Atypical (Walking) Pneumonia

“Walking pneumonia” is a way people often describe a mild form of pneumonia. As in, you might feel well enough to walk around without realizing you have a lung infection. Pneumonia is inflammation and fluid in the air sacs of your lungs, usually caused by an infection.

Walking pneumonia (pronounced “noo-MOHN-yuh”) might cause symptoms that feel more like a bad cold, like a cough or fatigue.

“Walking pneumonia” isn’t a medical term. Healthcare providers are more likely to call it atypical pneumonia.

Symptoms of walking pneumonia

Walking pneumonia symptoms may be more like common respiratory infections rather than pneumonia. They include:

• Sore throat
• Extreme tiredness (fatigue)
• Chest pain or discomfort
• Low-grade fever
• Chills
• Cough
• Headache

Walking pneumonia causes

The most common causes of walking pneumonia are atypical bacterial infections. These include:

• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Legionella
• Haemophilus parainfluenzae

Viruses and fungi can also cause it.

Is walking pneumonia contagious?

The germs that cause walking pneumonia are contagious. They usually spread through coughing and sneezing or sharing cups or utensils.

But they don’t always cause pneumonia. For example, the bacteria that can cause walking pneumonia are more likely to cause minor illnesses, like ear infections. Still, you should avoid others if you have walking pneumonia to prevent spreading the illness.

Risk factors

You’re more likely to get walking pneumonia if you:

• Are 2 or younger
• Are 65 or older
• Have a weakened immune system
• Have a lung or airway disease, like asthma or COPD (chronic obstructive pulmonary disease)
• Live or work in crowded places, like schools, dormitories, long-term care facilities or military housing
• Use tobacco products
• Regularly use inhaled corticosteroids

Complications

Even if you don’t feel bad enough to be in the hospital, walking pneumonia can still lead to serious complications. These could include:

• Fluid around your lungs (pleural effusion)
• Bacteria in your bloodstream, which can lead to sepsis and organ failure
• Lung abscess
• Acute respiratory distress syndrome (ARDS) and respiratory failure

These aren’t common. But see a healthcare provider right away if your symptoms get worse.

How do I know if I have walking pneumonia?

To make a diagnosis, a provider will examine you and listen to your lungs. They’ll use pulse oximetry — a small device that slips over your finger — to get an idea of how much oxygen is getting to your blood. They’ll get a chest X-ray to look for pneumonia on images of your lungs.

They might also get additional tests to determine the cause. These could include nose swabs or bacterial cultures. They might get samples for a bacterial culture from your blood, sputum or fluid from around your lungs.

In some cases, your provider might do an arterial blood gas test or use a thin, lighted tube called a bronchoscope to look at the inside of your lungs.

How is walking pneumonia treated?

Treatment for walking pneumonia depends on the cause. If bacteria are causing the infection, your provider may prescribe antibiotics. These could include:

• Macrolides, like azithromycin or clarithromycin
• Fluoroquinolones, like ciprofloxacin or levofloxacin
• Tetracyclines, like doxycycline or tetracycline

If you have a virus, you probably won’t be able to treat it with medication. But if you have the flu or COVID-19, your provider might prescribe antiviral medications. Be sure to take any medications as prescribed, even if you feel better. If you stop taking antibiotics too soon, the infection could come back and be harder to treat.

A provider may recommend over-the-counter medications to help relieve nasal congestion, cough and mucus buildup in your chest. You can also help loosen mucus by:

• Using a humidifier
• Drinking plenty of fluids
• Taking warm baths or showers

When should I see my healthcare provider?

See a healthcare provider if you think you have pneumonia, or if you’re taking antibiotics and your symptoms don’t improve after a few days.

Go to the ER or call 911 if you:

• Struggle to breathe or are short of breath while sitting still
• Have rapidly worsening symptoms over minutes to hours
• Have new or worsening chest pain
• Have blue or gray skin, lips or nails
• Are confused or can’t think clearly

What can I expect if I have walking pneumonia?

Many people start to feel better after a few days of antibiotics and rest. But you might cough, feel tired or have other lingering symptoms for a few weeks afterward.

How can I prevent it?

The following tips can help you prevent getting and spreading the germs that cause walking pneumonia:

• Cover your nose and mouth when you sneeze or cough. Don’t sneeze or cough into your hands.
• Wash your hands with soap and clean water frequently for at least 20 seconds. If soap and water aren’t available, use an alcohol-based hand sanitizer.
• Wear a mask around other people during cold and flu season or when COVID-19 is spreading if you have a condition that puts you at higher risk for severe illness.
• Get recommended vaccinations to protect you from respiratory illnesses that can lead to pneumonia.
• Don’t smoke or vape and try to avoid secondhand smoke.