Pneumonia — an infection of one or both of your lungs — can leave you coughing, feverish and feeling miserable. And sometimes, it can land you in the hospital struggling to breathe.
While the rate of pneumococcal infections has been decreasing since the introduction of pneumococcal conjugate vaccines in 2000, more than 40% of the bacteria that cause pneumonia are resistant to one or more antibiotics, according to the Centers for Disease Control and Prevention.
In October 2024, the CDC reported an increase in pneumoniae infections among children ages 2 to 17 in the United States. This rise in pneumonia cases is largely being caused by the bacteria Mycoplasma pneumoniae. M. pneumoniae infections are generally mild and mostly present as a chest cold but may also present as pneumonia. When an M. pneumoniae infection progresses to pneumonia, it’s typically a less severe form of bacterial pneumonia commonly referred to as “walking pneumonia.”
[READ: How to Get Rid of a Cold and the Flu]
What Is Pneumonia?
Pneumonia affects the air sacs of the lungs, called alveoli. As these air sacs become inflamed and infected, they fill with fluid, making breathing more difficult and reducing the flow of oxygen throughout your body.
Pneumococcal infections are more common in the winter and early spring.
Cases range from fairly mild to dangerously severe. According to the CDC, about 1 million people in the U.S. are hospitalized from pneumonia each year. It kills about 41,000 people in the U.S. yearly, most of them older adults and children under 5 years old.
“The danger with pneumonia is more related to the host, or the person experiencing the pneumonia, and their other medical conditions,” says Dr. Laraine Washer, a clinical professor in infectious diseases at the University of Michigan Medical School. “People who are more likely to have severe pneumonias are those of older age, those who have emphysema or other lung diseases and patients who perhaps have decreased immune systems, for various reasons.”
Having a history of stroke or other chronic illnesses also makes people more vulnerable to pneumonia, adds Washer, who is also the hospital epidemiologist for the University of Michigan Health System. Smokers are more likely to develop pneumonia.
A variety of bacteria, viruses and fungi cause different types of pneumonia. These germs enter the respiratory tract though your mouth or nose. There are several ways you can become infected:
— If an infected person coughs or sneezes on you
— If you breathe in the germs
— If you touch a contaminated surface and then touch your face
[READ: 10 Signs of Strep Throat]
Types
Experts break down pneumonia into two broad categories, depending on where you contract the infection:
Community-Acquired pneumonia
Group settings, such as college dorms, schools, workplaces, day care, public transit and anywhere people gather, are prime sources of contagion.
With community-acquired pneumonia, “It’s people who’ve just been living their day-to-day lives,” says Dr. David LaFon, a pulmonologist and an assistant professor in the Division of Pulmonary, Allergy and Critical Care Medicine at the Heersink School of Medicine at University of Alabama at Birmingham.
Certain kinds of bacteria — streptococcus, pneumococcus and H. influenzae — are commonly responsible for community-acquired pneumonia, LaFon says. “Those tend to cause the typical signs of pneumonia, like fever, cough and difficulty breathing.”
Having the flu can be a direct cause of pneumonia, he adds, or it can predispose people to eventually develop a bacterial infection. Walking pneumonia is a milder type of community-acquired pneumonia.
[READ: The Differences Between RSV, COVID and the Flu Symptoms]
Hospital-Acquired pneumonia
This is also called nosocomial pneumonia, meaning it originated or occurred in the hospital. Nursing home-acquired pneumonia is similar, although it’s contracted in a long-term care facility rather than a hospital. Nursing-home acquired pneumonia is one of top causes of hospital readmissions for residents.
If people with pneumonia have recently been exposed to a health-care or nursing-home setting, certain bacteria may be suspected, LaFon says. These can include antibiotic-resistant bacteria like MRSA and organisms called gram-negative bacteria.
Causes
The following are the main categories of organisms that cause pneumonia:
Bacterial pneumonia
Most cases of pneumonia are bacterial in origin, with Streptococcus pneumoniae the leading cause of bacterial pneumonia globally.
Bacterial pneumonia includes:
— Pneumococcal pneumonia. This common type of bacterial pneumonia is caused by Streptococcus pneumoniae.
— Mycoplasma pneumoniae.
