There are many causes for pneumonia, which we often associate with the winter months. Certainly the presence of influenza in the fall through early spring will put a person at risk for developing a serious lung infection, especially for older adults and individuals with lung diseases. There are many things that can cause serious lung infections; these include bacteria, viruses, fungus, inhaled chemicals and food.

A lung infection not necessarily tied to any particular season is known as atypical pneumonia or more commonly as “walking” pneumonia. It is referred to as atypical because the type of bacterial infection that causes it is different from more serious cases of pneumonia and does not make the person as ill.

Walking pneumonia is usually caused by a bacterial microorganism called Mycoplasma pneumoniae. People who have walking pneumonia are rarely ill enough to be confined to bed or hospitalized. Many are well enough to go to work and carry on with other regular routines, thinking they have a persistent cold. Mycoplasma infections are common in older children and adults younger than 40.

Individuals who live and work in crowded places have the highest risk of contracting the disease. It spreads when someone comes in contact with droplets from the nose and throat of someone who has it. That commonly happens when the person with walking pneumonia sneezes or coughs without covering his/her mouth.

Cases of walking pneumonia are most common in the late summer and fall. But infections can occur anytime during the year. And, even though the disease is contagious, it spreads slowly. The contagious period in most cases lasts less than 10 days. Some experts feel that it will take a more prolonged exposure to a person with the infection in order to get it. However, there are widespread outbreaks every four to eight years in many communities. When those outbreaks occur, walking pneumonia can account for as many as one out of every two cases of pneumonia.

It is often difficult to initially diagnose atypical pneumonia because the symptoms of cough (with and without violent spasms), small amount of mucus production, flu-like symptoms such as fever and chills, sore throat, headache and fatigue are common to other bacterial and viral infections. Chest X-rays initially will be clear and will show up only after a long-standing lung infection. Walking/atypical pneumonia is sometimes considered only after the initial course of a penicillin or cephalosporin antibiotics fails to improve the situation.

The appropriate treatment requires the use of a class of antibiotics that include mycin-based medicines. For those allergic to these medications, tetracycline has also been used. Instead of the traditional 10 to 14 days of treatment, atypical pneumonia often requires up to three weeks of medication. Many people will report lingering fatigue for an extended period of time after the chest symptoms have resolved.

Other reasons why people cough

There also needs be a discussion of other conditions with “atypical” presentations of lung conditions that cause a person to have a prolonged cough. Your family doctor or pulmonary specialist goes through a mental checklist of possible causes when you present with a long-standing cough. Below is a partial list of possible reasons:

• Cigarette smoking is the most common cause of chronic cough.

• Asthma is a disease of the airways, resulting in difficulty breathing or wheezing often characterized by abnormal breathing tests. Some asthma sufferers have a chronic cough as their only symptom. They may even have normal lung-function tests.

• Gastroesophageal reflux disease (GERD) refers to acid reflux or stomach acid and other contents coming up into the esophagus. The acid causes a reflex spasm of the small airways in the lungs that leads to shortness of breath and coughing. In some instances, acid reflux can be so severe that stomach contents can get into the lungs and damage lung tissue.

• Sinus problems and postnasal drip can also cause chronic cough with mucus. Individuals with this type of cough often complain of a “tickle in their throat” and frequent throat clearing.

• Whooping cough (pertussis) is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. Whooping cough commonly affects infants and young children, and can be prevented by immunization with a new pertussis vaccine. In adults, whooping cough can be a cause of chronic cough, but more importantly, adults can spread this to infants, young children and older adults who may become seriously ill.

• Chronic cough in children is uncommon. Foreign material obstructing the airways of the lungs, asthma, and allergies should be evaluated by your family doctor or pediatrician.

• Certain medications, especially ACE inhibitors used in treating high blood pressure, can cause chronic cough.

• Less common causes of chronic cough include allergies, tumors, sarcoidosis, congestive heart failure, or other lung diseases such as chronic obstructive disease (COPD) or emphysema.

If you are experiencing a cough that does not stop after a week, it is important to consult with your family physician. A cough associated with high fevers (over 101 F), increasing mucus, and/or shortness of breath requires emergency evaluation. Now that the influenza season is approaching, call your doctor’s office to find out when flu shots will be available. If you are a smoker, find out ways of stopping by talking with your doctor or groups such as the American Lung or American Cancer societies, or our local health department.