Walking pneumonia, also known as atypical pneumonia, is a mild form of pneumonia that doesn’t require bedrest or hospitalization. It’s caused by bacteria or viruses that are different from those that cause typical pneumonia. The most common culprits are Mycoplasma pneumoniae and Chlamydophila pneumoniae.
With walking pneumonia, you may have a cough that lingers for weeks or months, along with other upper respiratory symptoms like a low-grade fever, headache, fatigue, and a sore throat. Many people aren’t even aware they have pneumonia and think they just have a bad cold or the flu. This is why it can go undiagnosed for a long time.
So is it possible to have walking pneumonia for months without knowing it? Let’s take a closer look.
What are the symptoms of walking pneumonia?
The symptoms of walking pneumonia are often milder than regular pneumonia. They may include:
– Cough, which may be dry at first then produce mucus
– Fatigue and tiredness
– Low fever, usually less than 101°F (38°C)
– Chills
– Shortness of breath, especially with activity
– Sore throat
– Runny nose
– Headache
– Muscle aches
– Nausea, vomiting, diarrhea (more common in children)
Many of these symptoms overlap with those of the common cold or flu. The cough tends to be the most prominent symptom and usually gets worse over time. At first it may be dry, then after a week or so it starts producing thicker mucus.
Unlike regular pneumonia, walking pneumonia generally doesn’t cause high fevers, chills, chest pain, or rapid/labored breathing. Symptoms also come on more gradually over days or weeks, compared to just a few days with other types of pneumonia.
Why the symptoms are often missed
There are a few key reasons why walking pneumonia symptoms can be overlooked or mistaken for something else:
– **Mild nature of symptoms:** No severe fever, chills, chest pain or breathing issues that typically bring someone into the doctor’s office. Many people try to ignore symptoms or self-treat with over-the-counter medications.
– **Gradual onset:** Symptoms develop slowly over several days or weeks, making it less obvious that something is wrong.
– **Overlaps with cold/flu:** Symptoms like cough, sore throat, headache and fatigue mirror common colds and influenza. People assume they just have a bad viral illness.
– **May not feel ill:** Some people still feel relatively normal despite having walking pneumonia. They may only notice a lingering cough but otherwise don’t think they’re sick.
– **No imaging done:** Without getting a chest X-ray, walking pneumonia can be impossible to identify. Doctors don’t routinely order imaging for suspected colds and flu.
So in summary, the characteristics of walking pneumonia make it easy to dismiss or not realize the actual problem. Unless imaging tests are done or the cough persists/worsens, walking pneumonia can be missed.
How long can walking pneumonia last?
Walking pneumonia can linger for **weeks or even months** if left untreated. Here is an overview of how long it typically lasts:
– **Acute phase:** The acute infection lasts about **2-4 weeks** on average. During this time, symptoms like fever, cough, and fatigue are at their worst.
– **Lingering cough:** The cough is usually the most persistent symptom. It may last **4-8 weeks** or longer after other symptoms improve.
– **Fatigue:** Fatigue and tiredness can also trail behind and last for weeks after the initial illness.
– **Total duration:** From onset of symptoms to complete resolution, walking pneumonia can last **6-12 weeks or longer**. The lingering cough contributes to the extended duration.
In some people, the cough and fatigue may come and go in cycles over the course of a few months. Symptoms improve temporarily, only to return days or weeks later. This cycling pattern extends the total duration.
So in summary, walking pneumonia is often a long-lasting illness that drags out for many weeks or months. The cough tends to be the most stubborn, lingering symptom.
Risk factors
Certain factors put you at increased risk for developing walking pneumonia and having it turn into a long-term, persistent infection:
– **Age:** Older adults are more susceptible due to weakened immune systems. Walking pneumonia is most common in those over age 60.
– **Smoking:** Smoking impairs lungs’ ability to clear infection. Smokers are more prone to all types of pneumonia.
– **Asthma or COPD:** Chronic lung diseases make it harder to recover from lung infections.
– **Immune disorders:** Conditions that impair immunity like HIV/AIDS, cancer treatment side effects, and immunosuppressant medications used after organ transplants increase pneumonia risk.
– **Lung damage:** Structural lung damage from conditions like COPD or cystic fibrosis increase vulnerability to pneumonia. Damaged lungs have more trouble fighting off infections.
– **Recent respiratory infection:** A recent cold or flu can pave the way for a secondary pneumonia infection.
So people with the above risk factors need to be extra vigilant about pneumonia symptoms and seek medical care promptly, as they are vulnerable to more severe and prolonged illness.
Complications
While walking pneumonia is considered a mild form of pneumonia, complications can still occur in some cases. Potential complications include:
– **Progression to bacterial pneumonia:** Viral or atypical pneumonia can sometimes pave the way for a secondary bacterial pneumonia infection. This can cause a rapid worsening of symptoms.
– **Pleural effusion:** Fluid can build up in the pleural space between the lungs and chest wall, causing shortness of breath.
– **Respiratory failure:** Severe cases may lead to low oxygen levels that require hospitalization and breathing support. This is rare with walking pneumonia.
– **Blood infection:** The pneumonia bacteria may spread from the lungs into the bloodstream, causing a serious systemic infection known as bacteremia.
Other potential issues include lung abscess formation and acute respiratory distress syndrome (ARDS).
While not common with walking pneumonia, complications can occur, especially in high-risk individuals. Seeking prompt treatment is important to prevent complications and manage any that develop.
