Walking Pneumonia vs. Pneumonia: What’s the Difference?

“Walking pneumonia,” also known as “atypical pneumonia” or “white lung pneumonia,” isn’t a formal medical diagnosis. It’s an informal term sometimes used to describe a mild case of pneumonia. It’s called walking pneumonia because you can have it (and spread it) without ever knowing you’re sick.

It may not be a medical diagnosis, but this highly contagious sickness can still leave you feeling lousy. And while rare, serious illness can occur.

Pulmonologist Neal Chaisson, MD, compares walking pneumonia vs. pneumonia.

How do you know if you have walking pneumonia or pneumonia?

The only way to know if you have walking pneumonia vs. pneumonia — or more accurately, to know if you’re dealing with pneumonia at all — is to see a healthcare provider and be tested.

A provider will likely diagnose you based on a chest X-ray. They may also take blood or mucus samples, just to be safe.

Dr. Chaisson warns against starting antibiotics without confirming that you actually have pneumonia. Antibiotic overuse can lead to antibiotic resistance, allergic reactions or even a dangerous intestinal infection called Clostridium difficile, also known as C. diff.

Antibiotics probably shouldn’t be the first step. But they may end up being the right step if your symptoms linger for more than a few days. Especially if you also have a chronic illness like:

• Emphysema
• Asthma
• Diabetes
• Kidney disease
• Heart disease

Key differences in severity

How can you tell if you have walking pneumonia or pneumonia? Technically, you can’t — after all, again, walking pneumonia isn’t a medical diagnosis. But as a general rule, pneumonia is considered a more serious lung infection than walking pneumonia, so the symptoms tend to be more extreme.

To understand why, it helps to know what’s causing the illness.

Walking (or atypical) pneumonia is often caused by bacteria or viruses. A bacterium called Mycoplasma pneumoniae is the primary offender.

While not all types of pneumonia are contagious, the type associated with walking pneumonia usually is. It spreads through respiratory droplets. In other words, you’re most likely to become infected when someone coughs or sneezes near you and doesn’t cover their mouth.

While people usually use “walking pneumonia” to describe pneumonia caused by Mycoplasma pneumoniae, pneumonia has a variety of causes and may or may not be contagious. It can be bacterial or viral, yes. But in rare cases, you can also get pneumonia from fungi or single-celled organisms called protozoa, especially if your immune system is compromised or you take medicines that affect your body’s immune system.

Common symptoms

As walking pneumonia isn’t a formal diagnosis, it doesn’t have its own distinct symptoms. Its severity (or lack thereof) is what really distinguishes it.

Common complaints for both walking pneumonia and pneumonia include:

• Shortness of breath
• Sore throat
• Fever
• Chronic (and sometimes intense) dry cough
• Increased mucus production
• Headaches
• Chest pain
• Fatigue

While walking pneumonia tends not to feel much worse than a bad cold, pneumonia often does. Dr. Chaisson explains that your immune system fills the air sacs in your lungs with mucus, pus and other fluids. That congestion makes it difficult for oxygen to reach your blood, which can cause:

• A high heart rate
• Severe chest pain
• Confusion
• Difficulty breathing
• Blue skin, lips or nails (cyanosis)

Pneumonia can be serious — and these symptoms are a red flag that you need medical attention. Call 911 or emergency services.

Incubation and duration

Another difference between pneumonia and walking pneumonia is time: specifically, how long it takes to get sick and how long you stay that way.

Conventional wisdom says that people who have walking pneumonia start feeling unwell within two weeks of being exposed. But it can sometimes take up to a month. That’s bad news because you may be contagious throughout that incubation period, even though you have no symptoms.

Some types of pneumonia settle in faster — within just a few days. And most pneumonia isn’t contagious.

How long you stay sick can vary based on your health and other factors, but walking pneumonia, being milder, can go away on its own. Antibiotics may be necessary if your symptoms are particularly bad or hang around for more than two weeks, but it’s not a foregone conclusion, as it is when your doctor diagnoses you with pneumonia outright.

“A pneumonia diagnosis usually warrants antibiotics,” Dr. Chaisson reports. “You could even be hospitalized if you need oxygen, IV fluids or breathing treatments.”

When it comes to rebounding from your illness, Dr. Chaisson’s advice is the same no matter how severe your pneumonia is.

“It’s important not to try to rush your recovery,” he stresses. “Don’t push yourself too hard. Expect that it will take a few weeks until you’re up and running at full speed again.”

Risk factors and who should be careful

There are two risks to keep in mind with respiratory ailments:

1. Your chances of contracting the infection
2. Your odds of getting severely ill or having complications

Let’s start with your risk of getting sick. Lifestyle plays a big role here.

Children, young adults and people in crowded conditions are more likely to get any kind of pneumonia caused by a contagious condition, like COVID-19 or pneumococcal disease. They spread easily in enclosed spaces with lots of people, like daycares, schools and college dorms. They also hit assisted living facilities, raising the infection risk for people over 65.

Once you’re sick, how likely are you to get seriously ill? The risk is greatest for those:

• Under age 2
• Over age 65
• Who are immunocompromised or immunosuppressed
• With chronic illnesses like heart disease, diabetes or asthma
• Who smokes or used to smoke

If that sounds like you, consider talking to a provider about the pneumococcal pneumonia vaccine.

Does walking pneumonia ever turn into pneumonia?

Walking pneumonia is just another way to say “mild pneumonia,” so most people who have it get better with little or no treatment. Still, it’s possible for the infection to get worse. It’s most likely to happen if you:

• Fall into a high-risk category based on your age or health status
• Don’t get treatment, even though your symptoms have continued or become worse

If you don’t start feeling better after a week of rest, hydration and antibiotics (if you’re on them) or if your symptoms continue to worsen, Dr. Chaisson advises calling your provider. With pneumonia, it’s always better to be safe than sorry.