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Kyle Busch won a NASCAR Craftsman Truck Series race one week before he died. He was 41 years old, by all appearances healthy … and then he was killed by pneumonia. That is the kind of thing you hear about taking someone’s elderly grandfather, not a professional athlete in the middle of a season.

The two-time NASCAR Cup Series champion died after severe pneumonia progressed into sepsis. He had been sick weeks before, calling for a doctor during the Cup race May 10 at Watkins Glen. Fox Sports reported he was fighting a sinus cold. A week later after winning the Truck Series race at Dover Motor Speedway, he mentioned that the cough had been substantial. On May 20, he was coughing up blood, hot to the touch and on the floor in the bathroom when an ambulance was called. He died May 21.

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The racing world is still in shock. Outside of it, a lot of people are asking the same thing: How does that happen to someone his age?

USA Today spoke with Dr. Ryan Maves, chief of critical care medicine at Wake Forest University and an infectious disease physician, to find out. He was not involved in Busch’s care. He was careful to say that everything he offered was based on limited public information.

He also didn’t sugarcoat it.

“Whatever he had was weird and rare,” Maves said.

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How unusual is it for a 41-year-old to die of pneumonia.

Extremely. For people in their 40s who get sick enough to land in the hospital with pneumonia, roughly 1% die from it,” Maves said. Factor in everyone who gets pneumonia at that age and never needs to be hospitalized at all, and the number drops even lower. Most are treated at a clinic and sent home.

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Age changes the math in a hurry. By the 60s, the hospitalized mortality rate climbs to around 4%. For older patients carrying serious underlying conditions, it can reach 25%.

For a man Busch’s age, presumed healthy, with good access to care, Maves did not hedge.

“It is very unusual,” he said. “Very, very unusual.”

What is pneumonia, exactly?

Pneumonia is a broad term. It means inflammation in the lungs, usually from an infection. Most of what people catch going about their daily lives is viral. Common cold viruses that travel from the nose and throat down into the lungs.

Bacterial pneumonia tends to be a different animal entirely.

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People die from pneumonia in a few different ways. The lungs fill with fluid and stop pulling in oxygen. The infection sends the body into shock. Blood clots can form during days of lying still, break loose and reach the lungs. There is no single path and they can all overlap, overwhelming the care.

Where sepsis comes in

Sepsis is what happens when the body’s response to an infection stops being helpful and starts destroying the body itself. The infection triggers inflammation everywhere at once, setting off a chain reaction that can take down multiple organ systems. When it tips into septic shock, a severe and sustained drop in blood pressure, the risk of death climbs fast.

Pneumonia is one of the most common ways people develop sepsis. It doesn’t always go that way, but when it does, it can move frighteningly quickly.

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The clues

Maves was careful to say he has no access to Busch’s medical records and no special knowledge of what happened in the Charlotte hospital. What he offered was the thinking of an experienced critical care physician.

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Two things stood out to him.  Busch had been sick for weeks before his condition turned critical. And he was coughing up blood when 911 was called.

What can happen in certain post-viral pneumonias, Maves said, is that the lungs are damaged just enough to let a secondary bacterial infection take hold. Doctors call it a bacterial superinfection.

“People start with a viral pneumonia and then you get a bacterial superinfection on top of that,” he said. “Classically influenza, but some other viruses can do this as well.”

He noted that the bacteria that can exploit this are serious. Certain staphylococcal and streptococcal pneumonias move fast and leave little time for treatment.

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“These can be very severe, and they can progress very quickly,” Maves said. “When I think of a young man dying of pneumonia after a preceding period of illness, that is the thing I think about a lot.”

What people should learn from this

Maves does not want people to panic. A healthy 41-year-old dying of pneumonia is rare. He does want people to think about who around them might not be so fortunate if they get sick.

“The best way to deal with pneumonia is to prevent it,” Maves said. He recommended vaccines for anyone 50 or over and for younger people with asthma, heart disease, kidney disease or diabetes. Plus annual flu shots and other vaccines as recommended by doctors.

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“Your risk of death from pneumonia at 41 is very, very, very low,” Maves said. “But I bet you have a grandparent. Part of the prevention is not just for ourselves but for the vulnerable people around us.”

This article originally appeared on USA TODAY: Medical expert explains how severe pneumonia, sepsis killed Kyle Busch

Read the full article here

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