Diagnosis and Testing
Since walking pneumonia symptoms are often ambiguous, testing is needed to confirm the diagnosis. Here are the main methods used:
Chest X-ray
A chest X-ray is usually the first test ordered when pneumonia is suspected. With walking pneumonia, the chest X-ray may be normal or only show mild/non-specific abnormalities that are atypical for pneumonia. However, it can identify abnormalities that prompt further testing.
Complete blood count
A complete blood count (CBC) measures white blood cell levels. With bacterial pneumonia, white blood cells are usually elevated. Viral pneumonia may show normal or only slightly elevated white blood cells.
Pulse oximetry
This simple test measures oxygen saturation in the blood using a fingertip probe. Low oxygen levels can indicate respiratory distress and the need for supplemental oxygen.
Sputum culture
Coughing up a sputum (mucus) sample for culture can help identify the type of bacteria causing the pneumonia. However, sputum culture may be inconclusive with walking pneumonia.
Blood culture
If bacteremia is suspected, blood cultures can also help pinpoint the causative bacteria. Blood cultures are not routinely performed for mild walking pneumonia cases.
Polymerase chain reaction (PCR)
PCR testing of respiratory secretions can detect the presence of viruses and atypical bacteria that cause walking pneumonia, including influenza, adenovirus, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.
| Test | Purpose |
|---|---|
| Chest X-ray | Identify pneumonia and assess severity |
| CBC | Check for increased white blood cells |
| Pulse oximetry | Assess oxygen levels |
| Sputum culture | Identify bacteria causing pneumonia |
| Blood culture | Check for blood infection |
| PCR | Detect viruses and atypical bacteria |
The combination of a chest X-ray, CBC, pulse oximetry, and PCR testing of respiratory secretions can help diagnose walking pneumonia. Sputum and blood cultures may be ordered as well.
Treatment
Treatment focuses on relieving symptoms and shortening the duration of illness. Options may include:
Rest and hydration
Getting adequate rest and drinking plenty of fluids supports healing and prevents dehydration from fever, sweating, and increased breathing rate.
Cough medicine
Cough suppressants, expectorants, and cough drops can provide symptom relief.
Fever and pain reducers
Medications like acetaminophen and ibuprofen help reduce fever and muscle aches.
Antibiotics
Antibiotics are often prescribed for walking pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae. Commonly used antibiotics include:
– Macrolides: azithromycin, clarithromycin
– Tetracyclines: doxycycline
– Fluoroquinolones: levofloxacin, moxifloxacin
Antibiotics shorten duration of illness by 1-2 weeks compared to no treatment. They are critical for high-risk patients.
Bronchodilators
Inhalers like albuterol may provide relief for coughs by opening airways.
Oxygen therapy
If oxygen levels are low, oxygen delivered through a nasal cannula or mask can help normalize oxygen saturation.
Breathing treatments
Nebulized breathing treatments can help clear mucus from airways and ease shortness of breath.
Follow-up chest x-ray
Repeat chest x-rays may be recommended after treatment to confirm resolution of pneumonia.
Seeking treatment at the first signs of walking pneumonia can minimize complications and shorten duration of illness. High risk patients may need hospitalization for oxygen and breathing treatments.
Prevention
You can lower your chances of getting walking pneumonia with good preventive habits:
Get recommended vaccines
Vaccines for influenza, COVID-19, pertussis, and pneumococcal pneumonia help prevent respiratory infections.
Wash hands frequently
Thorough, regular handwashing lowers risk of viral and bacterial spread.
Avoid close contact with sick individuals
Keep your distance from anyone with cold or flu symptoms. Avoid large crowds during peak cold/flu season.
Don’t smoke
Avoid tobacco smoke, either first or second-hand. Smoking damages lungs’ natural defenses.
Get enough sleep
Adequate sleep ensures a strong immune system that can fight off infections.
Manage underlying conditions
Optimally control any chronic illnesses like asthma, COPD, diabetes or immune disorders.
Consider a pneumonia vaccine
The pneumococcal vaccines Prevnar 13 and Pneumovax 23 protect against bacterial pneumonia.
With diligent prevention, you can lower your likelihood of coming down with walking pneumonia. But if symptoms do develop, prompt medical treatment is key to minimizing complications.
Conclusion
Walking pneumonia often goes unrecognized or mistaken for a bad cold. Its mild nature at onset and non-specific symptoms like low fever, headache, and lingering cough make it easy to overlook. Without imaging and lab tests, it can be impossible to diagnose.
This leads many to battle walking pneumonia for weeks or months before seeking medical treatment. The gradual onset, overlapping cold symptoms, and typically slow progression allow it to fly under the radar. But allowing the infection to drag out for too long raises the risks of complications like pleural effusion or secondary bacterial pneumonia.
Those vulnerable to severe pneumonia, like the elderly, smokers, and those with chronic medical conditions, cannot afford to ignore possible symptoms. Early diagnosis and treatment in these patients can prevent complications and shorten duration of illness.
With the awareness that pneumonia can develop slowly and subtly, individuals should be alert for common walking pneumonia signs. A cough lasting over 3 weeks or consistent fatigue/tiredness calls for seeing a doctor. Appropriate lab testing and imaging will reveal if walking pneumonia is the culprit. With proper treatment, the majority of cases resolve within a few weeks to months. But untreated, walking pneumonia can linger indefinitely, still potentially causing organ damage in the absence of severe symptoms. So prompt diagnosis and care provides the best opportunity for a quick recovery.
