Unlike typical pneumonia, people with walking pneumonia usually experience only mild symptoms and can go about their everyday life unaffected. But the infection can be stubborn, hard to treat, and sometimes spreads to cause brain, skin, or heart damage. Read on to learn about the causes, symptoms, conventional and natural ways to combat it.
What Is Walking Pneumonia?
Walking pneumonia at first seems harmless, very much similar to the common cold. But unlike the common cold that’s caused by a virus, walking pneumonia is usually caused by bacteria that don’t respond to typical antibiotics (most commonly Mycoplasma pneumoniae). The symptoms, although mild, can be stubborn and difficult to treat. Rarely, these symptoms can progress and cause serious health issues [1, 2].
Is Walking Pneumonia Contagious?
Walking pneumonia is a bacterial infection and people can spread it mostly by coughing or sneezing. As the symptoms are usually mild, people who have it are likely to spread the bacteria by going to public places. Small outbreaks can happen in closed collectives, such as universities, libraries, and even military bases [3, 4, 5].
The largest outbreak in US universities in the past 40 years happened in 2012 at the University of Georgia. It involved 83 students, half of whom were completely unaware of the outbreak when surveyed. Public health authorities emphasized how important it is for students to stay at home, seek medical help, and rest when ill instead of putting others at risk .
But some infections are so mild that they pass without any symptoms, leaving people unaware that they even had an infection. In about 7% of the cases, however, the infection spreads to damage the lungs or reaches the brain and causes complications [3, 4, 5].
Signs and Symptoms
The symptoms of walking pneumonia are similar to those of regular pneumonia, but usually much milder. Depending on the bacteria that are causing the infection, symptoms can include the following [6, 1]:
- Coughing (possibly with phlegm)
- Chest pain
- Shortness of breath
- Ear pain
- Stomach pain and digestive problems
- Slowed heart rate
- Triggering or worsening of asthma
In more severe cases, it can lead to :
- Liver damage
- Brain damage
- Heart diseases
- Herpes-like skin eruptions
You won’t be able to tell walking pneumonia symptoms apart from the flu or another respiratory infection yourself. That’s why it’s important to seek medical help – with careful examination, physicians can tell apart the symptoms to identify walking pneumonia as the cause.
A doctor’s visit will typically involve a chest examination, which may reveal a wheezing or crackling sound in your lungs. There may be signs of infection in your nose or throat. Doctors will check to see if any other organs are affected and may pick up subtle changes in your heart rate.
Symptoms in Adults
Walking pneumonia is less common in people over 20 years of age. The symptoms are mild in people with a healthy immune system. Although “pneumonia” is synonymous with lung infections, walking pneumonia often doesn’t affect the lungs at all. But it can cause serious damage in older people or if it triggers an autoimmune response [7, 9, 10].
The bacteria that causes walking pneumonia has some similarities to some healthy cells and tissues in the body. When the immune system mounts a response to fight the infection, it can create antibodies to our own cells by mistake, triggering an autoimmune response. This leads to a release of inflammatory substances, blood and brain toxins that cause damage .
This autoimmune attack and inflammation can progressively spread to many organs, such as the brain, skin, muscles, joints, gut, liver, or blood cells .
Symptoms in Kids
Most cases of walking pneumonia include children over 5 years of age. Since their immune system is still developing, the symptoms are often more severe than in healthy adults. Children also experience a stubborn cough and more throat and ear pain, aside from other common symptoms [11, 12].
Causes and Risk Factors for Walking Pneumonia
Walking pneumonia is often described as “atypical” since it doesn’t resemble regular pneumonia. Walking pneumonia is different because:
- The infection sometimes doesn’t even affect the lungs
- The bacteria that causes it often doesn’t respond to “typical” antibiotics
This was so unusual that scientists thought that it’s not even caused by a bacteria for a while, but by other microbes. Today we know that, unlike viral pneumonia, bacteria are indeed to blame for walking pneumonia.
Several bacteria can cause walking pneumonia, including the following:
- Mycoplasma pneumoniae, which causes the majority of infections. All Mycoplasma bacteria are very small and don’t have a cell wall. Their proteins can trigger a strong autoimmune response that can spread to various organs in the body .
- Chlamydophila (Chlamydia) pneumoniae is much less dangerous and causes mild symptoms. But if left untreated, it can lead to heart and blood vessel diseases [13, 14].
- Legionella pneumophila causes serious symptoms. Luckily, it is less frequent than the previous two. If it progresses, the disease is no longer “walking” but becomes a severe form of pneumonia called Legionnaires’ disease .
All three types are contagious and can spread, especially in closed communities and households. Children, the elderly, people with a history of lung problems, or those with poor immunity are at the highest risk .
Since walking pneumonia is a bacterial infection, antibiotics are the most common treatment. Other drugs and remedies can be used to reduce symptoms, such as coughing, fever, mucus, and fatigue.
Bacteria that cause walking pneumonia don’t respond to penicillin and similar antibiotics called beta-lactams (such as Cephalexin). It’s important for doctors to identify an antibiotic that will kill these bacteria and avoid contributing to the rise in antibiotic resistance worldwide.
Lab tests can reveal which antibiotics the bacteria will respond to, but these tests can take 24 – 48 hours. If the symptoms are serious, the treatment can’t wait that long and doctors will choose the best antibiotic based on the symptoms. They’ll usually choose between two options that can combat the infection before the lab results are in [17, 9].
- A combination of antibiotics (macrolide antibiotics or doxycycline with beta-lactams)
- Just fluoroquinolone antibiotics (levofloxacin, ofloxacin)
The latter is usually not prescribed to children because of side effects, which can affect the muscles, bones, and teeth .
