Mystery Pneumonia (2)
A mysterious pneumonia was spreading rapidly across California. It looked like a completely new disease, with no clear treatment yet. It had been about a week since the authorities and hospitals started sensing something was wrong. Suspected cases were estimated at least in the dozens, centered around Sacramento...
I'd been reassigned to the pneumonia isolation ward. A hastily improvised setup with a rather ominous name. Senior resident James was standing in front of the newly installed vinyl curtain.
"Oh, there you are."
James let out a sigh of relief, as if I'd come to wipe out the infection single-handedly. I glanced at the temporary vinyl barrier.
"They already set up a new ward?"
"It's pneumonia that's not responding to antibiotics. The infectious disease folks decided we needed a new droplet isolation zone right away."
What a strange bug. James led me toward the station inside.
"I see..."
"The silver lining is that most patients are elderly or immunocompromised. Doesn't seem like it's spreading between healthy people."
James was an experienced internal medicine resident, after all. He could be serious when it counted. I nodded, and we started flipping through the patients' charts.
It sounded odd to call it fortunate that only the elderly were getting it, but it was better than everyone catching it... It also meant low likelihood of person-to-person transmission independent of immune status.
"Nothing turned up yet?"
"Just normal oral and respiratory flora. What do you think about Candida infection?"
I shook my head. Candida was a fungus, a type of mold. Most people carried it asymptomatically, and it rarely caused issues in healthy folks. It wouldn't spread like this.
"Doesn't fit the community-acquired pattern. Epidemiologically weird."
This was a headache. If multiple hospitals couldn't pinpoint the pathogen...
"Yeah, tell me about it."
"What antibiotics were tried?"
"Other hospitals went with penicillin. Here at Stanford, some got antifungals after Candida showed up in sputum cultures."
I scratched my head. The 1970s had no quinolones yet, and they didn't seem geared for gram-negative pneumonias systematically. So many antibiotics hadn't been invented. Or maybe gram-negatives just weren't common pneumonias back then? If Stanford was like this, other hospitals must be in even worse shape.
I kept scanning the charts. Treatments for intracellular bacterial pneumonias were inadequate.
"Situation doesn't look good."
"Nope."
Were there even pneumonias besides pneumococcal or staphylococcal that penicillin could handle? Treatment wouldn't be easy.
Anyway. After the transfer to infectious diseases, treatments for these pneumonia patients had splintered every which way. Just as James said: doxycycline, antifungals, vancomycin. Desperation in prescription form. They were throwing everything at the wall.
Not hugely effective, though.
"Still, James, doxycycline seems to be working on some here, right?"
"Yeah, it does look that way."
James trailed off. At least initial treatment was taking shape.
"I'll brief the professor."
But work remained. We needed the why to treat confidently. Why this new disease now?
It wasn't as complicated as I'd thought. Antibiotic failures? That was other places sticking to penicillin. Some of Stanford's choices showed partial success! At least to our eyes.
Doctors' personalities varied; some might not care about mechanisms or rationale before dosing.
I was at the station, reviewing the mystery pneumonia charts, when footsteps approached.
Respiratory medicine professor John Murray, the Stanford doc spearheading this crisis. He entered the ward station with a grave expression.
"Hello, sir."
I greeted Murray. He seemed pretty urgent. Hard to say if it was his nature or the situation.
"So, any thoughts on what this is?"
I nodded. Possible diagnoses had narrowed. Now just needed the solution and scientific backing.
Let me organize my thoughts.
"Fever and patient demographics point to an infectious disease."
Ditch allergies, parasites, toxins. Spread speed didn't fit.
"Likely."
"Basic antibiotics failed elsewhere, so not your garden-variety pneumonia. Clinical picture differs a lot from typical bacterial too."
Pure logic so far. Location, X-ray lesions—all alien to known pneumonias.
"Not bacterial pneumonia?"
I nodded.
"Looks like atypical pneumonia."
Murray flipped open a chart.
"Fair point, but... Atypical is still bacterial. Key is finding the principle. And isn't this different from usual atypicals?"
Typical atypicals weren't this severe. They called them "walking pneumonias."
Why the confusion? In modern terms, "atypical pneumonia" means intracellular bacterial pathogens. Treat with intracellular antibiotics like doxycycline.
But in the 1970s, the concept wasn't solid yet. Like that psittacosis case—vague awareness at best.
That was the theoretical backdrop on pneumonia classification.
"A few improved with doxycycline. Like psittacosis."
"Other causes? Fungal?"
"Would've shown on microscopy."
Murray frowned.
"I've racked my brain. Even bacteria should've been visible. We did cultures, Gram stains galore."
"What about intracellular bacteria?"
"Checked that too. ID docs worked their asses off. Intracellular stains aplenty. Viruses?"
Unlikely. WBC counts, ratios, inflammation markers, symptoms, epidemiology—no viral flags.
Some inconsistencies, though. Murray sighed.
"Good points, but still. A brand-new infectious disease? Unsettling. Where'd this pathogen come from...? What's your take?"
"I'll figure it out."
"We're missing something."
I'm no machine. Give me a day, at least.
A few suspects came to mind.
Time to see patients myself. Mask and disposable gown on, I cautiously entered the pneumonia ward.
Good no med staff infected yet.
Knock knock.
I entered a room.
"Hello."
The patient coughed a few times and turned to me. Elderly man with thick gray hair. Still looked pained, but not critically ill.
Coughs continued. Maybe the disease itself wasn't that virulent? Hit elderly first, delayed treatment made it seem worse.
But the why of this sudden new bug lingered.
The old man sat up in bed, eyeing me.
"Eastern doc, huh? Went to Tokyo in World War II myself... Right before it ended."
"I see."
I scratched my head. Delirium? Psychiatric symptoms? Cognition seemed okay.
Anyway.
"How's the body feeling?"
"Aigoo, just old age catching up. Why lie here for it? Send me home. New meds are helping a bit."
Need to nail the diagnosis. Good the drugs worked.
I nodded.
"Any triggers come to mind? Reason for a new disease. Recent woods trip, weird food?"
"Nah. Just wandering around. Hotel for an event."
"Hotel. Got it."
Tough-to-treat mystery pneumonia. Veteran. Brand-new disease. Hotel.
Puzzle complete. Now it clicked. Why this infection emerged now. Why other docs floundered on diagnosis and treatment. All Legionella—from hotel water systems. Legionella pneumonia.