What to do For Walking Pneumonia

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

What to Do for Pneumonia

In this X-ray, pneumonia covers most of this child’s left lung (which is on your right when looking at the picture). It looks white because there’s not just air in there; there’s fluid and swollen tissue.

by James Hubbard, MD, MPH

I have a confession. I’m a pneumonia survivor. And it wasn’t walking pneumonia either. I was in the bed for a week.

Yes, a few years ago, The Survival Doctor ended up a whimpering mess, dependent on other people’s care. It took a good month to feel like doing much walking. But I was lucky. Each year millions in the U.S. get pneumonia, and over 50,000 die. In a prolonged disaster situation, that number would be much higher.

Symptoms and severity of pneumonia can vary greatly. Me, I thought I was as healthy as a horse, doing just fine, wasn’t even feeling sick. Then, out of the blue, I had a teeth-chattering chill. I just shook all over. After that, I started feeling weak, my heart beating fast. I wasn’t coughing much, but I took my temperature, and it was over 102 F.

I took a couple of Tylenol and crawled in the bed. Soon my bedclothes were soaked in sweat. After the Tylenol wore off, I had another chill. The cough started next, but I thought I had the flu. Now I wasn’t thinking right because anytime anyone comes to my office, otherwise healthy, and they’re running fever, I ask if they’ve had a shaking-all-over type chill. If they have, my first thought is pneumonia.

Well, luckily, after a couple of days of lying in the bed, my wife made me see a doctor, of all things. I mean, I am a doctor. Although he couldn’t hear much in my chest, a chest X-ray proved the diagnosis. I started on antibiotics, but it took me a good week to feel able to go back to work, and a month before I felt like doing anything like going on a walk.

How Did I Get It?

I came down with pneumonia just before my daughter Leigh Ann’s wedding. Though I didn’t have the walking pneumonia type, I managed to deliriously walk her down the aisle—and promptly get driven home to bed. I couldn’t even stay for the reception, so you know I’m not exaggerating when I say this thing can get bad.

Pneumonia can be divided into two very general types, community acquired and hospital acquired. The first is what will be more prevalent during a disaster—especially if many people are sheltering together.

Community Acquired Pneumonia (CAP)

I expect I got mine from breathing in bacteria left in the air from someone coughing. It could have been in some public place as easy as it could have been in my office.

Walking Pneumonia
There’s really no such official diagnosis as walking pneumonia. If you have pneumonia and you still feel like walking around, you have walking pneumonia. Okay, it is true that usually this milder version is caused by the bacteria called mycoplasma. And it’s usually treated with some sort of erythromycin antibiotic like azithromycin (Z-Pak) or clarithromycin (Biaxin) or some sort of tetracycline, like doxycycline.

Pneumococcal Pneumonia
One of the most common types of CAP, and the kind I probably had, is caused from the bacteria pneumococcus. We usually treat these with erythromycins or quinolones (Cipro, Levaquin, etc.).

Legionnaire’s disease was first diagnosed in 1976 after several people attending an American Legion convention in Philadelphia came down with severe pneumonia. A bacteria now called legionella coming from the air-conditioning vent was isolated as the cause. The pneumonia can be severe but usually responds to erythromycin.

Pneumonia from the klebsiella bacteria is found in chronic smokers. Ciprofloxacin usually kills it.

Books adIn addition to bacteria, viruses are a common cause of CAP. Rarely a fungus can cause it.

Now, don’t get me wrong. Community acquired pneumonia can often be treated on an outpatient basis, but it can also be severe. You may need hospitalization, and people die each year from this type.

Hospital Acquired Pneumonia (HAP)

You are classified with this type if you’ve been in the hospital for more than a day or two and you get pneumonia. Many types of germs can cause HAP—things like MRSA from staph, other bacteria such pseudomonas, and fungi. HAP is usually treated with two or three different IV antibiotics. I won’t go into this type any further for the obvious reason that you won’t be seeing it out of the hospital

Pneumonia Diagnosis If You Can’t Get to a Doctor

As with my case, shaking chills and/or sweats is a clue, but high fever for any reason can cause that. Suspect pneumonia in someone who also has fever and a cough. Chest pain or discomfort is another clue, but it’s less common.

