I Had Pneumonia Without Fever, Why?

Q: I had bad cough last month, but I didn’t have fever, and the blood test showed normal white cell value and normal CRP value. The doctor asked me to take a CT scan, the result said pneumonia. I took medication including antibiotics, and cough relief medicines for like two weeks, and I recovered. I don’t cough at longer. But I just don’t understand, why I had pneumonia without any fever or abnormal value in blood test?

A:  First of all pneumonia is simply a diagnosis, that is, the infectious diseases of lung, referred to as pneumonia. For infectious diseases, there are three main types of pathogens, namely viruses, bacteria and fungi.

Virus – we all heard about upper respiratory tract infection, 80% of respiratory tract infection is virus infection, often leading to cough, nasal congestion, runny nose, sneezing and other local symptoms as well as limb muscle aches, malaise, dizziness, headaches and other systemic discomfort, and even fever. Common virus infection can be cured through people’s immunity, antibiotics are not applicable. However, some viral infections are serious, in particular, some of the more pathogenic virus, such as SARS, will infect lung tissue in a very short time, leading to viral pneumonia and lung ventilation.

Bacteria – Everybody knows something about bacteria. Antibiotics are used for bacterial infections, but not for viral infection or fungal infection. And, bacteria are classified, generally divided into gram-negative bacteria, gram-positive bacteria, anaerobic bacteria and atypical pathogens. Different antibiotics work on different antimicrobial spectrum, Stomatology is mainly anaerobic bacteria, Respiratory could be all the above. At the same time, the distribution of different antibiotics in the tissues of the human body is inconsistent, some antibiotics in the lung tissue distribution of high concentrations, more used to treat respiratory infections. Some have high concentrations in the genitourinary tract, some can penetrate the blood-brain barrier, some are high in the middle ear, and these drug properties are also used in different diseases, different sections of the cause. That is why we have to run test to know the causes. Back to the respiratory section, how to tell if it’s a bacterial infection?  There are several aspects.

1. Symptoms:  If there is purulent secretion, such as pus, or cough yellow phlegm, cough dense phlegm, or accompanied by fever, basically are accompanied by bacterial infection

2. The index of infection, such as blood test with white cells elevated or decreased, or white cell normal, but the neutrophil count increased or the percentage increased, procalcitonin, C-reactive protein and other indicators increased (ESR because the specificity is not high, temporarily not included).

3. Direct secretions produce bacteria. The above judgment has more than one item that can be considered to have bacterial infections, aimed at antimicrobial spectrum empirical antibiotic treatment.

Especially, I would like to talk about two types of bacteria, atypical pathogens and acid bacilli.

  • Atypical pathogens is, Mycoplasma, chlamydia and so on. This type of pathogen usually carries violent cough. Mixed infection usually carries visible thick phlegm, sometimes with blood. A blood test of antibody titer can help to diagnose. Treatment is mainly of the use of azithromycin and other large-ring lactone drugs.
  • Acid bacilli, yes, you think of TB, leprosy. Let’s talk about TB. The anti-acid antibacterial in the daily life is basically not visible, once you find anti-acid bacilli exist in blood test, it’s diagnosed. If it is Mycobacterium tuberculosis, at least six months of medication is a must. If it is other non-Mycobacterium tuberculosis, you can go to buy lottery, because TB common treatment program is not suitable for you, you need drug sensitive test to find the wrong medicine. 

Fungi – are not just mushrooms, spores and other sprouting things, there are Aspergillus, Candida, Fungi, Cryptococcal, Marneffei Penicillium. Fungi are found in people with low immunity, such as blood disease patients, cancer patients, tuberculosis, rheumatism, diabetes patients, HIV carriers. However, because of the aggressiveness and high pathogenicity of Aspergillus, it may cause disease in less healthy people. So please remember to wash your home air-conditioning, live in places with good ventilation, and wear masks when cleaning the house. 

Now we can talk about fever and why some pneumonia is non-fever?

Remember, pneumonia doesn’t necessarily cause fever, fever doesn’t necessarily be caused by pneumonia. Fever means inflammation, but doesn’t mean serious disease. 


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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.