Walking pneumonia or atypical pneumonia

There are many types of pneumonia depending on their cause and presenting symptoms. Walking pneumonia is also called atypical pneumonia.

What is walking pneumonia?

Walking pneumonia is a term in simple language also described by a medical expert as atypical pneumonia. In these cases, though patients show symptoms of pneumonia but with less severity so that they do not need to be hospitalized.

Rather than the usual cause of pneumonia Streptococcus pneumoniae this type of pneumonia is caused by some other pathogens.

What are the causes of walking pneumonia?

Atypical pneumonia is caused by multiple organisms. They can be bacterial or viral causes of atypical walking pneumonia.

Following are some common bacterial causes of atypical pneumonia:

  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumophila
  • Coxiella burnetii
  • Chlamydia psittaci

Following are viral causes of atypical pneumonia:

  • Respiratory syncytial virus
  • Parainfluenza
  • Adenovirus
  • Influenza A and B
  • Covid-19

What are the symptoms of walking pneumonia?

Symptoms of the atypical viral infections are milder that do not need hospitalization. In some patients, they may be severe needing hospital or ICU admission.

Usual common symptoms are:

  • Cough: It may be a dry cough or cough with expectoration. Cough episodes may come in spasms and there may be posted tussive vomiting episodes.
  • Chest pain: Chest pain may be mild to moderate grade and is felt when the patient takes a deep breath.
  • Sore throat: You may feel a sore throat and pain in the throat while eating or drinking fluids.
  • Headache: Some types of walking pneumonia-like in mycoplasma pneumonia patient may complain of headache that may be moderate to severe grade. It may aggravate when there is a fever.
  • Fever: In walking pneumonia, fever is usually of mild to moderate grade and may or may not be associated with chills.
  • Flu-like symptoms: Patients of atypical pneumonia may initially complain of symptoms like flu. They include running nose and stuffy nose with malaise and weakness.
  • Malaise and weakness, body ache: Patients with atypical pneumonia may experience malaise and weakness that is less severe than typical pneumonia.
  • Skin rash: Some patients with walking pneumonia may get skin rash.
  • Some microorganisms causing atypical pneumonia also ear infection presenting as ear pain decreased hearing.

Though atypical pneumonia called walking pneumonia is milder some patients may get seriously ill, need hospital or ICU admission.

How to diagnose walking pneumonia?

Atypical pneumonia is diagnosed mainly based on clinical symptoms. Diagnostic tests may not detect the exact cause of atypical pneumonia but they help to differentiate it from other illnesses.

Typical symptoms on history and supportive findings on physical examination usually guide further therapy.

Chest X-ray

Though chest X-ray does not help much in diagnosing atypical pneumonia, it may help to differentiate it from other diseases.

Lab tests

These lab tests may help to diagnose atypical pneumonia or may help to exclude other diseases with similar symptoms.

Some laboratory tests used to diagnose pneumonia include:

  • a culture of mucus from your lungs, which is called sputum
  • a sputum gram stain study
  • a throat swab
  • a complete blood count (CBC)
  • tests for specific antigens or antibodies
  • blood culture

What is the treatment for walking pneumonia?

Treatment depends on the severity of symptoms. The history, clinical examination, and investigations help to define the needed therapy. The underlying clinical condition and comorbidities need special care as these factors may aggravate the condition.

Treatment mainly includes symptomatic treatment and antibiotics.


NSAIDs and medicines which are antipyretics like paracetamol help to relieve the fever, body ache, and headache.

Dosing frequency is guided by the symptoms and underlying comorbidities of the patients.

Anti cold medicines

OTC cold medicines containing antihistamines, phenylephrine alone, or in combination with paracetamol may help to relieve the flu-like symptoms. Dosing frequency is guided by age and severity of symptoms.


If the patient has a cough because of bronchospasm they may get relief from medicine containing bronchodilators which can be given orally or by nebulizations. 


Antibiotics are needed if the bacterial cause of the atypical infection is suspected. Usually, macrolide antibiotics are used for this purpose alone or in combination with other antibiotics.

Supportive care

Those who are seriously ill may need admission to hospital or ICU and continuous monitoring and supportive care may be needed.

Who are at increased risk of walking pneumonia?

Anyone can get atypical pneumonia but few groups have an increased risk of getting it. These groups include:

  • Smokers
  • Those with respiratory allergies.
  • Children less than 2 years old
  • Adults above 60 years old
  • Those with immunosuppression.
  • Patients of comorbid conditions like COPD.
  • Patients on long term treatment on immunosuppressive drugs like corticosteroids.

How to prevent walking pneumonia?

It is a condition caused by multiple causative agents but still, some steps may help for prevention of the walking pneumonia.

Those preventive steps are as follows:

  • Vaccinate high-risk groups those less than 5 years and more than 60 years with the yearly flu vaccine.
  • Rigorous handwashing with soap and water or using alcohol-based sanitizers.
  • Using masks.
  • Following social distancing norms.
  • Stopping smoking.
  • Controlling co-morbidities like diabetes and hypertension
  • Controlling other respiratory co-morbidities like COPD.

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