What to pay attention to if there is no fever

Pneumonia is an infection of the lungs caused by bacteria, fungi or viruses (including COVID-19). Fever is a common symptom of pneumonia. However, in certain rare cases, some people have pneumonia without fever or with only a very mild form of it.

Several factors predispose people to developing pneumonia without fever: being very young (under 2 years of age), being over 65 years of age, or having a compromised immune system. It can also occur in cases of a milder form of the disease, called ‘walking pneumonia’.

Pneumonia varies widely in severity and causes breathing difficulties, congestion, mucus production and many other symptoms. The absence of fever in pneumonia does not necessarily mean that the infection is not serious or should not be taken seriously. Therefore, it is important to understand this rare aspect of the condition.

Pneumonia without fever

Fever is not a disease in itself; rather, it is a physiological response to illness. With a fever, the body essentially raises its own temperature to help kill pathogens and fight infections. As such, pneumonia without fever tends to represent a reduced immune response. Immunity tends to be weaker in certain population groups, including:

• Adults aged 65 or older
• Pregnant people
• Newborns, especially those born prematurely
• Babies and toddlers under 2 years old

Furthermore, a range of other conditions can affect immunity, including:

• Human immunodeficiency virus (HIV/AIDs)
• Cancer treatment with chemotherapy
• Taking certain medications, such as corticosteroids or others that suppress immune function
• Autoimmune diseases, including lupusmultiple sclerosis and rheumatoid arthritis
• After you have undergone an organ or bone transplant
• Drug, alcohol or tobacco use
• Exposure to dust, chemical fumes or passive smoking

Pneumonia without fever is also more likely in people with heart or lung conditions, including:

In addition, those who develop ‘walking pneumonia’, a common form of pneumonia caused by a respiratory infection Mycoplasma pneumoniae bacteria, may experience absent or severely reduced fever. Running pneumonia is mild and easily treatable and rarely requires hospitalization.

What’s important to remember about pneumonia without fever is that it can still be dangerous. In fact, it often arises precisely because the patient is already ill or more susceptible to diseases in general. The symptoms vary in intensity: from mild to very severe. Be aware of how you are feeling and don’t be afraid to seek help if symptoms worsen.

Symptoms of pneumonia

What makes pneumonia sometimes difficult to treat is that it has some of the same symptoms as pneumonia cold or influenza (the flu). The signs of pneumonia typically include:

• Fever
• Chills
• Cough
• Thick, colored mucus
• Shortness of breath
• Pain while breathing or coughing
• Headache
• Nausea and/or vomiting
• Diarrhea

The severity of symptoms depends on a person’s health status; Pneumonia is much more difficult to treat and presents with more severe symptoms in people with a weakened immune system or underlying lung conditions.

Symptoms may be age-specific. For example, pneumonia in older adults (over 65 years of age) and some immunocompromised patients may be associated with confusion. Babies and toddlers under the age of 2 may experience breathing problems, feeding problems, a bluish tinge to the skin or lips, restlessness and reduced urine production.

Complications

Although most cases of pneumonia can be treated effectively, it can be particularly dangerous if the disease progresses. What can happen? Here’s a quick overview:

• Respiratory failure: Severe inflammation and fluid buildup in the lungs can lead to very serious breathing difficulties, especially in people who already have lung conditions such as asthma or COPD. Respiratory failure can become severe and require emergency care.
• Lung abscess: This is the accumulation of pus (a yellowish or green, thick fluid) in the lung cavities. Lung abscesses need to be drained and in some cases they need to be surgically removed.
• Bacteremia: This is the spread of bacteria that cause pneumonia into the bloodstream, which can become particularly problematic. Bacteria can spread to other organs, leading to dangerous conditions such as kidney failure and meningitis (an infection of the fluid around the brain and spine).
• Pleural effusion: The tissue that lines the chest cavity and surrounds the lungs can become diseased or inflamed, causing the lungs to fill with fluid. This ‘water in the lungs’ can seriously affect breathing. It is treated by draining the fluid using a catheter or chest tube, sometimes requiring surgery.

Diagnosis

Because pneumonia causes symptoms similar to those of other diseases, the correct diagnosis often consists of two stages. Healthcare providers should determine the cause of the condition and test whether it is bacterial, viral, or fungal in origin.

A diagnosis may include the following:

• Evaluation and assessment of health status is the first step. The doctor will review your medical history, assess current symptoms, and perform a physical examination. An important early step is listening to your lungs with a stethoscope.
• Chest X-rays can reveal how much fluid is in the lungs and what the inflammation pattern is. This allows doctors to understand how serious and advanced your case is.
• Blood tests determine how well your immune system fights pneumonia. Typical one complete blood count (CBC)that measures the levels of all three types of blood cells (red blood cells, white blood cells, and platelets) is ordered.
• A blood culture may also be performed. This can detect whether the infection has started to spread from the lungs to other parts of the body.
• Pulse oximetry is a test of blood oxygen levels, something that may be needed in severe pneumonia. If levels are too low, the infection can cause your lungs to not work properly.

In more advanced or severe cases – especially those involving immunocompromised people – additional tests may be needed, including:

• A sputum testin which a sample of your mucus is clinically evaluated may determine the presence of a viral, bacterial, or fungal infection.
• Computed tomography (CT) scan of the chest checks for damage to the lungs or other complications. This type of imaging relies on multiple x-rays to create a three-dimensional view of the affected area.
• Pleural fluid culture is needed to assess whether bacteria or fungi are spreading to the pleura, the tissue on the outside of the lungs and along the inside of the chest cavity. This requires testing samples from the fluid surrounding these tissues.
• Bronchoscopy involves the use of an endoscope – a camera on the end of a specialized, adjustable tube – to visually assess the airway. This device allows healthcare providers to view video images of the inside of your lungs.

Treatment

The treatment of pneumonia depends on the cause of the disease; for example, what works for bacterial pneumonia would not work for viral types. Below is a list of treatment methods for each type of pneumonia:

• Bacterial pneumonia: The main remedy for bacterial pneumonia is antibiotics. The specific choice of antibiotic and duration of use are based on your overall health, other medications you are taking, and the severity of your case. Taking over-the-counter medications, taking comfort measures, and performing breathing exercises also help, requiring hospitalization in severe cases.
• Viral pneumonia: The challenging aspect of viral pneumonia is that there are not many medications to eradicate it. If the influenza virus has caused pneumonia, antiviral medications, such as Tamiflu (oseltamivir) and Relenza (zanamivir), can help relieve symptoms. Breathing treatments and over-the-counter medications also help here.
• Fungal pneumonia: Antifungal medications are the first-line treatment for fungal pneumonia, including those in the triazole class such as Sporalax (itraconazole), Diflucan (fluconazole), and amphotericin.

Forecast

In general, the success of recovery from pneumonia, with or without fever, depends on your health status. Most otherwise healthy adults see relatively rapid relief of symptoms with treatment. That said, if pneumonia continues to develop, or if you are in a vulnerable or immunocompromised population, the disease can be fatal.

In rare cases, there are long-term effects even after full recovery. For example, children who have had pneumonia can develop lifelong breathing problems. Chronic effects can cause:

• Reduced capacity for exercise and fitness
• Worsening heart conditions
• Cognitive decline and reduced mental function
• Overall reduced quality of life