Written by Damian McNamara, MA
How worried should you be about outbreaks of “white lung syndrome” pneumonia in children reported in Ohio, Massachusetts, and several countries in Europe?
WebMD asked experts this question, as well as if the cases are related to a similar outbreak in China, what symptoms are most common, and what advice they have for preventing infection in their families and for stopping further spread of this infection.
White lung pneumonia is not an official medical condition. Instead, it’s a sign of pneumonia that shows up as white areas on a lung X-ray, and it might prompt more testing to see if lung inflammation is viral, bacterial, or caused by exposure to pollution or chemicals.
Pneumonia: What You Should Know
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What Is It?
Pneumonia starts when a virus, fungus, or bacterium get into one of your lungs. It causes the tiny sacs inside to get inflamed and fill with fluid or pus. If you’re healthy and get treated right away, it usually isn’t serious. But it can be dangerous for young kids, the elderly, and people who have other health problems or weak immune systems.
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How It Happens
Most of the time, your body filters germs from the air to protect your lungs. Coughing also helps keep them out. If they do get in, your immune system usually fights them off before they make you sick. But if the germ is really strong or your body can’t do its part, your lungs can get infected. When your immune system sends cells to attack the germs, your lungs get inflamed, and that leads to pneumonia.
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Symptoms
You may have a high fever, chills, shortness of breath, and chest pain when you breathe. You’ll also probably have a deep cough that doesn’t go away and brings up a thick liquid called phlegm. If you’re able to go about your daily business with these symptoms, you might have “walking pneumonia,” which is often caused by a certain kind of bacteria called Mycoplasma pneumoniae. But if your symptoms are worse than that, you should see your doctor.
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Cause: Bacteria
Some of these tiny organisms are a natural and healthy part of your body, like in your gut, where they help you digest food. Others can make you sick. Most cases of pneumonia in U.S. adults are caused by bacteria. Antibiotics can kill them and help you get better.
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Legionnaires’ Disease
This less common form of pneumonia is caused by Legionella bacteria. You may have a headache, muscle pain, chills, and very high fever. You may also cough up blood and have nausea, vomiting and diarrhea. It spreads through water and can get in things like air conditioners, hot tubs, and mist sprayers in grocery stores. It’s also treated with antibiotics.
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Cause: Virus
The flu virus is the most common cause of viral pneumonia in adults, but any virus that infects your mouth, nose, throat, or lungs can lead to it. The symptoms are usually milder than with bacterial pneumonia, and your body typically fights it off in 1 to 3 weeks.
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Cause: Fungi
Some of these are useful: Mushrooms are a kind of fungus, and mold is what makes blue cheese blue. But some can cause pneumonia. Antifungal drugs are usually used to treat it, but people who have HIV or AIDS or who take drugs that make their immune systems weak, like some cancer drugs, can get a kind called pneumocystis pneumonia. It’s more serious and can be hard to get rid of.
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Diagnosis
You may not know you have pneumonia. It can seem a lot like a cold or the flu — until it doesn’t go away. Your doctor will ask about your symptoms and when they started, and they’ll listen to your lungs for crackling or wheezing. They may want a chest X-ray to get an image your lungs. It can tell for sure if you have pneumonia, but it won’t show what’s causing it.
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Bacteria, Virus, or Fungus?
It’s not always easy to find out what’s caused your pneumonia. Phlegm from your cough can be tested for bacteria, and urine tests can sometimes tell your doctor what’s causing it. They also may ask about recent travel, hobbies, animals, sick people you’ve been around, vaccinations, and drugs you take.
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Complication: Lung Abscess
This is a sore in your lung that’s filled with fluid or pus. In most cases, antibiotics are enough to get rid of it, but your doctor may recommend draining it with a long needle or possibly surgery. A CT scan can help your doctor see it better. This is when several X-rays are put together to make a more detailed picture of your chest.
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Complication: Bacteremia
This is when bacteria from your lungs get into your blood — it’s more likely to happen if you have certain other health issues, like liver disease or high blood pressure. It may spread to other organs, which can cause them to shut down. A blood test can tell if you have it, and it’s usually treated with powerful antibiotics put directly into a vein in your hand or arm.
