hydrophobic waxy coating. Given that we're talking about a 3rd world country, sneezing/coughing on cigars which would act as fomites that we later stick in our mouths and draw smoke through, one might think this is possible. Yeah, it'spossible. It's also possible OJ didn't kill his wife. Apparently, Cuba has TB under control. But if they didn't, and TB was a problem there, then that'd be the one that concerned me. It's wax-like coating lends to long survival rates outside the host and the minimum inoculum to infect is 1 or 2 cells (ie highly infectious).
I don't know if the phenomena of crystallized oils on the surface of wrappers (aka plume) exists. I know something similar does exist on potent strains of marijuana. But different. It's really more of a dessicated oozing of sap (which can be collected into little sticky balls of hasish). What I find odd is that no one has ever published any photo of a cigar wrapper with what is called plume and shown it to be anything other than mycelium. Forget electron microscopy- just an old school light microscopy photo of some crystals. I have never seen a photo of such but I have heard countless people swear by its existance.
I'm not not sickly, not immunocompromised, and I have no pulmonary diseases. So if I find a little white mold on a cigar, I personally imagine it to be something akin to a secondary or tertiary fermentation. If it's extensive I'm going to wipe it off, and if it's hardly noticeable I probably wouldn't risk damaging the wrapper or wasting my time and just smoke it up. Why? I can't find any documented cases of pulmonary fungal infections thought to be caused by smoking cigars. How many hundreds of millions of cigars a made and smoked each year? And not one case of a pulmonary fungal infection from a tainted cigar? They are all covered with fungal spores or mycelium. A big factor is we don't inhale this smoke, at least directly.
Now, Aspergillus can be blue and/or green. There are also documented cases of aspergillosis from marijuana (unique epidemic in some po dunk town). But you inhale that smoke (though not everyone apparently). So, if I ever saw something blue or green growning on a cigar I'd probably not smoke it.
There's an interesting irony here. Some people who are smoking cigars are worried about their health by smoking cigars which have an advanced degree of growth of an ubiquitous fungus. I think most likely plume is the white rind of brie to cigars.”