Pneumonia

Overview

What is pneumonia?

Pneumonia is an infection in one or both of your lungs caused by bacteria, viruses or fungi. When there is an infection in the lungs, several things happen, including:

  • Your airways swell (become inflamed)
  • The air sacs in the lungs fill with mucus and other fluids

How do the lungs work?

Your lungs’ main job is to get oxygen into your blood and remove carbon dioxide. This happens during breathing. You breathe 12 to 20 times per minute when you are not sick. When you breathe in, air travels down the back of your throat and passes through your voice box and into your windpipe (trachea). Your trachea splits into two air passages (bronchial tubes). One bronchial tube leads to the left lung, the other to the right lung. For the lungs to perform their best, the airways need to be open as you breathe in and out. Swelling (inflammation) and mucus can make it harder to move air through the airways, making it harder to breathe. This leads to shortness of breath, difficulty breathing and feeling more tired than normal.

How common is pneumonia?

Approximately 1 million adults in the United States are hospitalized each year for pneumonia and 50,000 die from the disease. It is the second most common reason for being admitted to the hospital -- childbirth is number one. Pneumonia is the most common reason children are admitted to the hospital in the United States. Seniors who are hospitalized for pneumonia face a higher risk of death compared to any of the top 10 other reasons for hospitalization.

Is pneumonia contagious?

Certain types of pneumonia are contagious (spread from person to person). Pneumonia caused by bacteria or viruses can be contagious when the disease-carrying organisms are breathed into your lungs. However, not everyone who is exposed to the germs that cause pneumonia will develop it.

Pneumonia caused by fungi are not contagious. The fungi are in soil, which becomes airborne and inhaled, but it is not spread from person to person.

How is pneumonia spread from person to person?

Pneumonia is spread when droplets of fluid containing the pneumonia bacteria or virus are launched in the air when someone coughs or sneezes and then inhaled by others. You can also get pneumonia from touching an object previously touched by the person with pneumonia (transferring the germs) or touching a tissue used by the infected person and then touching your mouth or nose.

How long do I remain contagious if I have pneumonia?

If you have bacterial pneumonia, you are still considered contagious until about the second day after starting to take antibiotics and you no longer have a fever (if you had one). If you have viral pneumonia, you are still considered contagious until you feel better and have been free of fever for several days.

Who is most at risk for getting pneumonia?

People who have an increased risk of pneumonia include:

  • People over the age of 65 and infants under age 2. The weakening immune system of older people makes them less able to fight off illnesses. Similarly, the immune system of infants is still developing and not at full-strength, making them more susceptible to infection.
  • People with a health-caused weakened immune system. Examples include:
  • People who have health conditions that affect the lungs or heart. Examples include:
  • People who have neurological conditions that make swallowing difficult. These people are at risk for pneumonia caused by aspiration. Examples include:
  • People who are in the hospital. In particular, people in the ICU or anyone recovering who spends a large amounts of time lying on their backs. This position allows fluids, mucus or germs to settle in the lungs. People who need ventilators to breathe are at even greater risk since they have a difficult time coughing up germs that could cause a lung infection.
  • People who smoke or drink alcohol. Smoking damages lung tissue and long-term alcohol abuse weakens the immune system.
  • People who are exposed to toxic fumes, chemicals or secondhand smoke. These contaminants weaken lung function and make it easier to develop a lung infection.
  • Pregnant women. Being pregnant increases the risk of developing pneumonia. This is due to the immune system of a mother not working at full strength because the body is working harder to support the growth of the baby.

Symptoms and Causes

What causes pneumonia?

Pneumonia can be caused by a wide variety of bacteria, viruses or fungi. Pneumonia is most commonly classified by the type of germ that causes it and by the location where the person became infected.

Community-acquired pneumonia is the most common type of pneumonia. This type of pneumonia occurs outside of a hospital or other healthcare facility. Causes include:

  • Bacteria: Streptococcus pneumoniae is the most common bacterial cause of pneumonia.
  • Mycoplasma pneumoniae and other atypical bacteria: Other types of bacteria with unique features can cause different types of pneumonia. These include Mycoplasma pneumoniae (causes “walking” pneumonia), Chlamydia pneumoniae (causes Chlamydia pneumonia) and Legionella pneumoniae (causes Legionnaires’ disease).
  • Viruses: Any virus that causes a respiratory tract infection (infections of the nose, throat, trachea [windpipe], and lungs) can cause pneumonia. The viruses that cause colds and flu (influenza) can cause pneumonia.
  • Fungi (molds): Pneumonia caused by fungi is the least common as pneumonia. Fungus in the soil in certain parts of the United States can become airborne and cause pneumonia. One example is valley fever.

