Pneumonia diagnosis

What Hillary Clinton’s pneumonia diagnosis means, medically speaking

On Labor Day, in the middle of a campaign rally in Cleveland, Democratic presidential candidate Hillary Clinton stopped to fight off a cough. She sipped a glass of water, turned away from her microphone, then shrugged. “Every time I think of Trump”, Clinton said“I become allergic.”

If only stump-talk jokes could defeat germs. Six days after the Ohio rally, traveling from a 9/11 memorial service held in New York, Clinton lost her balance and had to be helped into a waiting van. Bystanders videotaped the tripping and forced the campaign to be clear: Clinton had fallen ill. It turned out that a few days earlier, a doctor had diagnosed the 68-year-old candidate with pneumonia.

“Secretary Clinton is suffering from a cough related to allergies,” Clinton’s doctor, Lisa R. Bardack, said in a statement, as reported by The Washington Post on Sunday. “Friday, during the follow-up evaluation of his prolonged cough, he was diagnosed with pneumonia. She was put on antibiotics and advised to rest and change her schedule. At this morning’s event, she got overheated and dehydrated. I just checked her and she is now rehydrated and recovering well. Clinton canceled a planned trip to California.

Video of then-presidential candidate Hillary Clinton leaving a 9/11 memorial ceremony in 2016 appeared to show her collapsing and stumbling. (Video: Thomas Johnson/The Washington Post)

Clinton falls ill during 9/11 memorial service in New York

Although Bardack said his patient was on the verge of recovery, the pneumonia diagnosis may have left some voters wondering: Isn’t pneumonia, after all, a serious health condition?

The short answer, for now — based on the limited information available on Clinton’s case and considered independently of any other unknown health issues she may or may not be facing — is no.

“At this point, there is no reason to believe Secretary Clinton will be disabled” by pneumonia, American Lung Association science adviser Norman H. Edelman told the Post by phone Sunday night.

The long response to the severity of pneumonia begins over a hundred years ago, when pneumococcal bacteria were discovered in the 1880s. By the turn of the previous century, this disease had replaced consumption, or what we would now call tuberculosis, as the leading cause of death in cities like Chicago, according to Canadian physician William Osler. He made a scrupulous study of the disease and described it in almost poetic terms. In 1901 he wrote“The most widespread and lethal of all acute infectious diseases, pneumonia, is now the ‘captain of the men of death’.”

Osler also observed that pneumonia frequently struck those whose health was already compromised. He gave the disease another name, “the old man’s friend”, because it was a terminal – although by the standards of the time, painless – affliction in the elderly. So to speak, Osler would personally befriend the disease. He has succumbed to pneumonia in 1919.

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Had he lived two more decades, the doctor would have seen penicillin change the world. After World War II, the development of the drug and other antibiotics reduced the death rate of the disease to almost a third, compared to the early 1900s. Pneumonia fell from its perch at the top of the causes lethal, but not very far. Along with influenza, the disease was still the eighth leading cause of death in the United States in 2013. That year, it had a mortality rate of 17 deaths per 100,000 people, according at the Centers for Disease Control and Prevention.

Death is part of the spectrum of pneumonia. However, not all pneumonias are created equal.

“The problem is that we have a word for a disease that comes in many different iterations,” Edelman said.

You’ve probably heard of pneumonia, but you may not understand what it really is. This video explains the science behind the condition. (Video: Courtesy of Osmosis (www.osmosis.org[osmosis.org]), and available under CC BY SA license.)

Basically, pneumonia simply means that a germ has inflamed the air sacs in the lungs. Cold viruses infect the nose and throat; bronchitis affects the airways; and pneumonias afflict the dark, moist, warm parts of the lung itself. To complicate matters, the pathogens chewing up lung tissue could be one of a motley crew of bacteria, viruses or fungi.

The severity of pneumonia is as wide as its possible culprits. At the bottom is a mild disease. The disease is colloquially known as walking pneumonia, so named because the disease rarely puts someone out of commission and to bed. That’s probably where we find Clinton, at least from what her campaign has revealed so far.

The CDC estimates that 2 million people a year get sick with these milder forms of pneumonia. “Developing walking pneumonia doesn’t mean you have poor health,” Stanford University pulmonologist Marc Nicolls said in an interview with The Post. “Young, healthy people develop walking pneumonia.” It’s possible that there are even more cases than the CDC estimates, because walking pneumonia is difficult to diagnose. Symptoms rarely move away from cough, fever, fatigue and other average illnesses.

If Clinton does indeed have walking pneumonia, chances are — odds range from 1 in 50 to 1 in 5 — that the culprit is a named bug. Mycoplasma pneumoniae. Among bacteria, M. pneumoniae is an oddity. It is both exceptionally small – one of the smallest organisms on Earth – and exceptionally vulnerable, as it lacks the cell walls that envelop most other bacteria. As far as we know, it is an exclusive human parasite, unable to reproduce outside of warm, moist human organs. M. pneumoniae is transmitted from one person to another, by droplets expelled by the respiratory tract.

But that’s only one possibility. “Insects that cause pneumonia are common,” Edelman said. “A lot of people carry these insects in their noses and throats.” (That was about as close as an expert would speculate to the risk factor of shaking sweaty hands by millions during the campaign.)

It is too early to say with certainty whether M. pneumoniae or any other microorganism is responsible for Clinton pneumonia. Laboratory tests to determine a mild type of pneumonia, in fact, often take longer than the disease itself lasts.

Even the fact that Clinton takes antibiotics offers little insight into the nature of her illness. (Antibiotics are only effective against bacteria, not viruses.) Doctors may give such drugs if bacteria is suspected. A chest x-ray, meanwhile, will at least give some insight. Such an image may “show a diffuse whiteness that may appear worse than the patient,” Nicolls said. Viruses, in general, tend to spread, appearing on a chest x-ray in a sweltering white haze. Other types of microbes stay close. “Bacteria tend to localize to one lobe of the lung,” he said.

Regardless of the specific bug, this type of pneumonia is called community-acquired pneumonia. That is, he was caught anywhere but a health care system. Nosocomial or nosocomial pneumonias are much more serious illnesses, often involving drug-resistant pathogens. These diseases are a big part of why pneumonia umbrella continues to have a high rate mortality rate.

What’s also much less likely is that Clinton caught the pneumococcal form of the disease. The CDC recommends anyone over the age of 65 get vaccinated against the most serious type of pneumococcal disease. At 68, Clinton falls into that demographic. (The American Lung Association’s advice is also to vaccinate at age 65.)

Walking pneumonia is ultimately self-limiting, which means the disease should pass on its own, even without antibiotics. “It’s usual. It happens at all ages,” Edelman said. “It occurs in perfectly healthy people as well as in those who are sick.”

In fact, on Friday, the day of her diagnosis, Clinton attended several events, including a CNN interview and a national security meeting. “If she’s had it for more than a week or so,” Nicolls said, “you could say that indicates a certain amount of stoicism.”

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