Pneumonia - viral; Walking pneumonia - viral
Pneumonia is inflamed or swollen lung tissue due to infection with a germ.
Viral pneumonia is caused by a virus.
Viral pneumonia is more likely to occur in young children and older adults. This is because their bodies have a harder time fighting off the virus than people with a strong immune system.
Viral pneumonia is most often caused by one of several viruses:
- Respiratory syncytial virus (RSV)
- Influenza virus
- Parainfluenza virus
- Adenovirus (less common)
- Measles virus
- Coronaviruses such as SARS-CoV-2, which causes COVID-19 pneumonia
Serious viral pneumonia is more likely to happen in those with a weakened immune system, such as:
- Babies who are born too early.
- Children with heart and lung problems.
- People who have HIV/AIDS.
- People receiving chemotherapy for cancer, or other medicines that weaken the immune system.
- People who have had an organ transplant.
- Some viruses like the flu and SARS-CoV2 can lead to severe pneumonia in younger and otherwise healthy patients.
Everyone coughs from time to time. You might pick up a cold, have an allergy, or just get a tickle from something irritating your throat. But if you're really hacking and coughing up yellow or green mucus, and you've also got a fever, chills, and shortness of breath, you may have picked up a more serious infection, called pneumonia. And sometimes pneumonia's symptoms aren't as obvious. Pneumonia is caused by an infection in your lung. Bacteria or viruses like these can sometimes get into your lungs through your nose or mouth and make you sick. You're more likely to get pneumonia if you've got a problem with your immune system that makes it harder to fight off infections. You're also at greater risk if you've got a lung disease like COPD or cystic fibrosis, you've recently had the flu, or you're exposed to cigarette smoke. People who live in nursing homes are also more likely to get pneumonia. With pneumonia, you may cough up greenish or yellow phlegm. You also may run a fever and have the chills. Pneumonia can make it hard to breathe. You may feel like you've run up a flight of stairs when you were just sitting still. Your doctor can tell that you have pneumonia and not just a cold by listening with a stethoscope for crackle sounds in your chest. You may need a chest x-ray or blood tests to know for sure that you have pneumonia. If bacteria caused your pneumonia, your doctor can give you antibiotics, drugs that kill bacteria. Keep taking the antibiotic until you finish the whole prescription so you don't re-infect yourself. To help loosen all of that mucus clogging your lungs, breathe in the warm mist from a humidifier and drink plenty of water. Take it easy too. Don't try to run back to work and infect everyone else. Rest until you feel better. Whatever you do, don't smoke, it will only make your pneumonia worse. If your pneumonia is really severe or you have another serious health problem, your doctor may recommend that you get treated in the hospital. While there, you'll get antibiotics and fluids through a vein. You may also be given oxygen to help you breathe easier. The best way to deal with pneumonia is to avoid getting it in the first place. Older adults, children, and people with serious conditions like diabetes, asthma, cancer, and emphysema should talk to their doctor about getting vaccinated against pneumonia and the illnesses that cause it. Once you get treated, your pneumonia should clear up within a couple of weeks. Your doctor may want to check your lungs to make sure they're clear. Sometimes pneumonia can lead to serious lung complications, so call your doctor right away if your breathing problems get worse, you have chest pain, or you cough up blood.
Symptoms of viral pneumonia often begin slowly and may not be severe at first.
The most common symptoms of pneumonia are:
- Cough (with some pneumonias you may cough up mucus, or even bloody mucus)
- Shaking chills
- Shortness of breath (may only occur when you exert yourself)
Other symptoms include:
- Confusion, often in older people
- Excessive sweating and clammy skin
- Loss of appetite, low energy, and fatigue
- Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
Exams and Tests
The health care provider will perform a physical exam and ask about the symptoms.
If the provider thinks you have pneumonia, you will also have a chest x-ray. This is because the physical exam may not be able to tell pneumonia from other respiratory infections.
Depending on how severe your symptoms are, other tests may be done, including:
- Complete blood count (CBC)
- CT scan of the chest
- Blood cultures to check for viruses in the blood (or bacteria that might cause secondary infections)
- Bronchoscopy (rarely needed)
- Throat and nose swab tests to check for viruses such as the flu
- Open lung biopsy (only done in very serious illnesses when the diagnosis cannot be made from other sources)
- Sputum culture (to rule out other causes)
- Measuring levels of oxygen and carbon dioxide in the blood
Antibiotics do not treat this type of lung infection. Medicines that treat viruses may work against some pneumonias caused by influenza and the herpes family of viruses. These medicines may be tried if the infection is caught early.
Treatment may also involve:
- Corticosteroid medicines
- Increased fluids
- Use of humidified air
A hospital stay may be needed if you are unable to drink enough and to help with breathing if oxygen levels are too low.
People are more likely to be admitted to the hospital if they:
- Are older than 65 years or are children
- Are unable to care for themselves at home, eat, or drink
- Have another serious medical problem, such as a heart or kidney problem
- Have been taking antibiotics at home and are not getting better
- Have severe symptoms
However, many people can be treated at home. You can take these steps at home:
- Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children because it may cause a dangerous illness called Reye syndrome.
- DO NOT take cough medicines without first talking to your provider. Cough medicines may make it harder for your body to cough up sputum.
- Drink plenty of fluids to help loosen secretions and bring up phlegm.
- Get a lot of rest. Have someone else do chores.
Most cases of viral pneumonia are mild and get better without treatment within 1 to 3 weeks. Some cases are more serious and require a hospital stay.
More serious infections can result in
When to Contact a Medical Professional
Call your provider if symptoms of viral pneumonia develop or your condition gets worse after starting to improve.
Wash your hands often, after blowing your nose, going to the bathroom, diapering a baby, and before eating or preparing food.
Avoid coming into contact with other sick patients.
DO NOT smoke. Tobacco damages your lungs' ability to ward off infection.
A medicine called palivizumab (Synagis) may be given to children under 24 months old to prevent RSV.
The flu vaccine, is given each year to prevent pneumonia caused by the flu virus. Those who are older and those with diabetes, asthma, chronic obstructive pulmonary disease (COPD), cancer, or weakened immune systems should be sure to get the flu vaccine.
If your immune system is weak, stay away from crowds. Ask visitors who have a cold to wear a mask and wash their hands.
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McCullers JA. Influenza viruses. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 178.
Musher DM. Overview of pneumonia. In: Goldman L, Schafer AI eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020;chap 91.
Roosevelt GE. Pediatric respiratory emergencies: diseases of the lungs. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 169.
Last reviewed on: 8/3/2020
Reviewed by: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.