ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Tuesday, January 14, 1997 TAG: 9701140096
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Two days before Thanksgiving, a friend died of streptococcal pneumonia that followed a bout of influenza. Before getting the flu, he was perfectly healthy with no known risk factors for lung infections - a nonsmoker and occasional social drinker with a healthy heart, immune system and respiratory tract.
He was only 58 years old, too young - in theory - to warrant taking the pneumonia vaccine, which protects people against 23 strains of Streptococcus pneumoniae, the most common causes of bacterial pneumonia.
When I told others about how my friend died, the typical response was, ``But no one dies of pneumonia these days.''
Wrong. This year 4 million people will contract pneumonia, 800,000 will require hospitalization for it and 10,000 to 40,000 will die from it.
In fact, for bacterial pneumonia, the death rate has not changed in 20 or 30 years, said Dr. Alan Tice, an infectious disease specialist in Tacoma, Wash. Pneumonia remains the sixth leading cause of death overall and the leading cause of deaths from infectious diseases in the United States.
Unfortunately, how people self-treat upper respiratory infections and flu may actually increase their chances of ending up with pneumonia.
Failing to drink lots of plain fluids and taking antihistamines that dry and thicken secretions in the respiratory tract may allow infectious organisms to gain a foothold in the lungs. Smoking or drinking alcohol - even taking alcohol-based cough medicines - can interfere with the mechanisms that flush out invading organisms.
And those who take antibiotics as a ``preventive'' when they have an upper respiratory viral infection can set the stage for a particularly hard-to-treat form of bacterial pneumonia by knocking out the competition and allowing antibiotic-resistant bacteria to thrive.
Furthermore, an all-too-common failure to act quickly when the first signs of pneumonia appear greatly increases the risk of developing a severe and even life-threatening illness if the cause is bacterial.
Recognizing the possible signs that an infection has attacked the lungs and getting to a doctor without delay could be a lifesaver.
The particular danger of streptococcal pneumonia results from its ability, if not eradicated from the lungs early in the disease, to invade the bloodstream, where it may release toxins that can attack vital organs and cause a precipitous drop in blood pressure.
Once this toxic stage develops, the chance of survival with the most advanced medical care may be only a few percent, even in otherwise healthy people.
Fortunately, most cases of pneumonia do not get to that stage. And, fortunately, relatively few people who contract a bad cold or flu end up with pneumonia. But every year at this time, the incidence of pneumonia and deaths from it rise.
According to reports published this month in Infectious Diseases in Clinical Practice, there has been a marked increase in recent years in the kinds of organisms that cause pneumonia, as well as an increase in the share of the population that is especially susceptible to this disease.
Among those particularly at risk are people over 65, people with chronic diseases (many of whom now live much longer than in years past) and people who have illnesses or are undergoing treatments that suppress their immunity, including those with HIV infection, and cancer patients receiving chemotherapy or bone marrow transplants.
Last month, Dr. Carl Sagan, the astrophysicist who popularized astronomy, died of pneumonia while undergoing treatment for bone marrow disease. The treatment may have impaired his immune system.
In addition to several kinds of bacteria, pneumonia can be caused by viruses - including the influenza virus - and, rarely, fungi. Sometimes more than one organism is involved. It is not uncommon for a person to develop viral pneumonia at first, setting the stage for a more severe bacterial pneumonia.
This winter, the number of cases of pneumonia and deaths from it are expected to be unusually high, because a new strain of the more severe type A influenza is making its way across the country, attacking millions who failed to get this season's flu vaccine. Especially susceptible among the unimmunized are those who have never had influenza caused by a close cousin of the new viral strain.
Dr. Brian Scully, an infectious-disease specialist at Columbia University's College of Physicians and Surgeons in New York, said there are two ways pneumonia develops after a case of flu.
First, a person may develop viral pneumonia, which acts like a worsening of the flu, with shortness of breath, a dry cough and fever.
Alternatively, a flu victim may seem to be recovering, only to develop a bacterial pneumonia, with a relapse of fever, possibly chest pain when breathing or coughing and a cough that brings up darkened sputum. If either of these circumstances develops, see a doctor without delay.
However, not everyone with pneumonia develops classic symptoms. The lack of obvious signs may delay a person's decision to seek professional care and make the doctor's job of diagnosis especially difficult.
An examination of a person who might have pneumonia should include a careful history, a blood test and listening for sounds in the lungs through a stethoscope.
If on the basis of the examination the doctor suspects the possibility of pneumonia, a chest X-ray is needed to confirm the diagnosis, and a blood culture should be done to try to determine the specific cause so the best therapy can be prescribed.
There is no specific therapy for viral pneumonia, which usually is a far less severe form of the disease. For bacterial pneumonia, particularly when the specific cause is not known, the doctor may choose a broad-spectrum antibiotic such as ceftriaxone (Rocephin), in a class of drugs called cephalosporins.
Infectious-disease experts say it is unwise to wait for the culture results before starting an antibiotic when there is a strong suspicion that the patient has bacterial pneumonia. A treatment delay could result in a far more serious illness and possibly a fatal one.
Obviously, preventing pneumonia is far better than having to treat it. Anyone can get a flu shot, and everyone at high risk of complications, including all people over 65, should be immunized against the flu every year in October or November.
In addition, people over 65, those of all ages with chronic illnesses and those working in high-risk environments, such as nursing homes, also should take the pneumonoccal pneumonia vaccine once every five to 10 years. The cost of both vaccines is covered by Medicare.
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