Let’s Talk About Pneumonia Symptoms
Everything you need to know about what this lung infection looks and feels like, plus how to get better in a hurry.
You probably know that pneumonia can cause a fever and nasty cough. But did you know that mental confusion can also be a sign of pneumonia…or that people with weakened immune systems may actually have fewer symptoms of this illness than younger or healthier people—and may not cough or have a fever at all? Here’s what to know about this sometimes-tricky infection, plus the most effective ways of treating it.
Our Pro Panel
We went to some of the nation’s top experts in lung disorders and infectious diseases to bring you the most scientific and up-to-date information available.
Michael Gutwein, M.D.
Chief Emeritus, Infectious Disease Division
Missouri Baptist Medical Center
St. Louis, MO
Jeffrey Pernica, M.D.
Head, Division of Infectious Diseases and Associate Professor, Department of Pediatrics
Rachel Scheraga, M.D.
Assistant Professor of Medicine and Associate Staff Physician, Pulmonology and Critical Care Medicine
No. In fact, people over 65 often have neither a cough nor fever, helping their lung infection to stay under the radar. Experts say a key sign of pneumonia in this age group (and sometimes the only sign) is a sudden change in mental awareness.
Babies may have less-typical symptoms of pneumonia. They may vomit or appear restless or listless, with low energy. They may also grunt, have a bluish tone to their skin and lips, or have difficulty eating. Any of these are good reasons to call your pediatrician.
COVID-19 pneumonia is not more deadly than other types of severe pneumonia, but it does last longer. In a Northwestern University study, researchers found that the SARS-CoV-2 (COVID) virus hijacks the lungs’ own immune cells and uses them to very slowly spread over the lungs over a period of days or weeks; this is different from how other bacteria and viruses behave in the lungs.
Once you’re diagnosed and start treatment, your symptoms should start to improve pretty quickly. But full recovery can take a week to a month. If you have one or more other medical conditions, you’ll probably recover more slowly than someone with no underlying conditions. Even after your infection clears up, expect the cough from pneumonia to linger for a while.
Recap: What Is Pneumonia?
Pneumonia is an infection in your lungs, usually caused by viruses or bacteria; less commonly, it can be caused by a fungus. Specifically, pneumonia affects your lungs’ air sacs (alveoli) and the tissue surrounding them. To help visualize this, let’s quickly review the anatomy of your lungs.
Your trachea, or windpipe, leads into an airway, or bronchus (plural: bronchi) that connects with each lung. These bronchi branch off into smaller bronchi, which in turn branch off into thousands of even smaller airways called bronchioles. The bronchioles culminate in millions of tiny air sacs called alveoli. The alveoli are covered in very small blood vessels called capillaries, which get oxygen from the alveoli to carry to the cells throughout your body and return carbon dioxide to be exhaled.
When your lungs are infected, however, the alveoli fill up with fluid or pus rather than air, while the bronchioles may become inflamed and swollen, making it harder for air to move through them. All of this makes it harder for oxygen to get into your bloodstream and leads to difficulty breathing.
Pneumonia might affect one lung, in which case it’s called unilateral pneumonia, or it might strike both lungs, called bilateral pneumonia. Anyone can get pneumonia, but it’s most common in people older than 65, infants and very young children, and people with weakened immune systems (for example, due to a medical condition or the use of immunosuppressive medications).
In some cases, pneumonia can result from a lingering cold or a bout with the flu, bronchitis, or now, COVID-19. Other times, it strikes on its own. A case of pneumonia can range from super mild (you might not even know you have it) to serious or life-threatening. It’s also a relatively common illness: Prior to the coronavirus pandemic, pneumonia affected millions of people in the U.S. each year, sent about 1.3 million to the emergency room, and killed more than 50,000, according to the National Center for Health Statistics. COVID caused those numbers to rise dramatically: From January 2020 to April 2021, more than 260,000 people in the U.S. died from pneumonia related to COVID alone, according to government estimates.
What Causes Pneumonia?
COVID is one possible contributing factor to getting pneumonia, but there are many other causes. Almost all cases begin when microorganisms—tiny germs you can’t see—are able to overcome your body’s natural defenses and get down into your lungs, where they multiply.
The vast majority of the germs that cause pneumonia are bacteria or viruses. Viruses that cause pneumonia include influenza, respiratory syncytial virus, rhinoviruses, and coronaviruses. These germs can be transmitted through respiratory droplets that you breathe in from the air (for example, if someone who is sick coughs or sneezes near you) or pick up by touching a surface that was coughed on, sneezed on, or touched by an infected person, and then touching your nose or mouth.
Sometimes, pneumonia develops from germs that are already inside your body: For example, you could have an existing upper respiratory infection, such as a cold or the flu (both caused by viruses), and the germs spread to your lungs, causing pneumonia. Additionally, bacteria that normally live in your nose and throat without causing trouble can take advantage of a weakened immune system—from a recent illness, a chronic illness, or an immune-suppressing medication, say—to migrate downward into your lungs.
