Seasonal Diseases: Winter (Part 2)
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Winter's A Bitch (Part 2).
Last time on Seasonal Diseases: Winter (Part 1) we discussed making your characters ill with the Common Cold, the Flu, and Sinus Infections.
Today we're going to make your characters even more miserable, with heavier hitters like Pneumonia, Strep Throat, and Bronchitis.
Before We Go Any Further
I know we said this last time, but please remember that this blog is for writing. This is about storytelling, not self-diagnosis or home remedies or treating yourself. Feel sick? Go to your doctor. I take no responsibility for your actions. Okay? Okay. Disclaimer applies here too.
Let's Make Some Characters SICK!
Pneumonia
What Is It? Pneumonia is an infection in the lungs. It's usually bacterial, though it can come from other sources like a virus or even a fungus. Medfolk would characterize pneumonia that didn't come from a hospital or healthcare setting as CAP (community-acquired pneumonia), to differentiate it from HCAP (healthcare associated pneumonia), HAP (hospital-acquired pneumonia) or VAP (ventilator-acquired pneumonia).
It's worth noting that there are entire books, and guidelines, and really just stacks of papers about pneumonia, and it will get its own post someday.
What Are The Symptoms? The classic pneumonia triad is a fever; a wet, productive cough; and yellow, green, or brown phlegm. (A productive cough is a cough which brings up sputum, as opposed to a dry cough, which does not.)
Your pneumonia-afflicted character may be breathing rapidly and may or may not have chest pain when they cough, which medfolk would call dyspnea and pleuritic chest pain respectively.
How Long Does It Last? When left to its own devices, pneumonia usually goes one of two ways. It either gets better, or someone gets astoundingly sick. Sometimes it simply settles into a "walking pneumonia", where the patient is essentially chronically sick but able to partially function in the world over an extended period of up to a month.
What Will They Do To Feel Better? Doctor characters will draw blood cultures and take chest X-rays to get a look at the infection itself and try to figure out which bacteria is causing the problem.
Fevers are usually managed with antipyretics (fever reducers) such as Tylenol / acetaminophen or Advil / Motrin / ibuprofen.
The infection itself will be managed with antibiotics. Which antibiotics are chosen will depend on a number of things, including the common local infections, local protocols, and the opinion of the doctor treating them.
The doctor will also have to decide whether or not to admit the character to the hospital or treat them on an outpatient basis. That decision is based on vital signs (very low blood pressure or high respiratory rate) and suspected complications from other conditions, such as COPD or heart failure.
The current treatment guidelines are as follows:
Outpatient: azithromycin or doxycycline if previously well; levofloxacin / Levaquin or amoxicillin-clavulanate / Augmentin if chronic heart/liver failure or chroning lung disease (for instance, COPD) Inpatient: amoxicillin-clavulanate / Augmentin OR (ceftriaxone PLUS azithromycin) ICU: ceftriaxone PLUS azithromycin
What's the Worst That Can Happen? The character can develop sepsis and die.
Sepsis is a dysregulated immune response to an infection, where the body goes all-out attacking the infectious agent and winds up killing, or nearly killing, itself. It's characterized by rapid heart rate (tachycardia), either high fever or hypothermia (low core body temperature), and low blood pressure.
Sepsis can also cause failure of other organs like the heart, kidneys, and liver, due to inflammation and low blood pressure.
The character could also develop Acute Respiratory Distress Syndrome, or ARDS, and need to be intubated (have a breathing tube placed) and put on a ventilator. ARDS is a form of pulmonary failure, and can require that the character be placed on ECMO. ECMO stands for Extra-Corporeal Membrane Oxygenation, which basically works as an artifcial lung when the gas exchange in the lungs fails.
Bronchitis (Acute)
What Is It? Acute bronchitis is an inflammation of the large airways of the lung (bronchi), which bring air from the trachea to the lungs for gas exchange. It often develops from a cold or other respiratory infection.
It differs from chronic bronchitis in two major ways. First, chronic bronchitis is usually related to smoking, not infection. Second, chronic bronchitis comes and goes for most of the year, whereas acute bronchitis is a one-time ordeal.
What Are The Symptoms? Bronchitis may present with:
a wet, hacking cough
mucus production which may be clear, white, yellow, or green
tiredness (fatigue)
shortness of breath and/or chest discomfort
low-grade fever < 100.4*F / 38*C
Your characters may spike a higher fever or have their sputum be tinged with blood due to irritation from coughing. Bronchitis may also produce wheezing, especially in asthmatics.
Symptoms can last from 3-4 days to 6 weeks.
What Will Characters Do To Feel Better? The treatment for this doesn’t vary much for that of the common cold, and while pharmacies will sell a million and one “remedies” for a viral infection, there isn’t much out there that will actually make the disease go away except time.
Characters may drink tea with honey for throat irritation, they may take cough drops or cough suppressants, etc.
In some cases, doctors may take a chest x-ray of your character to check for pneumonia. They may also run tests on the sputum to check for whooping cough or other bacterial infection.
What’s The Worst That Can Happen? In some cases bronchitis can develop into pneumonia. Chronic bronchitis can lead to pulmonary dysfunction, pulmonary hypertension, and other negative effects, but acute bronchitis usually goes away on its own and doesn’t have long term effects.
Pharyngitis (Sore Throat) (including Strep Throat)
What Is It? Pharyngitis is an infection of the back of the mouth and throat, usually caused by a virus.
More rarely, it’s caused by a bacterial infection of Group A Streptococcus (GAS), better known as “strep throat”.
What Are The Symptoms? Pharyngitis is typically associated with:
Pain or scratchiness in the throat that gets worse when swallowing or speaking
Hoarse, scratchy voice
Swollen glands in the neck
Difficulty swallowing and, in extreme cases, breathing
Inflamed tonsils
Fever
Cough
Body aches
Runny nose (rhinorrhea)
Strep throat will have many of the above symptoms, but will usually also have white patches or pus on the tonsils.
What Will Characters Do To Feel Better? Care of a sore throat is usually managed by treating the symptoms, because the cause is usually viral. This may include warm salt-water gargles, cough drops, cough suppressants, antipyretics like acetaminophen (Tylenol) for fever, hot tea with honey, or other home remedies.
Herbal approaches may include slippery elm, licorice root, marshmallow root, or honeysuckle flower. These are usually prepared as teas, sprays, or lozenges.
Doctors who see patients present with a sore throat will usually swab for a sample to make sure they’re not dealing with a bacterial infection. Many offices have the ability to test that swab in about 10 minutes.
If that swab is positive for streptococcal bacteria, the doctor will prescribe your character a course of antibiotics. Penicillin, amoxicillin-clavulanate (Augmentin), and azithromycin are all common prescriptions for GAS infections; characters will be advised to finish the entire course of antibiotics even if they feel better before the course is done. If characters stop antibiotics early, their pharyngitis may return even worse than before.
Severe cases that affect the ability to breathe or swallow may be prescribed a short course of steroids, such as a methylprednisolone (Medrol) dose pack.
What’s The Worst That Can Happen? In the absolute worst cases, airway swelling can be life threatening.
In addition, pharyngitis can be a symptom of Epstein-Barr virus, which is the virus that causes mononucleosis (mono).
It can also be the first presenting symptom of an HIV infection.
Well, That About Wraps Up Winter!
What other diseases would you like to inflict upon your characters? Let me know in the comments and I'll keep cooking up some diseases!
xoxo, Aunt Scripty
Like I said, disclaimer applies here too.
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