FIX: Hillary Clinton’s campaign said she was ”overheated” at an event Sunday and she appeared to be somewhat unsteady on her feet – at least briefly. Are symptoms like this consistent with a diagnosis of pneumonia, which apparently Clinton had received 48 hours earlier?
Simpson: These symptoms and signs are absolutely consistent with a diagnosis of pneumonia 48 hours previously. “Overheated” may well mean that she had a fever, although it is difficult to say. Pneumonia is commonly associated with intravascular volume depletion, or more precisely, causes intravascular volume depletion, which the lay public may call dehydration. Often, the inflammation associated with pneumonia causes poor appetite and poor thirst, while the fever causes increased evaporative losses.
FIX: What, exactly, is the medical description of pneumonia? How does it affect the body?
Simpson: Pneumonia is an infection involving the parenchyma, or alveolar air sacs of the lungs, along with the inflammation or immune cell activation that causes some injury to lung tissue. If localized, it causes some impairment of the ability of the lungs to remove oxygen from the air and place it onto red blood cells. Generally, there are systemic (body-wide) symptoms, such as fever, loss of appetite, muscle aches, as well as more local symptoms, such as cough, sputum (phlegm) production – which is sometimes streaked with blood, stabbing chest pain when taking a deep breath or coughing, and shortness of breath.
When pneumonia is severe it may cause serious deficits in oxygenation, and may cause severe sepsis, which is life-threatening organ dysfunction, due to a disregulated host response to the infection. Organs involved may be central nervous system (confusion or stupor), cardiovascular system (low blood pressure, or hypotension), lungs (severely low blood oxygen), kidneys (decreased urine output or increased in kidney chemistries), blood clotting (known as disseminated intravascular coagulation and usually spotted by a low platelet count), and lactic acidosis. Lactic acid is produced by two things: cells metabolizing with inadequate oxygen supply, and heavy stimulation of various cells by adrenalin.
Any of these organ dysfunctions would or should prompt admission to the hospital.
Lay people often refer to “walking pneumonia”. This is not a medical term, but simply means that a patient is not ill enough to require hospitalization.
FIX: Are there different types of pneumonia? Some people are hospitalized for it. Other seems to handle it more easily. Why?
Simpson: Yes, there are different types, mostly related to the organism that is invading. Bacterial pneumonias typically cause the symptoms I listed above. Viral pneumonias, such as influenza, also can make a patient seriously ill, but are not typically associated with the chest pain; they tend to be more diffuse, rather than localized to a particular area of the lung. Viral pneumonia may lead to subsequent bacterial pneumonia, because of damage to the interior defense mechanisms of the lungs and because of alterations to immunity.
No one handles pneumonia “more easily”. It is a serious infection with potentially serious consequences, including death. However, receiving early, appropriate medical attention is key. Early antibiotics may stop its progression quickly. It is true that in some patients, the progression from first symptoms to dire illness occurs very rapidly. This can be due to patient factors, such as immune status, disruption of mechanical barriers to bacterial or viral invasion, or high symptom tolerance. Sometimes the progression appears to be rapid, when it is not; the patient simply does not complain until the burden is high.
FIX: What’s the prognosis for pneumonia? How long is the typical recovery time for a patient of Mrs. Clinton’s age and medical history?
Simpson: Men and women 65 years of age and up -- e.g. both presidential candidates -- are particularly susceptible to pneumonia, which is a very common cause of death among the elderly. However, the prognosis for pneumonia that does not require hospitalization is quite good. Although a person of this age should be able to function to do their job within a few days – if they take adequate time to rest and recuperate – longer if they try to work through it, it generally takes four to six weeks to feel back to normal, in terms of stamina.
Some diseases, such as chronic heart failure, chronic lung diseases (emphysema, COPD, or pulmonary fibrosis), chronic liver disease (cirrhosis), chronic kidney disease, alcoholism, cancer and/or cancer chemotherapy, chronic immunosuppression for arthritis or related diseases are associated with especially high risk of pneumonia and of recurrent pneumonia. Patients who have had a stroke or who have a chronic neuromuscular disease, such as muscular dystrophy, myasthenia gravis, or ALS (Lou Gehrig’s disease) may have impaired swallowing and mechanical defenses against pneumonia. Adults of any age with any of these risk factor should have a pneumonia vaccine.
Adults, even those over age 65, who have an otherwise clean bill of health should not have an increased risk of subsequent pneumonia. They do still retain the higher risk of being over age 65. On average, women tolerate pneumonia and survive it somewhat better than men.