Rarely, pneumonia can be caused by a fungus (a.k.a. mold). Unlike bacterial and viral pneumonia, fungal pneumonia can’t spread from person to person. You get it by breathing in microscopic fungal spores that get into the air from the soil or from bird or bat droppings.
Risk Factors for Pneumonia
Along with these various causes, certain risk factors play an important role in determining who gets pneumonia. Some of them you can control, while others you can’t:
Being older than 65 or younger than 2
Having an underlying lung condition such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis
Having another chronic medical condition, including heart disease, type 2 diabetes, and chronic kidney disease
Difficulty swallowing (dysphagia) or coughing
Heavy alcohol use
Living in a long-term care facility
Recent major surgery or injury
Recent viral respiratory illness such as the common cold, flu, or COVID-19
What Are the Symptoms of Pneumonia?
For some people, a bout of this lung infection can be a painful blur of fever, coughing, fatigue, and breathlessness that feel like they’ll last forever. Other people have such mild illness that they don’t even know they’re sick, or figure they just have a cold (you may have heard this referred to as “walking pneumonia”). To complicate matters, the symptoms of pneumonia can overlap with those of other respiratory illnesses, like colds, flu, bronchitis, and COVID—all of which can also lead to pneumonia themselves.
For reasons that aren’t totally clear, older adults and people with weakened immune systems often have fewer and milder symptoms of pneumonia than younger adults—even though the illness is more dangerous for them. For example, older adults often have no fever and may not have noticeable respiratory symptoms. Instead, they might suddenly become confused or lethargic or have other mental changes.
Interestingly, how quickly your symptoms come on can be a clue to what kind of pneumonia you have: Viral pneumonia usually begins gradually, with earlier symptoms resembling those of other viruses like the flu, then worsens after 12 to 36 hours. Symptoms of bacterial pneumonia typically start abruptly. These are some of the common signs to look for.
In viral pneumonia, the cough may be dry, especially early on in the infection. With bacterial pneumonia, the cough is often “productive,” meaning you’re coughing up phlegm (also called sputum). The phlegm may be green or yellowish-tan or in color or even bloody. As viral pneumonia worsens, the cough sometimes becomes productive. Even after your infection clear up, the cough from pneumonia may hang around for a while—sometimes up to 6 weeks.
The pain might feel sharp or stabbing. It may get worse when you cough or when you take a deep breath. This symptom may be related to fluid build-up in the lungs (known as pleural effusion, or “water on the lungs”) that happens with pneumonia. Some people don’t even know they have this symptom, but it is apparent on an X-ray. Generally, chest pain begins to improve once treatment is started.
Not everyone with pneumonia gets a fever, but if you have this symptom it can range from a low-grade temperature (around 100°F) to as high as 105°F (this is extremely high, and it’s dangerous). A sudden high fever is more likely if your pneumonia is caused by bacteria. While fever with viral pneumonia usually starts off low, as the infection progresses your temperature can get higher, according to the Cleveland Clinic.
Chills can happen with either bacterial or viral pneumonia and can be bad enough that they cause full-body shaking. As a general rule, you should call your doctor anytime you have a fever above 102°F, or, if you’re immunocompromised, 100.4°F. An interesting fact: Older adults with pneumonia not only are less likely to have a fever but may actually have lower-than-normal body temperature. This is also true of people with weakened immune systems.
This symptom is more common in people over 65; in fact, experts say that confusion or other sudden changes in cognitive function, like becoming disoriented, are sometimes the only warning sign of pneumonia in older adults. This may be partly due to differences in older adults’ immune responses compared to those of younger people. Additionally, older adults are more likely to have underlying conditions—often multiple ones—that can cause symptoms to manifest differently.
Shortness of Breath
We’re not talking about getting winded during Soul Cycle-level exertion; this is breathlessness that happens when you’re doing everyday activities that you normally accomplish without difficulty, like walking up the stairs or getting the mail. You might even feel breathless when you’re sitting still and doing nothing at all. You may also notice that your breathing is shallow.
Less Common Pneumonia Symptoms
While the symptoms above are the most prevalent signs of this illness, there are other less-common red flags to key an eye out for. Other symptoms you might experience include:
Fatigue or weakness
General body aches and/or muscle pain. This is more common in viral pneumonia, and usually early in the course of illness. These are these “I hurt everywhere” aches that also accompany the flu.
Loss of appetite
Nausea and vomiting. This is more common in young children.
Rapid breathing. Usually defined as a resting breathing rate of more than 25 breaths per minute in adults. For comparison, a normal breathing rate in a healthy adult or child age 12 or older is 12 to 18 breaths per minute. (Younger children naturally breathe faster; a normal breathing rate for a 1 to 5 year old is 20 to 30 breaths per minute.)
