Academy Award-winning actress Whoopi Goldberg, wanting to raise awareness about the dangers of pneumonia, brought her two physicians to her morning talk show to recount the close call she had with the illness earlier this year.
The physicians, Jorge Rodriguez, MD, an internist and gastroenterologist, and pulmonologist Martin Greenberg, MD, revealed that Goldberg was so severely ill with pneumonia and sepsis when she came into the hospital, that she had a "one in three" chance of dying from the infection.
Goldberg, 63, reports that she originally got a cough back in November 2018 and thought that it would eventually go away on its own. On February 6, Whoopi says she "didn't feel well" and called her business partner Tommy Leonardis to say she thought she needed to go to a hospital. He contacted her primary doctor, Rodriguez, who told the audience that when he spoke to her: "I could barely understand Whoopi. Her teeth were chattering, she was gasping for air." When she told him all she wanted to do is lay down and go to sleep, he became even more concerned. "I tried not to sound scared ... I was afraid she wasn't going to wake up because you don't know if someone, when they give you those clues ― is she really now just tired or is she going to become unconscious and this is it?"
He arranged for an ambulance to take Goldberg to the hospital where she met Greenberg:
"When I first met Whoopi, she was in a bad way. She had a high fever, she was short of breath, very rapid heart rate, and a low oxygen level, which is not a good sign."
Goldberg was diagnosed with pneumonia and sepsis. She had a pulmonary effusion which was drained twice. When the effusion reoccurred, a radiologist inserted a tube for an ambulatory chest drainage device (see below).
She was hospitalized for three weeks, and did not return to "The View" until April, and even then, on a part-time basis.
Goldberg hoped that talking about her illness with her doctors would motivate others to be more proactive about their health, saying "It's OK to go to the doctor because you don't feel good."
"The crazy thing is people don't take (pneumonia) seriously," Goldberg acknowledged, admitting that she didn't initially. "I just (tried to) fight through it, and you can't do that. It will kill you. Inactivity, not doing anything, not checking, will kill you."
"So, get your ego together and say 'yeah I'm going to the doctor because I don't feel good.' You'd rather be alive bitching about it than be dead."
Pneumonia Basics
Pneumonia is a bacterial, viral, or fungal infection of one or both sides of the lungs that causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus. Pneumonia tends to be more serious for children under the age of five, adults over the age of 65, people with certain conditions such as heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), or people who have weak immune systems due to HIV/AIDS, chemotherapy for cancer, or organ or blood and marrow stem cell transplant procedures.
Bacteria are the most common cause of pneumonia in adults. Many types of bacteria can cause bacterial pneumonia. Streptococcus pneumoniae or pneumococcus bacteria is the most common cause of bacterial pneumonia in the U.S.
The term "atypical pneumonia" is applied to pneumonia caused by:
- Legionella pneumophila. This type of pneumonia sometimes is called Legionnaires disease, and it has caused serious outbreaks. Outbreaks have been linked to exposure to cooling towers, whirlpool spas, and decorative fountains.
- Mycoplasma pneumoniae. This is a common type of pneumonia that usually affects people younger than age 40. People who live or work in crowded places like schools, homeless shelters, and prisons are at higher risk for this type of pneumonia. It's usually mild and responds well to treatment with antibiotics. However, Mycoplasma pneumoniae can be very serious. It may be associated with a skin rash and hemolysis. This type of bacteria is a common cause of "walking pneumonia".
- Chlamydia pneumoniae. This type of pneumonia can occur all year and often is mild. The infection is most common in people ages 65 to 79.
The influenza or flu virus is the most common cause of viral pneumonia in adults. Respiratory syncytial virus (RSV) is the most common cause of viral pneumonia in children younger than one year old. Other viruses can cause pneumonia such as the common cold virus known as rhinovirus, human parainfluenza virus (HPIV), and human metapneumovirus (HMPV).
Most cases of viral pneumonia are mild. They get better in about one to three weeks without treatment. Some cases are more serious and may require treatment in a hospital. Having viral pneumonia increases the risk of getting a secondary bacterial pneumonia.
Here are some pneumonia statistics in the U.S. .
Mortality:
- Number of deaths/yr: 48,632
- Deaths per 100,000 population: 15.1
Emergency department visits:
- Number of visits to emergency departments with pneumonia as the primary diagnosis: 257,000
- For U.S. adults, pneumonia is the most common cause of hospital admissions other than women giving birth. About 1 million adults in the U.S. seek care in a hospital due to pneumonia every year.
Vaccination:
- Percent of adults ages 65 and over who had ever received a pneumococcal vaccination: 69.0%
Pleural Effusion
A pleural effusion is an excessive accumulation of fluid in the pleural space.
There are two types of pleural effusion:
- Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause.
- Exudative effusion is caused by blocked blood vessels or lymph vessels, inflammation, infection, lung injury, and tumors.
Pleural effusions are found in at least 40% of bacterial pneumonias. They are divided into three groups:
- Uncomplicated parapneumonic effusion: An exudative effusion with neutrophils which forms when more pleural fluid is produced than the pleura can reabsorb. It typically resolves with the resolution of the pneumonia.
- Complicated parapneumonic effusion: Bacterial and neutrophil invasion of the pleural space leads to pleural fluid acidosis, caused by anaerobic metabolism of glucose by the bacteria and neutrophils. Cultures of this fluid are frequently falsely negative, although Gram stain can identify bacteria being present. A deposition of fibrin on both layers of the pleural can lead to loculation of the fluid.
- Thoracic empyema: Evident bacterial infection of the pleural fluid either in the form of pus or presence of bacteria on Gram stain. Anaerobic bacteria have been cultured from .
In addition to an appropriate antibiotic regimen, many pleural effusions and all empyemas need a drainage procedure. As mentioned above, most uncomplicated effusions will resolve on their own with antibiotic treatment alone. Complicated pleural effusions may require drainage, typically by tube thoracostomy (chest tube), typically placed under CT or ultrasound guidance. Empyema usually requires drainage and many patients also undergo thoracoscopic or open debridement of the pleural space.
Thoracostomy tubes are commonly made from PVC or silicone. The majority are fenestrated along the sides of the insertion end, and the tubes have a radiopaque stripe. After placement, the distal end of the tube is connected to a pleura-evac system. There are three chambers of a pleura-evac: suction chamber, water seal chamber, and the collection chamber. The water seal chamber acts as a one-way valve allowing air to escape from gravity, but .
Some patients with persistent pleural effusion may have an ambulatory chest drain device placed. These devices use a mechanical one-way valve as an alternative to the traditional underwater drain. They consist of the flutter valve, flutter bags, chest seals, and stoma bags. They are less bulky and allow the patient to be ambulatory, thus, reducing the risk of complications from immobility.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.