Hospital-acquired pneumonia develops during a stay in the hospital for another illness. This type of pneumonia can be more serious because the person is already sick and antibiotics typically used may be less effective. Bacteria adapt and change over time when exposed to antibiotics, making them less effective (called antimicrobial resistance). People in hospitals spread their drug-resistant bacteria to others, leading to more severe and difficult-to-treat cases of pneumonia. People who are on breathing machines (ventilators) are at increased risk for hospital-acquired pneumonia.

Long-term care facility-acquired pneumonia occurs in long-term care facilities (such as nursing homes) or outpatient, extended-stay clinics. Like hospitalized patients, drug-resistant bacteria are found in this setting.

Aspiration pneumonia is another type of pneumonia. Aspiration is when solid food, liquids, saliva or vomit go down the trachea (windpipe) and into the lungs instead of going down the esophagus and into the stomach. If you can’t cough up these substances, these particles remain in lung tissue and can become infected and pneumonia may develop.

What are the signs and symptoms of bacterial versus viral pneumonia in adults?

Symptoms of pneumonia can range from mild (cold- or flu-like symptoms) sometimes called “walking pneumonia” to severe. How serious your case of pneumonia depends on the particular germ causing pneumonia, your overall health, and your age.

Bacterial pneumonia: Symptoms of bacterial pneumonia can develop gradually or suddenly. Symptoms include:

  • High fever (up to 105° F)
  • Tiredness (fatigue)
  • Trouble breathing: rapid breathing or shortness of breath
  • Sweating
  • Chills
  • Cough with mucus (might be greenish in color or contain a small amount of blood)
  • Chest pain and/or abdominal pain, especially with coughing or deep breathing
  • Loss of appetite
  • Confused mental state or changes in awareness (especially in older adults)

Viral pneumonia: Symptoms usually develop over a period of several days. Early symptoms are similar to flu symptoms, which include:

  • Fever
  • Dry cough
  • Headache
  • Sore throat
  • Loss of appetite
  • Muscle pain
  • Weakness

Additional symptoms appearing about a day later include:

  • Higher fever
  • Cough with mucus
  • Shortness of breath

How can I tell if I have pneumonia versus the common cold or the flu?

Do I have a cold or could it be the flu or even pneumonia? It’s tough to tell the difference but critical to know when to seek medical care

Watch for these ongoing symptoms that occur in pneumonia:

  • Serious congestion or chest pain.
  • Difficulty breathing.
  • A fever of 102 or higher.
  • Coughing that produces pus.

Pneumonia symptoms last longer than cold and flu. If your symptoms aren’t severe, it’s okay to try such home remedies as getting more rest, drinking more fluids and taking some over-the-counter medicines and see what happens. But if you don’t see improvement in your symptoms after three to five days, or if you are experiencing more serious symptoms such as dizziness or severe difficulty breathing, see your healthcare provider. Don’t let it go. Pneumonia-like symptoms in very young children or in adults older than 65 are a cause for concern. Also, pneumonia can cause permanent lung damage if left untreated for too long. And always seek immediate care if you experience chest pain or have breathing difficulties.

What are the signs and symptoms of pneumonia in children?

The signs and symptoms of pneumonia in children vary from child to child and also depend on your child’s age, cause of the infection, and severity of their illness.

Usual symptoms include:

  • Fever, chills, general discomfort, sweating/flushed skin.
  • Cough.
  • Rapid breathing (tachypnea).
  • Difficulty breathing, which can be seen as:
    • A widening of nostrils while breathing (nasal flaring)
    • Inward movement of chest wall when a child breaths in (lower chest in-drawing). With normal breathing, chest moves outward when breathing in.
  • Wheezing.
  • Pain in chest, especially when coughing or breathing deeply.
  • Bluish tint to lips or nails due to decreased oxygen level in the blood.
  • Loss of appetite.
  • Vomiting.
  • Increased tiredness (fatigue).

Babies and toddlers may show these symptoms:

  • Cough.
  • Fever.
  • Difficulty feeding.
  • Trouble breathing. Makes a grunting sound with breathing; noisy or rattly breathing.
  • Temporarily stop breathing during sleep.
  • Decreased amount of urine production.
  • Pale color
  • Appear limp.
  • Cry more than usual. Are restless or more fussy.

Adolescents have the same symptoms as adults, including:

  • Cough.
  • Fever.
  • Difficulty breathing/shortness of breath.
  • Chest pain.

Newborns are at greater risk of pneumonia caused by bacteria present in the birth canal. In young children, viruses are the main cause of pneumonia.

Pneumonia caused by bacteria tends to happen suddenly, starting with fever and fast breathing. Symptoms appear more slowly and tend to be less severe when pneumonia is caused by viruses.

Are symptoms of pneumonia different in seniors?

Older adults may have milder symptoms and may not have a fever. A sudden change in mental state is sometimes a sign of pneumonia in this age group.