— Staph pneumonia. Staph pneumonioa is caused by Staphylococcus aureus. MRSA is an antibiotic-resistant form of S. aureus bacteria.
— H. influenzae pneumonia. Although similar-sounding, Haemophilus influenzae bacteria are not related to the flu virus.
— Gram-negative pneumonia. This is pneumonia caused by bacteria such as E. coli, Klebsiella or Pseudomonas. (They’re called gram-negative because of how they respond to a chemical staining process in the lab.) This type of pneumonia is more common in health care facilities than in the community.
Viral pneumonia
Viral pneumonia includes these types:
— Influenza pneumonia caused by influenza (flu) viruses A and B.
— RSV pneumonia (respiratory syncytial virus). RSV is more common in children.
— Adenoviruses, rhinoviruses and human metapneumovirus are less common causes of viral pneumonia.
Walking pneumonia
Mycoplasma pneumonia is also called atypical or walking pneumonia. Caused by bacteria called Mycoplasma pneumoniae
, it’s milder than typical bacterial pneumonia. M. pneumoniae infections can occur at any age, but they most often occur among children ages 5 to 17 years and young adults.
Fungal pneumonia
Pneumonia can develop from diseases that are caused by breathing in airborne fungal spores. Fungal pneumonia is less common than viral or bacterial types.
In addition to contagion from outsides sources, your nose can be “colonized” with bacteria without you realizing it. That bacteria may stay there indefinitely or become invasive and actually cause infection, Washer explains.
[READ: Flu vs. the Common Cold.]
Symptoms
It can be hard to tease out whether symptoms you’re experiencing are due to a common cold or pneumonia, and if you need to be seen by a doctor. The time frame provides a clue, says Dr. Heather Alden, a family medicine physician in Sandy, Utah.
“Most patients start getting concerned when they have maybe an illness, like a cold, that’s lasting much longer than they expect,” Alden says. “A lot of patients come in and say, ‘It’s been almost two weeks and I’m still having fevers.’ So it’s the length of symptoms, the persistence of fever or new symptoms. They’re having chills; they’re coughing more mucus and thick phlegm. These are usually reasons why people eventually come into the office.”
Pneumonia symptoms:
— Cough with or without phlegm
— Blood-tinged phlegm
— Fever and chills
— Wheezing
— Breathing difficulty or shortness of breath
— Night sweats
— Nasal flaring and rapid breathing in infants
— Chest pain when breathing or coughing
— Decreased energy
— Appetite loss
— Low blood oxygen levels
Older adults may experience weakness, confusion or a lower-than normal temperature instead of a fever. Sometimes babies may vomit, appear restless or have low energy, or show signs of breathing problems.
Diagnosis
Even with milder symptoms, such as low-grade fever,
an ongoing cough, feeling tired or loss of appetite, you might need an examination from your primary care provider.
“I usually tell patients: If you’re having cold symptoms 7 to 10 days and things still aren’t getting better, that’s when you should go see your doctor,” Alden says.
To diagnose pneumonia, health care providers evaluate your symptoms, listen to your lungs with a stethoscope and possibly order a chest X-ray or other imaging tests. The extent of testing varies depending on whether your infection is likely community-acquired or hospital-based, your age and medical history and the severity of your symptoms.
Patients admitted to the hospital typically get blood work done and sometimes have sputum samples taken to isolate a particular bacteria causing the pneumonia, LaFon adds.
Treatment
Pneumonia that’s treated at home typically involves oral medication and supportive measures.
Antibiotics
Bacterial pneumonia is treated with antibiotics.
“Over time, we have found shorter courses are equally effective as longer courses,” Washer says. “Currently, for most patients, five days of antibiotics are sufficient. There’s a lot of good data that suggests that, in fact, longer courses are probably worse for the patients.”
Antibiotics may cause side effects, particularly GI symptoms, including nausea, abdominal pain, diarrhea or just decreased appetite, Alden notes. Taking antibiotics with food can help prevent these symptoms, she says, and an over-the-counter probiotic supplement or simply eating yogurt may also help.
“I would encourage anybody who is prescribed antibiotics for anything to ask the prescriber what side effects to look out for, or if there are any interactions with other medications that they need to watch for,” LaFon says. Your doctor or pharmacist can go over your current medications to make sure they’re compatible with a newly prescribed antibiotic.
