News that car racing great Kyle Busch died of sepsis that developed from severe pneumonia has surprised and saddened people across the country. Many are left wondering how it could have happened to someone so young.
MUSC Health critical care specialist and lung expert George Carter, M.D., explains the circumstances that can lead to this type of medical emergency in this Q&A.
Q: First, what is severe pneumonia?
A: Pneumonia is an infection of the lungs, most commonly caused by viruses or bacteria that enter through the airways, leading to inflammation and damage inside the lungs. Typical symptoms of pneumonia are shortness of breath, cough, chest pain and fever; however, none of these are specific to pneumonia, so diagnosing and treating pneumonia requires an evaluation by a trained physician.
Pneumonia is considered severe when it progresses to the point of causing impaired function: low oxygen levels, rapid heartbeat, low blood pressure and/or problems with other body systems – most commonly issues like confusion or poor kidney function. Severe pneumonia is more likely in patients who are over 65 or who have high-risk preexisting medical conditions, such as cancer or severe heart, lung or kidney disease.
Q: What is sepsis?
A: Sepsis occurs when an infection causes an inflammatory response that extends beyond just the local area of infection and starts to cause problems throughout the body and its other organ systems. The human body is a marvelous thing, and many of its built-in protective responses, like fever, flushing and swelling, are beneficial in fighting infections locally but become potentially dangerous when they start to affect the entire body.
If untreated, sepsis can lead to widespread organ dysfunction and damage, followed by outright system failure and even death in the most severe cases. Although critical illness and death are at the very extreme end of the sepsis spectrum, as an intensive care physician, I see sepsis and its complications every day and am very familiar with its diagnosis, treatment and outcomes.
Q: How do you develop that from pneumonia?
A: Pneumonia is one of the most common causes of sepsis overall. The lungs are at risk of infection from a variety of viruses and bacteria that can be breathed in through the airways, which is why your lungs are protected by a very active and effective immune system.
When an infection does occur in the lungs, if it isn’t treated appropriately, there is a high risk for the infection and its inflammatory byproducts to spread quickly through the bloodstream, causing sepsis.
Infections that are untreated or undertreated can also lead to complications, like abscesses, which make future management more difficult, which is why timely identification and treatment are so important for pneumonia.
In addition to standard treatment with antibiotics, some of the bacteria that cause severe cases of pneumonia have vaccines available. If you are over the age of 65, or if you have high-risk preexisting medical conditions, ask your physician about the pneumonia vaccine.
Q: Is sepsis treatable? If so, how?
A: Thankfully, sepsis is very treatable. In fact, our treatments for sepsis continue to evolve and improve, which I have witnessed firsthand, even during my own training and career in medicine.
The first and most important treatment for sepsis is identifying the underlying infection and treating it quickly, usually with antibiotics for bacterial infections. Before antibiotics – not that long ago, since the 100th anniversary of the discovery of penicillin is still a few years away – pneumonia was a leading cause of death worldwide, and it still is in many parts of the developing world with limited access to essential medications.
Many patients with sepsis need additional supportive care, often provided in hospitals, including fluids, nutrition, symptom control and, in some cases, oxygen or other forms of organ support.
By using timely and appropriate antibiotics and providing effective supportive care, we have significantly improved sepsis outcomes in our modern medical system, and we continue to make progress since sepsis is a major focus of ongoing medical research here at MUSC and in the broader medical community.
Q: Kyle Busch was 41 years old. Is it unusual for someone that age to die from sepsis?
A: Kyle Busch’s death is first and foremost a tragedy, especially for his wife and children. I want to be clear that I am praying for peace and comfort for his family, and I want to be careful to respect their privacy by avoiding speculation about the circumstances of his death.
I don’t have any firsthand knowledge of the medical details of Kyle Busch’s case, so none of this should be taken as commentary on the particulars of his death. With that said, his well-deserved fame and the publicity surrounding his passing have led to many questions like this, and I’ve had similar conversations with multiple friends in the past few days.
In my experience, a case like this is unusual, but it also isn’t unheard of. Kyle Busch was very near my own age, and when I see a patient that young die of sepsis, most of the time there’s an obvious medical reason.
Young patients who die of sepsis tend to be those with severe comorbidities, like cancer or end-stage disease of organs like the lungs, heart, kidneys or liver. Those individuals have a much lower tolerance for the stress and damage of sepsis.
By contrast, people who are young and previously healthy, such as a high-performing professional athlete, are generally more likely to tolerate aggressive treatment and to recover from even serious illnesses like sepsis.
However, something that we do have to be aware of is the effect of delayed recognition of illness. It’s not unusual for young and healthy people to try to “tough it out” through even a significant illness since they have a higher capacity to tolerate the effects of the illness.
The potential downside of that tolerance, what we often call “reserve,” is that by the time they eventually realize how sick they are and come in for medical care, things may have gotten very serious and can deteriorate very quickly, sometimes even beyond our ability to treat.
Bottom line, if you are young and healthy, you shouldn’t have anxiety that you’re going to die of sepsis the next time you have an infection, but you also shouldn’t delay seeking care if you have a serious illness.
Q: The AP is reporting that he was thought to have had a “sinus cold” that a TV broadcast said “was exacerbated by the intense G-forces and elevation changes at the New York road course” where he raced May 10. How might that have happened?
A: A cold or sinus infection is an extremely common type of upper respiratory infection in the airways of the head and throat while pneumonia is a lower respiratory infection in the airways inside the chest).
While most colds and sinus infections are self-limited and recover with time and minimal/simple treatment, in some cases, they can progress and even spread down the airways to cause pneumonia. Rapid shifts in airflow and pressure, like what might be experienced while racing, in addition to the general stress of high-stakes performance, can indeed cause problems with the body’s ability to control respiratory infections; this is one reason that rest is so important when recovering from illness.
One of the specific concerns with these types of milder infections is that occasionally the inflammation and damage of the initial infection can lead to a second, more severe infection. We call this process “superinfection” or “secondary infection,” and it can result in much more serious illness, potentially even critical or life-threatening if unrecognized.
The classic warning sign of this happening is when an initial infection has stabilized, and often is even improving, but then the patient has a sudden and rapid worsening of symptoms, usually even worse than the initial infection. If you have an illness that progresses in that way, it’s time to get seen by a physician.
Q: What do you want people to know about the warning signs of severe pneumonia and sepsis?
A: 1. Typical symptoms of pneumonia include shortness of breath, cough, fever and chest pain. If you have these symptoms and they persist or worsen, and especially if you have dehydration-like symptoms, such as excessive fatigue, confusion or decreased or darker urine, you should be seen by a physician so that you can be tested for pneumonia – typically an examination, a quick chest X-ray and potentially some lab testing – and treated appropriately.
2. If you have any infection, particularly a respiratory one like a cold or sinus infection, and you start to feel much worse after initially feeling better, come in to get evaluated for a potential secondary infection.
3. If you are over the age of 65, or if you have high-risk preexisting conditions like cancer or heart, lung or kidney disease, then the above signs are extra important for you. If you’re feeling sick, get your symptoms checked out by your physician.
4. If you are prescribed antibiotics for an infection, take them and finish them as instructed, even if you feel better before the last dose. Undertreatment of pneumonia can be just as bad as, if not worse than, not treating it at all.
5. Lastly, remember that pneumonia and sepsis are treatable, but when we diagnose and treat them early, we usually get better outcomes and quicker recovery. Don’t delay seeing your physician if you have warning signs of serious illness, especially if you’re getting sicker. Even better, if you’re in the over-65 or high-risk groups, see if you can get vaccinated to prevent this serious illness before it has a chance to begin.
