Pneumonia Symptoms: How to Recognize Early Warning Signs

Pneumonia symptoms can vary widely from a mild flu to a life-threatening emergency. Cough, fever, and fatigue are common, but you should seek help for more serious symptoms like shortness of breath, chest pain, and confusion.

People in high-risk groups, such as older adults, children, or people with immune compromise or an underlying health condition, are more likely to have a severe case. Knowing the various signs and symptoms of pneumonia can help you seek early diagnosis and treatment before serious complications occur.

Pneumonia Symptoms

Pneumonia is an inflammatory condition affecting the lungs, most commonly caused by bacterial or viral infections that move from the upper respiratory tract to the lower respiratory tract. The infection causes the overproduction of mucus and the build-up of fluid that clogs the tiny air sacs of the lungs, known as alveoli.

When this happens, a person may experience:

• A cough with sputum that appears green, yellowish, or bloody
• High fever with chills
• Profuse sweating
• Shortness of breath, often with rapid, shallow breathing
• Lung sounds, including crackles and rales (these suggest fluid in the lungs)
• Fatigue and weakness
• Chest pain, especially when you cough or take a deep breath
• Loss of appetite

People may have different symptoms based on the type of pneumonia:

• Bacterial pneumonia, the most common form, tends to be more serious, sometimes leading to dangerously high fever (over 105 F) accompanied by signs of delirium.
• Viral pneumonia tends to develop gradually over several days, often with milder symptoms easily mistaken for the flu.

The type of pneumonia can affect sputum production and color, breath sounds, and associated symptoms that affect the digestive tract or joints.

How Symptoms Differ in Adults vs. Children

In children under age 10, pneumonia can be difficult to spot because the symptoms are often very different from those in adults. This is especially true in infants and newborns who may not show any signs of infection.

Possible signs and symptoms of pneumonia in children include cough, fever, and shortness of breath, just as they do in adults. Other symptoms in kids include:

• Headache
• Breathing changes (grunting, nasal flaring, chest retractions, wet sounds)
• Digestive disruption (stomach pain, nausea, vomiting)
• A pale appearance
• Difficulty feeding due to breathing problems
• A bluish skin tone (cyanosis) due to a lack of oxygen

Keep in mind that in children younger than two months, there may not even be any coughing.

Who Is More Likely to Develop Pneumonia?

Some people may be more at risk of developing pneumonia. Older adults, especially those age 65 and older, have higher rates of pneumonia. So do children younger than age 5.

Co-occurring health conditions, medications, and lifestyle factors can contribute to the risk, too. Among them are:

• Chronic lung disease
• Kidney disease
• Liver disease
• Diabetes
• Heart disease
• Dementia disorders like Alzheimer's disease
• Anticholinergic medication (used to treat Parkinson's disease, for example)
• Smoking and/or excessive alcohol use
• Immune compromise, as with chemotherapy or steroid use

Pneumonia can lead to different symptoms in specific groups. Older adults living in long-term care facilities may develop sudden urinary incontinence, for example.

How Pneumonia Is Diagnosed

Pneumonia can be difficult to diagnose because the symptoms are variable and may sometimes be mistaken for flu or a cold.

If pneumonia is suspected, your healthcare provider will review your medical history (including recent travel), perform a physical exam (including listening for lung sounds), and order a battery of tests to confirm the pneumonia diagnosis, including:

• Complete blood count (CBC) to check for blood abnormalities suggestive of an infection
• Chest X-ray, which would show a "ground-glass" appearance where fluids have accumulated
• Pulse oximetry, a clamp-like device used to measure blood oxygen
• Sputum cytology, which tests a sample of phlegm to check for bacteria or viruses
• Arterial blood gases to check oxygen levels from blood taken from an artery
• Pleural fluid culture, removing a sample of fluid from the lungs to identify germs
• Bronchoscopy, involving the insertion of a flexible scope into your windpipe to view the lungs

Your healthcare provider also may evaluate other symptoms that occur with your illness, such as abdominal pain, or that arise because of a co-occurring health condition.

How Pneumonia Is Treated

Bacterial pneumonia is treated with antibiotic drugs, most often Amoxil (amoxicillin) and doxycycline given over five to seven days.

Viral pneumonia often does not require treatment but may benefit from antiviral drugs, such as Tamiflu (oseltamivir) for influenza. Veklury (remdesivir) may be given for COVID-19, if symptoms are severe or a person is at risk of severe complications.

Treatment also may depend on specific symptoms that indicate the cause of the infection. For example:

• Viral pneumonia, most commonly due to respiratory syncytial virus (RSV), is more likely to cause wheezing than bacterial pneumonia.
• Pneumonia caused by Streptococcus pneumoniae bacteria is associated with rust-colored sputum.
• Pneumonia caused by Legionella bacteria may be accompanied by abdominal pain, diarrhea, and extreme confusion.
• Pneumonia caused by Chlamydia pneumoniae bacteria is associated with sore throat, vocal hoarseness, and a runny nose.

Some people with more severe symptoms may need hospitalization to receive treatments such as extra oxygen or intravenous antibiotics.

Preventing Pneumonia

There are a number of steps you can take to prevent pneumonia, including decisions to stay away from people who are sick. A healthy diet, proper rest, and other lifestyle measures can help to protect your overall health. Other prevention measures include:

• Washing hands carefully or using hand sanitizer if away from water
• Wearing a mask in public settings
• Maintaining good oral hygiene care, to limit the exposure to bacteria that can be inhaled into the lungs
• Not touching your mouth and face

Talk with your healthcare provider if you have an underlying health condition that could increase your risk. For example, a swallowing difficulty could make it more likely that you'd inhale liquids or food particles into your lungs.

When to See a Healthcare Provider

Certain symptoms can be early warning signs of pneumonia. See your healthcare provider if you experience:

• Fever that doesn't improve
• Productive cough that worsens or doesn't get better
• Shortness of breath
• Chest pain or chest tightness
• Mental confusion

Additionally, if you've had a cold or the flu but then suddenly feel worse, see your healthcare provider about your symptoms.

Summary

Classic symptoms of pneumonia include a "wet" cough, fever with chills and sweats, shortness of breath, chest pain with breathing, and fatigue. The signs and symptoms of pneumonia can differ by type of infection, or by the affected population.

Treatment will depend on whether pneumonia has a bacterial cause, which can be treated with antibiotics, or a viral cause. It also will depend on the full range of symptoms and their severity. To prevent pneumonia, practice good hygiene and consider getting a vaccine.