Experts emphasize the importance of taking antibiotics as prescribed and finishing the entire course, notifying your health care provider if you have any side effects. Completing your antibiotics helps prevent any remaining bacteria from becoming drug-resistant.
“Within 48 hours of antibiotics, you should start feeling a lot better, but don’t expect to be fully 100% back,” says Alden, who tells patients to give themselves 7 to 14 days to recuperate.
[Read: Getting Your Probiotic Fix When Taking Antibiotics.]
Antivirals
Viral pneumonia does not respond to antibiotics. For influenza-related pneumonia, antiviral medications like oseltamivir (brand name Tamiflu) may be prescribed.
“In most of the viral illnesses, specific antiviral treatment isn’t indicated for otherwise healthy people,” Washer says.
Supportive care
While you’re recovering from pneumonia at home, these supportive measures can help:
— Your primary care provider or pediatrician may suggest an over-the-counter medication such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) to reduce fever.
— Stay hydrated by drinking as much water and other fluids as possible.
— You may need help with a troublesome cough. “Coughing, in itself, is not necessarily a bad symptom,” Alden says. “It’s your body trying to get rid of the excess mucus and phlegm and clear your lung out a little bit.” However, she adds, some people may cough so excessively that they can pull muscles in their chest. Sleep can also suffer. “If it’s keeping them up at night and they’re not getting good rest, I usually will prescribe a cough suppressant for patients.”
— Rest to recuperate. Avoid the temptation to jump back into your daily routine as soon as you start feeling a little better. It’s usually OK to return to activities like exercising once antibiotics are done, Alden says, although you might have to reduce the rigor or intensity at first, then gradually ramp up.
Complications
“The good news is that most pneumonias are fairly easy to treat, as far as noncomplicated, community-acquired pneumonia,” Alden says. “They’re very receptive to antibiotics. However, in certain situations, people can have complications such as sepsis.”
Sepsis, a systemic complication of infection, can lead to plunging blood pressure and organ failure, and can be lethal.
For pneumonia severe enough to hospitalize a patient, treatment is more aggressive. Intravenous (IV) antibiotics and fluids are more likely to be given at first. Supplemental oxygen may be needed for patients with trouble breathing.
If supplemental oxygen is not enough, patients may require intubation, or insertion of a tube, and mechanical ventilation to help them breathe until the pneumonia resolves.
Empyema is the development of infected fluid (pus) in the space around the lungs. In addition to IV antibiotics, a patient might need a drainage procedure with a chest tube to treat this infection, Washer says.
Permanent damage to lung tissue may occur with severe pneumonia, possibly resulting in decreased lung capacity from scarring. In very serious cases, damaged sections of the lung may also need to be removed to help prevent pneumonia from happening again.
Prevention
Pneumonia, or pneumococcal, immunization programs in recent years have led to a substantial reduction in infection caused by strains of pneumococcal bacteria.
Vaccines
There are two types of pneumonia vaccines recommended by the CDC:
— Pneumococcal conjugate vaccine 13 (PCV13) for children younger than 5 years old, adults 65 years or older and people 6 years or older with certain risk factors
— Pneumococcal polysaccharide vaccine (PPSV23) for adults 65 years or older and high-risk people 2 through 64 years old
It is now recommended that all people with asthma and anyone exposed to tobacco smoke also receive the pneumonia vaccine.
Discuss the pneumonia vaccine with your doctor, as some groups should receive both shots. What most people don’t realize is that this vaccine also protects against sinus infections and ear infections, as it’s the same bacteria that causes pneumonias.
Minimizing exposure
You can take steps at home to prevent pneumonia from affecting your family.
— Avoid exposure to people whom you know are sick .
— Wash your hands frequently, either with soap and water or an alcohol-based hand sanitizer, to keep you from transferring viruses or bacteria from your hands to your face, nose or mouth.
— If you have pneumonia, avoid infecting others when you are contagious. “Typically, contagiousness can occur a day or so prior to the onset of symptoms,” Washer says. “As a rule of thumb, if you’re coughing or feverish, certainly you’re likely to be most contagious at that time.”
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A Patient’s Guide to Pneumonia: Causes, Treatment and Prevention originally appeared on usnews.com
Update 11/25/24: This story was published at an earlier date and has been updated with new information.