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Complication: Trouble Breathing
If you’re older, have other health problems, or your pneumonia is serious, your lungs may not work the way should. If they don’t, you may not have enough oxygen in your blood, which your brain, muscles, and other organs need. Your doctor can find out if this is the case with a blood test or a sensor on your finger. You may need to get more oxygen through a breathing mask, or possibly use a machine to help you breathe — called a ventilator — until your lung heals.
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Complication: Pleural Effusion
Sometimes called water on the lungs, pneumonia can make fluid build up in the tissue around your lungs. If the fluid gets infected or makes it really hard for you to breathe, your doctor may need to put a tube in your chest or do surgery to drain it.
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Prevention
Vaccines can protect you from certain kinds, but good habits also help. Keep your hands and face clean with soap or hand sanitizer to kill the germs that cause it. Eat a healthy diet and exercise regularly to keep your immune system strong. And don’t smoke — that makes it harder for your lungs to fight off germs and can lead to more health problems if you do get pneumonia.
Medically Reviewed by Minesh Khatri , MD on August 22, 2021
We asked Vandana Madhavan, MD, MPH, a pediatric infectious disease expert at Mass General for Children in Boston, and William Schaffner, MD, an infectious disease expert at Vanderbilt University in Nashville, to share their take on white lung pneumonia.
Q: How concerned should we be about the cases of ‘white lung’ pneumonia reported in Ohio, Massachusetts, and some European countries?
Madhavan: “We’re seeing more respiratory infections that are circulating because it’s December and we’re in North America and the Northern Hemisphere. Is this a natural seasonal spike? It’s hard to know, but right now we’re not seeing numbers of any particular virus or bacterial infection at such levels that are concerning.”
Schaffner: “Similar things have been seen in Denmark, the Netherlands, and here in the United States. This is not a surprise. This variety of respiratory viruses and mycoplasma bacteria that are circulating are very common. Some of them get down deeper into your chest and cause pneumonia.”
Q: What are the main symptoms, and do they differ from other respiratory infections?
Schaffner: “There are symptoms that involve the upper respiratory tract, like stuffy nose, runny nose, sore throat, and cough, if the virus gets down into the bronchial tubes. If the virus or the bacteria gets out into the substance of the lungs, it can cause difficulty breathing, or create sputum that you’re bringing up that suddenly looks greenish or is streaked with blood. If any of those things happen, if you have any difficulty breathing, if you develop a high fever, you may well have pneumonia. Please contact your health care provider right away.
Q: Any connection to similar illnesses reported in China?
Schaffner: “There’s been a lot of whoop-de-doo about white lung pneumonia. It started with a report in Northern China that they had an increase in pneumonia. The Chinese learned something since COVID – because everybody was afraid that we’d seen this movie before.” Chinese officials met with experts at the World Health Organization where Chinese public health said there was no new virus. “This was nothing like COVID. Instead, it was an early, seasonal increase in respiratory infections, including pneumonia, caused by a variety of winter respiratory viruses.”
Q: How severe are the cases reported in the United States?
Schaffner: “There is a spectrum. A lot of individuals, kids, and older persons have milder respiratory infections that can be managed at home. But each year, we have to hospitalize some children and some adults because they do have pneumonia and difficulty breathing.” A few even have to be on a ventilator for a short time, he said. “The vast majority of folks do get better. That should be reassuring.”
Q: Any advice on steps parents can take to protect their children and prevent further spread of this illness?
Madhavan: “Hand-washing, being mindful that if your child is sick – not going out – and asking if everyone is well if you’re going to a party or holiday gathering.” Wearing a mask in crowded public areas could also help, she said. “Also make sure your family is up to date on influenza, COVID, and respiratory syncytial virus (RSV) vaccines.”
Schaffner: “I would like to remind everyone that we have some vaccines available.” Vaccines for flu, RSV, and COVID-19 are available for many, many people, he said. “Beyond the vaccines, let’s try to be careful and avoid people who are coughing and sneezing. The second thing, which is also tough to do in some households, is if anyone is sick, don’t send you child to day care. They can just spread it to everyone else.”
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