In addition to antibiotics to fight off the infection, your doctor may prescribe other medications to improve the symptoms depending on their severity and the age and health status of the patient. They include:
- Cough Medicine: this medicine is especially recommended in people whose cough reduces their sleep quality. However, there is insufficient evidence supporting the effectiveness of cough medicines in the particular case of pneumonia. In addition, coughing helps fight off the infection by moving fluid from the lungs. For this reason, it’s preferable to use the lowest possible dose.
- Fever Reducers and Pain Relievers: you may take aspirin, ibuprofen, or Tylenol as needed to reduce the fever and discomfort caused by walking pneumonia.
There is currently not enough research to show that natural alternatives can replace conventional antibiotics. But these remedies can improve the outcomes of conventional therapy when used as an add-on and reduce side effects. Discuss with your doctor if the following substances may help in your case and never take them in place of what your doctor recommends or prescribes.
Many natural substances had microbe-fighting properties, alleviated coughing and congestion, balanced the immune system, or protected the gut from dysbiosis in human and animal studies:
- Andrographis helped with the common cold in clinical trials and could fight antibiotic-resistant bacteria that cause pneumonia in cellular studies. Its effects on walking pneumonia have not been clinically researched, but it will probably help reduce headaches, cough, fever, and fatigue. Andrographis is safe for both kids and adults [19, 20].
- Raw honey may suppress coughing and support the immune system. It can be combined with other bee products such as propolis and royal jelly, which are rich in antioxidant flavonoids. Bee products seem to act in synergy to reduce inflammation and fight infections. Plus they may also reduce the Th2 response and boost Th1, important for people who easily catch infections or also have allergies 
- Myrtol is a standardized essential oil from pine (Pinus spp), lime (Citrus aurantifolia ) and Eucalyptus (Eucalyptus globulus). It can reduce cough severity and frequency. Use caution, though, as essential oils are not always safe for inhalation and can irritate the respiratory tract in high concentrations .
- Thyme, ivy leaf, and evening primrose oil can also reduce cough symptoms .
- African geranium (Umcka) mostly helps with bronchitis .
- Echinacea may help if taken early on .
- Amla can reduce coughing and asthmatic symptoms .
- Capsaicin may help reduce cough frequency and chest pain [24, 25].
- Probiotics (especially L. rhamnosus GG and S. boulardii) help prevent gut microbiome imbalances and diarrhea from antibiotics .
- Zinc maintains a balanced immune response and may even help improve health outcomes in severe forms of pneumonia. In fact, zinc deficiency is common in older people, reduces immune defense, and increases the risk of walking pneumonia and other infections [27, 28, 29, 30].
- Steam inhalation is an old and simple approach that can also improve congestion and cough in some people and doesn’t cause any side effects .
Walking pneumonia is most common in late summer and fall, but you can get it at any time of the year. The steps you should take to prevent catching walking pneumonia are similar to prevention against the common cold and other respiratory infections. Keep in mind these tips:
- Vitamin C can help with prevention in children and physically-active adults (especially in athletes), but it doesn’t really improve the symptoms once you catch the infection [22, 32].
- Adequate sun exposure is very important. It will help you maintain healthy vitamin D levels and reduce your risk of infections .
- Immune-stimulant herbs may work for Th2-dominant people who are more prone to catching infections anyway. These include astragalus, reishi, ginger, quercetin, bee products.
- Adequate vitamin and mineral intake to prevent deficiencies, including vitamin B6, B12, folate, C, E, selenium, zinc, copper, and iron.
- Proper hygiene also matters. Don’t forget to wash your hands for at least 20 seconds when using soap/foam and water. Alcohol-based hand rubs an alternative.
- Avoid crowded places where you’re more likely to catch an infection. If you start experiencing symptoms, stay at home and avoid crowds at all costs to prevent spreading the infection to others.
Genes Linked to Walking Pneumonia
The link between genetics and pneumonia is still uncertain. There is even less information specifically about walking pneumonia, but a couple of studies shed some light on it:
- Certain genetic variants in genes that affect the immune response can make some people more vulnerable to the bacteria that cause pneumonia. For example, the gene TLR2 codes for receptors involved in fighting bacterial infections. Variants at one of its SNPs (rs5743708) were linked to dangerous Legionella infections and with other types of pneumonia .
- Another study discovered that genetic changes involved in the immune recognition of cells may play a role in triggering the autoimmune response that causes serious health complications in pneumonia [35, 36].
Walking Pneumonia Vs. Bronchitis
Symptoms of walking pneumonia and bronchitis can overlap, the main difference being in their intensity. People with walking pneumonia are more likely to experience mild symptoms, fever, and fatigue.
Bronchitis affects larger air pathways in the lungs and typical pneumonia affects small air sacs in the lungs, while walking pneumonia sometimes doesn’t affect the lungs at all.
It’s often tricky for doctors to differentiate between walking pneumonia and bronchitis. Lab tests or some scans are sometimes needed. For example, your doctor might order an X-ray if suspecting pneumonia; the scan would show liquid instead of air in lung sacs, while in bronchitis and walking pneumonia the airways are usually clear.
Limitations and Caveats
Walking pneumonia is an informal term, and might not always mean the same as the medical term atypical pneumonia. Even the term atypical pneumonia is not well defined in the medical community.
Some of the natural remedies listed here have only been researched in animals or cells. It’s uncertain if and to what extent they could help fight infections like walking pneumonia in humans. More clinical studies are needed to determine this.