Chronic Pneumonia

Published: March 7, 2016
Last reviewed: June 15, 2017

What is chronic pneumonia?

By definition, chronic pneumonia is a lung infection that lasts at least 6 weeks [1].


Chronic pneumonia is usually caused by slowly growing microbes (Chart 1[1,3,4]. Circumstances in which chronic pneumonia can develop:

  • Acute pneumonia that does not respond well to treatment
  • Untreated atypical pneumonia, for example Mycoplasma (walking) pneumonia
  • Fungal pneumonia in individuals with poor immunity

Chronic pneumonia rarely occurs in otherwise healthy individuals.

Chart 1. Chronic Pneumonia Causes and Spread




Actinomyces [6,13] Aspiration of mouth bacteria Thoracic actinomycosis
Mycobacterium tuberculosis [7] Droplet, by coughing and sneezing Pulmonary tuberculosis; cavities in lungs
Aspergillus [10,15] Inhalation from indoor or outdoor environment Chronic necrotizing pulmonary aspergillosis
Blastomyces [3,8] Inhalation from decaying vegetables and soil Pulmonary blastomycosis; round lung mass, skin sores
Candida [4] Aspiration of fungi that live in mouth or nose Pulmonary candidiasis
Coccidioides [1,3,4] Inhalation of microbes from soil during excavation work or travel Pulmonary coccidiomycosis
Cryptococcus [9] Inhalation of bird droppings from soil Pulmonary cryptococcosis; associated with meningitis
Histoplasma [4,12] Inhalation of bird and bat droppings (in barn cleaners, farmers, bridge painters) Pulmonary histoplasmosis; lung cavities
Sporothrix [4] Inhalation from decaying vegetables (in gardeners) Pulmonary sporotrichosis; lung cavities
Parasites (one-cell)
Entamoeba [11,14] Fecal-oral infection from water or food contaminated by human stool Pulmonary amoebiasis; pleural effusion, liver abscess
Parasites (worms)
Ancylostoma [11] Fecal-oral infection by food contaminated by human stool; or through skin cuts Pulmonary ancylostomiasis; bronchopneumonia
Ascaris [11] Fecal-oral infection by food contaminated by human stool Pulmonary ascariasis; lung granulomas
Schistosoma [11] Ingestion of parasites during swimming in water contaminated by human stool Pulmonary schistosomiasis; lung nodules, enlarged liver
Strongyloides [11] Autoinfection from the stool in the intestine; in HIV/AIDS; in South Asia Pulmonary strongyloidiasis; bronchopneumonia

What is recurrent pneumonia?

Recurrent pneumonia is defined as two or more episodes of lower respiratory tract infection separated by at least a month [1]. Common causing microbes are Streptococcus pneumoniae and Haemophilus influenzae [17].

Risk Factors

Risk factors for chronic and recurrent pneumonia [1,3,4,17]:

  • Impaired immunity, for example, in HIV/AIDS, chemotherapy, corticosteroid or immunosuppressant therapy, removed spleen (asplenia), low blood leukocytes (neutropenia)
  • Underlying chronic diseases: chronic obstructive pulmonary disease (COPD), bronchiectasis, alcoholism, diabetes mellitus, cancer, leukemia, cystic fibrosis [16]
  • Chronic conditions that allow frequent aspiration: difficulty swallowing, neurological conditions (dementia, Parkinson’s disease), alcoholism, seizures, gastroesophageal reflux disease (GERD) [18]


Symptoms of chronic pneumonia usually develop slowly, can be mild or severe and can include [2,3]:

  • Persistent dry cough or, rarely, coughing up yellow or green mucus or blood, chest pain during coughing
  • Shortness of breath during exercise
  • Low-grade fever, night sweets
  • Anorexia, weight loss
  • Fatigue
  • Swollen lymph nodes in the chest, neck and armpits
  • Skin rash


Tests to identify microbes [11]:

  • Culture from blood, sputum and bronchial secretions
  • Antibodies against microbes (IgE antibodies in parasites)
  • Blood cells: eosinophils in parasitic pneumonia

X-ray can show patchy lung infiltrates (bronchopneumonia), lung cavities, abscesses or enlarged chest lymph nodes [11].

Differential Diagnosis

Health conditions that can mimic chronic or recurrent pneumonia [4]:


Treatment includes management of the underlying diseases, antibiotics for bacterial pneumonia, antifungals for fungal and metronidazole and other antiparasitic drugs for parasitic pneumonia.

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