Often, if you have a stethoscope or put your ear on the person’s chest and you know what you’re listening for, you can hear crackles in an area of one or both lungs. If your hair is long enough, rub a few strands together next to your ear. That’s what one type of crackles (medical term—rales) sounds like. Sometimes rales can sound coarser.

Many people with pneumonia get short of breath with exertion. Some are short of breath at rest.

How Contagious Is Pneumonia?

Pneumonia is contagious but not highly so. When treating someone who has it, using a mask would be of small benefit. Better would be having fresh air if possible, along with taking the typical disease-prevention precautions such as washing your hands.


It’s very hard to get an exact cause for the pneumonia even if you’re in the hospital. Fortunately, any antibiotic in the ciprofloxacin, erythromycin, or tetracycline family usually treats the community acquired type. Rest and fluids help also. Bring down the fever with acetaminophen (Tylenol) or ibuprofen (Advil).

I usually save the ciprofloxacin for smokers or those who appear pretty sick. Of course, the really sick ones—the ones short of breath who don’t respond to an asthma inhaler, the ones who can’t keep down fluids, the confused ones—I usually send to the hospital.

People with chronic diseases, such as heart disease, diabetes, or emphysema, are at higher risk for complications also, as are even healthy people over 65 and under age 2.


The most common community acquired pneumonia is caused by pneumococcus bacteria or comes on after a bout of the flu. You already know about the annual flu vaccine, but you may not know that there’s a pneumococcus vaccine you can get every ten years. It doesn’t prevent them all, but it can cut down on your risk considerably. It’s usually recommended for people age 65 and older or who are at high risk for complications.

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X-ray courtesy Mike Blyth.

  • crystal

    I am a 40 year old african american women with heart and stage 3 kidney failure. My first time ever getting the flu was amost two years ago. I went to the er last week and was told I have walking pneumonia. First time with this as well. I was givin a z pack and felt better as I finished the medicine, now I’m gradually starting to feel the severe fatigue feeling creeping up again. It’s hard to tell witg the fatigue because of my condition. Will I be ok? Kind of a who thinks I’m dying all the time.

  • Momma2Boo

    I was diagnosed with walking pneumonia last week after teeth chattering chills (rigors, really), drenching sweats with fever, severe muscle aches/pain, and malaise/fatigue. The back of my lungs still ache and hurt. I have one more day left on the Zpak. I would like to go to the gym and workout one of these days…plus, I start a new job on Monday…but I’m worried about pushing myself too far too fast. I also have asthma. How do I judge when to return to the gym and how should I manage a new job when still recovering? By 2pm each afternoon, I’m wiped and need a nap but can’t do that at work! Any advice would be great!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      It usually takes several weeks to recuperate. A followup visit with your doctor would be a good idea. He/she can recommend activity specifically for your case. Otherwise it sounds like your best bet is to continue rest until Monday. And don’t plan any other activities, except for work, until you can manage work without getting so tired. Be sure to drink plenty of fluids and eat well. Allow your body to use all the energy and resources it can to recuperate.

  • vegskye

    I have walking pneumonia and I’m on an inhaler and a strong amoxicillian. I’ve been out of work for a week and although I think I’m improving the fatigue is the worse. I can’t imagine going back to work on Monday.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Hopefully you have a follow-up with your doctor.

  • arley

    scary to see how many people are put on quinolines… please do your research on the medicine before you take it. I am a Cipro victim, there are many more like me out there…please look up Fluoroquines before you take it. there are other antibiotics out there with less side effects ( and ones that don’t permanently damage you… I still suffer from CNS side effect 3.5 years later )

  • Nickmbb

    Four weeks ago I sneezed, two days later I had rattling chills, went to MD and X-ray showed pneumonia in lower right lung. Z-pack did nothing so my doctor told me it’s viral. I wasn’t hospitalized, but stayed home for last 4 weeks. It’s really cold outside and I need to go out, how dangerous is breathing cold air with this still in me?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You should ask your doctor. In general, breathing cold air from, say, the house to the car to a store, shouldn’t be so bad. Breathing it for a long time or exercising in the cold might trigger some wheezing (really more due to the dryness of the cold air.) The other thing, of course, is has the pneumonia cleared. Do you have fever, did you have a followup with your doctor to see if it has cleared.

