Pneumonia is an acute or chronic inflammation of the lung tissue (pneumonia). Inflammation can be limited to either the alveoli (alveolar pneumonia) or the lung support scaffold (interstitial pneumonia). Of course, mixed forms can also occur.

If the inflammation predominantly occurs in the alveoli, it is often referred to as typical pneumonia characterized by its classic symptoms, such as sudden fever, coughing with sputum, and shortness of breath. If the inflammatory process is more likely to occur in the supporting and connective tissue of the lungs, this is referred to as atypical pneumonia, in which the classical symptoms may be less pronounced or not at all pronounced.

A pneumonia without fever, also known as "cold pneumonia", so may well occur. Because of their atypical course, it is not always easy to recognize them directly, so that is why it is no less dangerous than the classic pneumonia.


Causes of pneumonia are generally different pathogens, which may be both bacteria, viruses and fungi. Which pathogen is the most likely to be affected depends on where the pneumonia was acquired, ie in an outpatient home environment or nosocomially in a hospital, eg as part of another treatment in which a hospital stay was necessary. In addition, the typical pathogens have different sites of inflammation. Some pathogens are more likely to trigger inflammation in the alveoli, while others trigger lung support.

The most common cause of outpatient pulmonary inflammation is the bacterium Streptococcus pneumoniae (pneumococci). The most common causes of nosocomial pulmonary inflammation are the bacteria Escherichia coli, Staphylococcus aureus or Pseudomonas aeruginosa.

Outpatient atypical pneumonia is classically triggered by bacteria such as mycoplasma, chlamydia or viruses (eg influenza). Nosocomial atypical pneumonia are most commonly caused by bacteria such as Legionella (Legionella pneumoniae) or fungi (Aspergillus fumigatus, Pneumocystis jirovecii).

Other causes of pneumonia may include parasites, inhaled poisons or aspiration (inhalation) of gastric juice / acid.


If pneumonia is suspected, the diagnosis should be confirmed by an accurate physical examination. This is not always easy, as the atypical pneumonia without fever often does not show quite classical, pronounced examination findings. When listening to the lungs, one typically hears rattling noises and exacerbated breath sounds. In addition, you can often hear a muted knocking sound when tapping the back.

In this case, an examination of the blood for infection and inflammation (eg white blood cells, C-reactive protein) and pathogens (blood cultures) can help. In addition, the pathogen determination can be done by saliva samples or samples of lung secretions. In particularly unclear cases, a tissue extraction (biopsy) from the lung tissue may be necessary to determine the exact clinical picture. In addition, an X-ray of the chest is often made in which, for example, shadows in the lungs can provide further evidence of a possibly existing pneumonia.

  • Blood levels in pneumonia
  • Diagnosis of pneumonia


The symptoms often vary greatly depending on whether it is a typical or atypical pneumonia.

Atypical pneumonia, in which the focus of inflammation mainly focuses on the lung supportive tissue, often has less pronounced symptoms.

In addition to shortness of breath, which can occur depending on the severity of the disease either during exercise or even at rest, it usually comes to an unproductive cough. The cough is dry and not accompanied by phlegm. When fever occurs it is usually not as high as in classic, typical pneumonia, ie below <38.5 ° C. Under certain circumstances, the fever may be completely absent. Due to the possibly occurring shortness of breath, the respiratory rate can be increased and the performance limited. The strength of the subjective feeling of malady can be very differently pronounced individually.

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If the inflammation also affects the lung pleur (pleuritis), respiratory pain may occur in the chest area.

  • Symptoms of pneumonia "
  • "Signs of pneumonia"
  • Course of pneumonia

Without cough and fever

Pneumonia can occur without fever and without coughing. In general, it is then a so-called atypical pneumonia with predominant infestation of the lung supporting tissue (interstitial pneumonia).

Thus, if pneumonia manifests itself merely as a result of a more or less pronounced shortness of breath or due to nonspecific symptoms of a flu infection, it is not always easy to recognize these directly and treat them adequately as such.

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Further information on the topic can be found here: Pneumonia without cough


One of the first treatment measures for pneumonia is the strict bed rest to give the body the opportunity to recover and regenerate. In addition, it is important to ensure adequate hydration and to provide the body with sufficient nutrients. When fever occurs, antipyretic drugs may be given.


Depending on the degree of severity of the emergency, it may be necessary to administer oxygen via a nasogastric tube. In all cases, breathing exercises and inhalations with saline make sense. Whether a treatment should be done by the family doctor or in the hospital always depends on the severity of the pneumonia and the possibly existing pre- and secondary diseases. In the case of pneumonia caused by bacteria, antibiotic therapy always makes sense in order to combat the pathogen efficiently. If the pneumonia has been triggered by viruses antivirals can be used. To prevent additional infection (superinfection) by bacteria antibiotics are used. Antifungals can be used in fungal infections.

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The duration of pneumonia can sometimes be very different. It is often dependent on the particular pathogen, the course, the therapy and the type of pneumonia (typical or atypical).

With proper, timely therapy, the symptoms of pneumonia usually resolve within 2-3 weeks. Only in severe cases or in case of missing, wrong or too late therapy can the symptoms persist for up to 12 weeks. One speaks then of a chronic pneumonia. Also existing pre and secondary illnesses and the general condition of the immune system and / or the defenses contribute to the duration of the illness, so that the cure of a pneumonia can vary individually very strongly.

If the pneumonia is treated adequately with the right antibiotic, it will already within 3-4 days to a significant improvement in the symptoms. The recovery should take place after a minimum duration of 10 days in uncomplicated courses.

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Risk of infection of pneumonia without fever

The length of time pneumonia is contagious can not be summed up, since the course of the disease can be very different and depends on many different factors such as the type of pneumonia, the course, the severity, the effectiveness of the drugs and the strength of the immune system.

In principle, the causative agents of pneumonia are contagious until complete eradication and can be transmitted via saliva droplets when coughing, sneezing or speaking and infect other people. But not everyone who picks up these pathogens, also gets sick and suffers equally pneumonia. The intact immune system of a healthy person can usually ward off the pathogens.

In general, it can be said roughly that after the beginning of adequate antibiotic therapy the pneumonia loses its infectivity within 3-4 days. At the latest after the end of the therapy and the complete disappearance of all symptoms, the risk of infection should no longer exist.


Pneumonia in children

The immune system of children is usually not fully developed. Therefore, they are generally more susceptible to infections, pathogens and thus also to pneumonia.

Pneumonia is one of the most common respiratory diseases in children and infants. They can become untreated and undetected even life threatening and lead to the death of the child.

In children and infants in particular, an atypical pneumonia can often be found, in which the usual symptoms often do not occur, so that a diagnosis is not always easy. High fever and coughing with sputum may be absent or only slight.

Typical symptoms in children with pneumonia without fever are nostrils, accelerated breathing, apathetic behavior and increased pulse rate.

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