Is it possible to have pneumonia without having a fever?

It’s not the norm but, yes, it’s possible to have pneumonia with a low fever or even no fever. If this occurs, it’s usually in the very young (newborns and infants) and in older adults or adults with a weakened immune system.

What are the complications of pneumonia?

Anyone can experience complications from pneumonia. However, people in high-risk groups are more likely to develop complications, including:

  • Breathing difficulties: Pneumonia can make breathing difficult. Pneumonia plus an existing lung disorder (such as COPD, emphysema, asthma) can make breathing even more difficult. Breathing difficulties may require a hospital stay to receive oxygen therapy or breathing and healing assistance with the use of a breathing machine (ventilator).
  • Fluid buildup in the lungs (called pleural effusion or “water on the lungs”): Pneumonia can cause a buildup in the fluid between the membranes that line the lungs and the inside of the chest cavity. It is a serious condition that makes breathing difficult. Pleural effusion can be treated by draining excess fluid with a catheter, chest tube or by surgery.
  • Bacteria in the bloodstream (bacteremia): The bacteria that cause pneumonia can leave your lungs and enter your bloodstream, spreading the infection to other organs. This condition is treated with antibiotics.
  • Lung abscess. A lung abscess is a pus-filled cavity in the lung that is caused by a bacterial infection. It can be treated by draining the pus with a long needle or removing it by surgery.

Diagnosis and Tests

How is pneumonia diagnosed?

Your doctor will do a thorough exam. During your exam he or she will:

  • Ask about your health history and conduct a physical exam.
  • Listen to your lungs with a stethoscope.
  • Possibly order a chest X-ray to look for signs of pneumonia and the extent of the infection.
  • Conduct a pulse oximetry test to measure the amount of oxygen in your blood (indicates how well your lungs are moving oxygen into your bloodstream).
  • Order laboratory tests of your blood and/or mucus to determine the type of infection – bacteria, virus, or fungus – that has caused pneumonia.

If you are a high-risk patient, your doctor may order other tests.

Management and Treatment

How is pneumonia treated?

How pneumonia is treated depends on the germs that cause it.

  • Bacterial pneumonia: Bacterial pneumonia is usually treated with antibiotics. The specific antibiotic choice depends on such factors as your general health, other health conditions you may have, the type of medications you are currently taking (if any), your recent (if any) use of antibiotics, any evidence of antibiotic resistance in the local community and your age. Medicines to relieve pain and lower fever may also be helpful. Ask your doctor if you should take a cough suppressant. It’s important to be able to cough to clear your lungs.
  • Viral pneumonia: Antibiotics are not used to fight viruses. (In some cases antibiotics may be given to fight a bacterial infection that is also present.) There are no treatments for most viral causes of pneumonia. However, if the flu virus is thought to be the cause, antiviral drugs might be prescribed, such as oseltamivir (Tamiflu®), zanamivir (Relenza®), or peramivir (Rapivab®), to decrease the length and severity of the illness. Over-the-counter medicines to relieve pain and lower fever are usually recommended. Other medicines and therapies such as breathing treatments and exercises to loosen mucus may be prescribed by your doctor.
  • Fungal pneumonia: Antifungal medication is prescribed if a fungus is the cause of your pneumonia.

Is pneumonia treated any differently in children?

Essentially no. Just like adults, bacterial causes of pneumonia in children may be treated with antibiotics. Antibiotics are not used to treat pneumonia caused by viruses. Flu-related pneumonia may be treated with antiviral medicine if caught early in the course of illness. Most cases of pneumonia are treated with “comfort care” measures that ease symptoms. These may include:

  • Drinking more fluids.
  • Getting more rest.
  • Taking over-the-counter medicines for cough and acetaminophen for fever. Be sure to check with your healthcare provider or pharmacist if you have any questions or concerns about giving medicines to your child.
  • Using a cool mist humidifier in your child’s room.

How soon after treatment for pneumonia will I begin to feel better?

How soon you will feel better depends on several factors, including:

  • Your age
  • The cause of your pneumonia
  • The severity of your pneumonia
  • If you have other “at-risk” conditions

If you are generally healthy, most symptoms of bacterial pneumonia usually begin to improve within 24 to 48 hours after starting treatment. Symptoms of viral pneumonia usually begin to improve within a few days after starting treatment. A cough can last for several weeks. Most people report being tired for about a month after contracting pneumonia.

When would I need to be hospitalized for pneumonia?

If your case of pneumonia is more severe, you may need to stay in the hospital for treatment. Hospital treatments may include:

  • Oxygen
  • Fluids, antibiotics and other medicines given through an IV (directly into the vein)
  • Breathing treatments and exercises to help loosen mucus

People most likely to be hospitalized are those who are most frail and/or at increased risk, including:

  • Babies and young children
  • People over age 65
  • People with weakened immune systems
  • People with health conditions that affect the heart and lungs

It may take six to eight weeks to return to a normal level of functioning and well-being if you’ve been hospitalized with pneumonia.