  • Stacy

    Hi there…I am a 30 year old otherwise very active healthy adult. Recently I was sick with a cold that turned into sinusitis. I was put on amox, however I did the wrong thing and stopped taking my meds before I had finished them completely. A month later I started to have this pain in my right lung when I take a deep breath, soon after I started with the cold symptoms and night sweats. Went back to the doctor and was diagnosed with pneumonia. The doctor did a chest x-ray and could barely see anything and I sounded pretty clear. But with all the symptoms and history, then the small amount seen in the chest x-ray…the doctor said I have pneumonia and started me on another antibiotics, levaquin. I have been on the levaquin for 6 days now (only one day left) and I still have the sharp pain in my right lung when I take deep breaths. Other than the pain when taking deep breaths and some fatigue, I feel fine. Should I make another visit to my doctor or is the pain I am experiencing just part of it. I don’t know anyone who has had pneumonia so I’m not really sure what is normal or if I am being overly concerned.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Pain with breathing and fatigue can certainly be part of pneumonia. If you don’t have a follow-up scheduled then, yes, I’d get one, to make sure everything is progressing ok.

  • Judy

    I came down with the flu four days ago. It started with a dry cough and progressed from there. I ended up with sinus pressure and sinus headache but not a lot of discharge. The cough has loosed up quite a lot. I am coughing but I am not short of breath and do not have chest or back pain. My respiration is normal. I was running a fever up to 103 but it’s come down to an average of 100.3 today…but had dropped to 99.2 a couple times over the weekend. The sinus pain pressure is also better. This virus effected my appetite so I have not been eating much but continue to force fluids. I had only aspirin to take and I think that was part of what was effecting my stomach so I stopped taking aspirin. My stomach does feel better and I was able to eat a little something today. For the past three days I’ve been having diarrhea as well. I’m just concerned that I seem more washed out today. Shaky and feeling like I want to break out in a sweat when I move around. I guess this could be a result of not eating much the past few days and just the virus in general. Is this normal? I’m expecting to feel better by now. Maybe I’m rushing things? Is there anything else I should be doing for myself?
    Thanks so much!

  • Pingback: H1N1: Your Flu Questions, Answered

  • Lou

    I had pseudomonas pneumonia a yr ago from water born bacteria. In y left lung was ill for 2 months whilst they eventually worked out which bacteria and what it was resistant to. They gave me levofloxin, which helped but didn’t eliminate the pseudo, however I then spontaniously recovered but he said it could be dormant. Exactly one year later I have pneumonia again, been ill for 7 wks but only found out at 6 wks it was pneumonia, Symptoms similar (exhausted, breathless, night sweats) but no cough or crazy temps. This time he thinks it possible I have gerd related pneumonia as I get indigestion (althoughI have for 10 yrs!) And has put me on Clarythromycin, I also had Amoxyclav from GP 3 wks in as they thought they were treating a standard chest infection. The issue I have is that neither seem to make any noticeable difference. My peak flow is somewhere between 300-350 when normally 5000 to 550. He also thinks part of the breathing is down to GERD. However 5 months ago by chance I had a flair so had an endoscopy which came back totally clear. So I don’t think the breathing is due to the GERD, which they’re saying could be silent. Totady I dropped to 320 of peak flow so used my sons sarbutamol and then went up to 450. I have never had asthma or even chest infections, please help I am desperate to know what to do. I struggle to talk and breath its awful and been happening for 7 weeks now.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Lou, the only thing I know is see a good pulmonary doctor and infectious disease doctor (if the pulmonologist thinks it’s worthwhile). Or, if you’ve done that, you could seek second opinion.

  • Nicole

    Been sick for a about 3 weeks went to the dr a week ago. They took a chest X-ray told me I had pneumonia. I’ve been on antibiotics for a week and decided to go back to work today. After about two hours I started getting chest pain and trouble breathing and went home. On the way home my whole body was shaking and I was sweating…again. (That happens to me every other night) now I’m terrified that it’s gotten worse and don’t know if I should wait for my appointment with my dr tomorrow or go back to the ER.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Nicole, perhaps call your doctor and ask if they can see you or if they suggest you go back to the ER. Sounds like you went back to work too soon.