It feels like the flu-your body aches, the cough persists, a fever soars. But it’s really pneumonia, which, if left untreated or treated too late, can kill and kill swiftly.
Its victims: the old, the very young and people with diabetes or other diseases that impair their immune systems so they can’t fight the infection.
Veteran Miami Herald movie critic Bill Cosford, a diabetic whose sudden death at 47 shocked his readers and colleagues, thought he had a cold on a recent Monday. By Tuesday night he had to be hospitalized, and by early Thursday morning, his diabetes and pneumonia joined forces to take his life.
Combined with influenza, pneumonia ranks as the country’s sixth leading cause of death. Most people remember the sudden-death-from-pneumonia headlines when Muppet creator Jim Henson died unexpectedly at 53 in 1990. Henson had flu-like symptoms and delayed treatment, news stories reported. That same year, Elizabeth Taylor became seriously ill with a hard-to-identify strain of pneumonia.
“We do have a cavalier attitude sometime, both doctors and people in general,” says Dr. Eben Rubin, associate director of the intensive care unit at Jackson Memorial Hospital in Miami. “We’re used to treating pneumonia and having people survive. But sometimes they don’t, particularly if they have other illness.”
With pneumonia, a lung infection, the air sacs fill with pus and other liquid, and oxygen has trouble reaching the blood. If the body’s cells don’t get enough oxygen, they can’t work well.
In the worst cases, the lung infection can spread through the bloodstream to different organs, causing heart and kidney failure. (By the time Henson was hospitalized, doctors estimated that the infection had progressed for at least three days. Large doses of antibiotics didn’t help. Henson died less than 24 hours after being hospitalized.)
Despite its common name, pneumonia isn’t a single, simple disease; it has more than 30 causes. A number of bacterial infections can cause pneumonia. Another cause is viral infections, such as influenza. This year’s version is the Type A-Beijing influenza.
Other causes are mycoplasmas-hard-to-classify agents that have characteristics of bacteria and viruses-and fungi, gases and dust.
Once called “the captain of the ship of death” because it killed so many, pneumonia today can usually be treated successfully with antibiotics if diagnosed early. People should see a doctor if they have shortness of breath and chest pain and are coughing up greenish mucus, says Dr. Glenn Singer, associate director of pulmonology at Broward General Medical Center in Ft. Lauderdale.
Because people in risk groups are more vulnerable, they may need to consult a doctor sooner.
Pneumonia and diabetes together, for instance, can become a “vicious cycle,” says Dr. Jay Skyler, an endocrinologist and specialist in diabetes at the University of Miami Medical School. “The presence of pneumonia makes the diabetes worse. And diabetes makes it more difficult to fight pneumonia. For that reason, during flu season, we pay particular attention to colds and flus in diabetics.”
When a diabetic’s blood sugar is high, white blood cells don’t function as well.
“With pneumonia in particular, you need the phagocyte cells to work. These are the white cells that swallow bacteria,” he says. “Pneumonia-type infection is the worst kind of infection to have if you have diabetes, because when the blood sugar is high, white cells don’t work as well.”
Better than battling the disease is to avoid it. Because influenza can lead to pneumonia, medical experts generally recommend that people in risk groups-particularly the elderly and those with chronic illnesses-get a flu vaccine every fall, at the start of the flu season. The vaccine is made each year so it contains the viruses expected to cause illness. (Singer, the pulmonary specialist, says it isn’t too late to get a flu shot this year. But understand that it takes three or four weeks to become effective.)
There’s also a vaccine for pneumococcal pneumonia, a bacterial pneumonia that accounts for 10 to 25 percent of all pneumonias and 40,000 deaths yearly. Because it’s more controversial than the flu shot in terms of effectiveness, the vaccine isn’t as widely used.
People in high-risk groups also should talk to their doctors about other precautions. In particular, diabetics should have a written plan for sick days, says Skyler, the endocrinologist.
During illness, he says, diabetics should monitor their blood sugar more frequently than usual, check more often for ketones (toxic substances) in the urine and drink plenty of fluids. By diligent monitoring, they’ll know if they need to adjust their intake of insulin to avoid serious problems.
For everyone else, practice good health habits, says Singer, the pulmonary specialist. Don’t smoke. Get plenty of rest. Exercise. Eat a well-balanced diet. Avoid contact with sick people.
“You know what you should do,” he says. “Take care of yourself.”