Rapid pulse. This is also known as tachycardia and is usually defined as more than 100 beats per minute in adults. (A normal resting heart rate for adults is 60 to 100 beats per minute.) Children’s resting heart rates are naturally higher: A normal heart rate for an infant up to 12 months old is 100 to 160. The normal range for kids ages 1 to 11 is 70 to 120.
Sore throat. This is more common in viral pneumonia, early on.
Emergency Pneumonia Symptoms
In severe cases, people with pneumonia can experience serious difficulty breathing or develop a blue tinge to their lips, fingernails, or other skin areas (a sign that blood oxygen is dangerously low). If either of these happens to you or someone you’re with, it is a medical emergency: Call 911 immediately.
Additionally, infants and very young children with pneumonia sometimes can’t drink enough fluids to stay hydrated, evidenced by a dry mouth or not wetting their diapers regularly. If this happens to your child, take him or her to the emergency room, since IV fluids might be needed to prevent dehydration.
Are My Symptoms Pneumonia, COVID, or Both?
You may have noticed something about the symptoms listed above: Many of them overlap with those of COVID. So how do you know which you have—COVID, or pneumonia? Or neither? Or both? There’s only one way to tell, and that’s to have a COVID test.
The SARS-CoV-2 virus (the new coronavirus that causes COVID-19) not only can cause symptoms that are similar to those associated with pneumonia, like coughing and fever, but can cause pneumonia itself (known as SARS-Co-V-2 pneumonia or COVID-19 pneumonia). Having a bout of COVID also puts you at risk of developing a “secondary” case of bacterial pneumonia. (This is true of all respiratory viruses, because of the toll they take on your immune system and the acute damage they can cause to your respiratory tract.)
Whether or not you have or end up getting pneumonia, it’s important to know if you have COVID since it can damage many other organ systems and, of course, is highly contagious. All the more reason to consult your doctor pronto if you are having the symptoms discussed in this section—and make sure that any diagnosis you get includes COVID testing.
How Is Pneumonia Diagnosed?
If you have symptoms that you think might be pneumonia, it’s a good idea to call your doctor—especially if you have an underlying medical condition, are immunocompromised, or are older than 65, or if the person having the symptoms is a baby or young child. Only a doctor can determine for sure if you have pneumonia, since the diagnosis generally depends on an X-ray or other imaging to show infection in your lungs.
If your doctor determines you have pneumonia, along with medications, there are a few at-home measures you can use to help yourself feel better:
Avoid alcohol. It weakens your immune system.
Don’t smoke. There’s nothing worse you could do for your lungs right now. Smoking causes damage to the lungs that limits their ability to fight off infection.
Ease coughing or a sore throat with lozenges or hot water with lemon and honey.
Get plenty of rest. Put off tasks you don’t need to do until you are feeling better. If possible, have someone else do the dishes and laundry or help with childcare.
Stay well-hydrated. Your body needs extra fluids right now. Drink plenty of water or other nonalcoholic beverages. Being hydrated also helps to loosen up your lung secretions (see bullet below).
Take over-the-counter pain relievers like Tylenol (acetaminophen), Advil/Motrin (ibuprofen), or Aleve (naproxen) as needed to reduce a fever or and ease aches and pains.
Breathe in moist air to loosen up lung sections. This will make them easier to cough up and spit out. You can use a cool-mist humidifier, take a hot shower, or sit in a steamed-up bathroom.
Preventing and Recovering From Pneumonia
Here’s some good news about pneumonia: Once you start treatment for pneumonia, you should start feeling better within a couple of days, and most people recover fully in one to three weeks. But there’s lots of variation between people, and if you’re already living with one or more chronic conditions it could take more time to recover from any type of pneumonia. Even after your infection clears up, your cough could linger for up to six weeks, and you may still feel tired or weak for about a month.
Another piece of good news is that there are concrete—and effective—steps you can take to help prevent pneumonia. Wash your hands often or use a hand sanitizer with at least 60% alcohol. Disinfect commonly touched surfaces, stay away from people who are sick, and avoid touching your mouth, nose, or eyes without first washing or sanitizing your hands.
But smart infection-prevention measures aren’t all you can do. There are two vaccines that can help protect you against the most common kinds of pneumonia. One is your annual flu shot: By protecting you against influenza, it also protects you from influenza’s potential complications, including pneumonia. The second is the pneumococcal vaccine, which prevents infection by Streptococcus pneumonia, also known as pneumococcus. This germ causes the most common type of bacterial pneumonia.
Bottom line? Pneumonia symptoms can be unpleasant and sometimes scary. Knowing what to look for and when to see the doctor can help maximize your chances of catching the infection early, before it can do too much damage. If you’re diagnosed with pneumonia, follow your doctor’s instructions to help your body can heal. With the right treatments, rest, and self-care, you will be back to your usual self soon.
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