Alaska Regional Hospital - January 20, 2020

You might expect that if you had pneumonia, you’d know it. It’s reasonable to assume that a severe lung infection would likely stop you in your tracks and cause hard-to-miss symptoms like a wet cough, difficulty breathing, fever and chills.

But if you have some minor cold-like symptoms, such as a low-grade fever, along with a persistent dry, hacking cough that just won’t quit, you could actually have a form of the infection called atypical or “walking” pneumonia that can be mild.

“Walking pneumonia can last longer, and you may not feel as sick, as symptoms are less pronounced,” explains James McClune, MD, an HCA Healthcare interventional pulmonologist in critical care. “People who have walking pneumonia may think they have a common cold, as symptoms are not as severe as what people assume with traditional pneumonia.”

Telltale signs of walking pneumonia

Walking pneumonia symptoms typically come on slowly and include sore throat, headache, malaise and low-grade fever—which tend to be less severe than they are with pneumonia. In fact, symptoms of walking pneumonia may be so mild that they don’t affect your ability to carry out your day-to-day routine.

A wet or dry cough usually follows these early symptoms. Some people may also experience chest pain caused by inflammation in the lining of the lungs, which gets worse when they take a deep breath.

There are several possible reasons why people may develop a chronic cough, but if you have walking pneumonia, you may find yourself coughing so much that your chest becomes sore. And unlike a cold that resolves in a matter of days, the nagging cough associated with walking pneumonia could persist for weeks. Over time, symptoms could get worse. You might develop a higher fever. Your dry cough could also become wet, causing you to cough up discolored phlegm.

“With a virus, symptoms typically run their course in about three to four days—five days at the most. Then you start to notice that symptoms improve,” explains Dr. McClune. “However, with walking pneumonia, symptoms linger.

Crowded indoor conditions increase your risk

Generally speaking, young children and teens are at greatest risk for walking pneumonia but anyone could be affected, particularly if they live or work in crowded settings, such as schools, college dorms, military barracks and nursing homes.

“Walking pneumonia is spread by droplet particles usually within a few feet of an individual when they cough,” McClune says. In most cases, people become sick after having prolonged close contact with an infected person.

Those recovering from a recent respiratory illness, or those who have a weakened immune system, may also have an increased risk for walking pneumonia.

“Specifically, any patient that has an underlying lung disease, like asthma, emphysema or COPD—and the elderly—are at a higher risk for any type of infection, especially pneumonia,” adds McClune.

These higher-risk patients are also more likely to have a more severe case of walking pneumonia, which can lead to complications, such as serious pneumonia, asthma attacks, swelling of the brain, kidney problems and certain skin conditions.

When to get a persistent cough checked

If you’re struggling with a lingering cough but not sick enough to stay in bed, it may be unclear exactly when to seek help. So, how do you know when to call the doctor?

“If symptoms are out of the ordinary for you, if you’re getting worse instead of better in that [initial] three to five day period, or if they persist, consider that it might be walking pneumonia as opposed to a typical cold, and check in with your doctor,” McClune advises.

In order to diagnose walking pneumonia, your doctor will perform a physical exam. A chest x-ray and some additional tests may also be needed.

While it’s possible for people with walking pneumonia to (slowly) recover without treatment, many patients with a confirmed Mycoplasma pneumonia infection benefit from antibiotics.

“Antibiotics are very effective against walking pneumonia—typically a five to seven day course is prescribed,” says McClune. “It may take about 10 to 14 days before you actually start feeling back to baseline, but once the walking pneumonia is treated, symptoms should resolve completely.”

Keep in mind however, walking pneumonia isn’t always mild. Some cases are severe and require hospitalization.

Steps to prevent walking pneumonia

Since walking pneumonia is often spread by coughing and sneezing, you can help prevent the transmission of germs by covering your mouth when coughing or sneezing, whether with a tissue or your upper sleeve.

In order to stay healthy, you should also:

  • Wash your hands regularly with soap and water or use hand sanitizer.
  • Don’t smoke (and avoid exposure to secondhand smoke).
  • Take steps to help boost your immune system by getting adequate sleep, eating a healthy diet, and exercising regularly.
  • Avoid exposure to others who are sick.

“In particular, people who have underlying lung disease should be careful and have a heightened awareness of what steps to take to prevent walking pneumonia,” notes McClune.

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