Prevention

Are vaccines available to prevent pneumonia?

Yes, there are two types of vaccines (shots) specifically approved to prevent pneumonia caused by pneumococcal bacteria. Similar to a flu shot, these vaccines won’t protect against all types of pneumonia, but if you do come down with pneumonia, it’s less likely to be as severe or potentially life-threatening – especially for people who are at increased risk for pneumonia.

  • Bacterial pneumonia: Two pneumonia vaccines, Pneumovax23® and Prevnar13®, protect against the most common causes of bacterial pneumonia.
    • Pneumovax23® protects against 23 different types of pneumococcal bacteria. It is recommended for all adults 65 years of age and older and children over 2 years of age who are at increased risk for pneumonia.
    • Prevnar13® protects against 13 types of pneumonia bacteria. It is recommended for all adults 65 years of age and older and children under 2 years of age. Ask your healthcare provider about these vaccines.
  • Viral pneumonia: Get a flu vaccine (shot) once every year. Flu vaccines are prepared to protect against that year’s virus strain. Having the flu can make it easier to get bacterial pneumonia.

If you have children, ask their doctor about other vaccines they should get. Several childhood vaccines help prevent infections caused by the bacteria and viruses that can lead to pneumonia.

Besides vaccination, what else can I do to prevent bacterial and viral pneumonia?

Receiving all recommended vaccinations is one of the best ways to prevent pneumonia. Additionally, there are several other ways to prevent pneumonia, including:

  • Quitting smoking, and avoiding secondhand smoke. Smoking damages your lungs.
  • Washing your hands before eating, before handling food, after using the restroom, and after being outside. If soap is not available, use an alcohol-based hand sanitizer.
  • Avoiding being around people who are sick. Ask them to visit when they are feeling better.
  • Not touching or sharing objects that are shared with others. Germs can be transferred from object to you if you touch your nose or mouth without washing or sanitizing your hands first.
  • Eating a healthy diet, exercise, and get enough rest. Healthy habits keep your immune system strong.
  • Getting treated for any other infections or health conditions you may have. These conditions could weaken your immune system, which could increase your chance of infections.
  • Avoiding excessive consumption of alcohol.

Outlook / Prognosis

What is the outlook for pneumonia?

People who are otherwise healthy often recover quickly when given prompt and proper care. However, pneumonia is a serious condition and can be life-threatening if left untreated and especially for those individuals at increased risk for pneumonia.

Even patients who have been successfully treated and have fully recovered may face long-term health issues. Children who have recovered from pneumonia have an increased risk of chronic lung diseases. Adults may experience:

  • Decreased ability to exercise
  • Worsening of cardiovascular disease
  • Mental decline
  • General decline in quality of life for months or years

Living With

What can I do to feel better if I have pneumonia?

  • Finish all medications and therapies prescribed by your doctor. Do not stop taking antibiotics when you start feeling better. Continue taking them until no pills remain. If you don’t take all your antibiotics, your pneumonia may come back.
  • If over-the-counter medicines to reduce fever have been recommended (aspirin, acetaminophen, ibuprofen, naproxen), take as directed on the label. Never give aspirin to children.
  • Drink plenty of fluids to help loosen phlegm.
  • Quit smoking if you smoke. Don’t be around others who smoke or vape. Surround yourself with as much clean, chemical-free air as possible.
  • Use a humidifier, take a steamy shower or bath to make it easier for you to breathe.
  • Get lots of rest. Don’t rush your recovery. It can take weeks to get your full strength back.

If at any time you start to feel worse, call your doctor right away.

When can I return to work, school and regular activities if I have pneumonia?

You typically can resume your normal activities if your symptoms are gone, mild or improving and you do not have new or worsening:

  • Shortness of breath or tiredness (less energy)
  • Chest pain
  • Mucus, fever or cough

If you are generally healthy, most people feel well enough to return to previous activities in about a week. However, it may take about a month to feel totally back to normal.

When should I see a doctor?

Call your doctor if you:

  • Have new or worsening:
    • Shortness of breath with activities or when lying down
    • Fever or cough with mucus
    • Tiredness (fatigue)
  • Have a change in appetite (less hunger)
  • Feel uneasy and know that something is not right

If you or your loved one with symptoms is in a high, “at-risk” group, see your doctor as soon as possible. Pneumonia can become a life-threatening condition.

When should I go to the emergency room?

Go to the emergency room or call 911 if you:

  • Struggle to breathe or are short of breath while sitting still
  • Have new or worsening chest pain
  • Are confused or cannot think clearly

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