An empty hospital corridor lit by daylight from a row of windows, with no people present

The Plague Death in Irkutsk: What We Know, What Russia Won’t Say, and Whether Americans Should Worry

On October 6, 2026October 6, 2026 By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Written October 6, 2026. This story is five days old and still moving. Dates and numbers below are what could be verified as of this morning.

A patient put it to me plainly on a video visit: do we have to be worried about a new pandemic with the Russia plague that is in the news?

Fair question. I did not give them a clean yes or no, because five days into something like this, anyone offering a clean yes or no is guessing.

Here is what I can tell you, and more usefully, here is what nobody can tell you yet.

A 28-year-old lab tech, four days, and a death certificate that says pneumonia

Darya Shipilova was 28 years old and worked as a laboratory technician at the Irkutsk Anti-Plague Research Institute in Siberia. On September 25, according to Russian media reporting, she broke a test tube of live bacteria while collecting samples. She was admitted to the hospital on September 29 with what her chart called pneumonia of unknown etiology. She died either October 1 or October 2, depending on which outlet you read, and the fact that we cannot pin down the date a woman died is itself a small piece of information about how much is being released.

Four days from the reported accident to the hospital. Two days from the hospital to the morgue.

Then the response. Roughly 197 people who had contact with her were identified, and 189 of them were hospitalized for observation, 114 at one facility, 63 at another, and 12 sent to the anti-plague institute itself. Contacts were isolated in a center that had been used for COVID patients. FSB officers started escorting the ambulances. By October 4 and 5, City Clinical Hospitals No. 1, No. 3 and No. 10, the Ivano-Matreninskaya Children’s Hospital and at least one maternity hospital in Irkutsk were under three-week quarantine.

That is a plague response. Three weeks is not an arbitrary number, it is roughly what you choose when you want to clear the incubation period of something serious and then clear it again.

The part of this that got reported backward

A lot of the coverage I have seen, and the version most people have in their heads, is that Russia said a test tube broke.

Russia said no such thing. Rospotrebnadzor, the state public health agency, has stated there was no accident involving pathogenic microorganisms at the institute, that no microorganisms associated with her professional work were found in her body, and that the epidemiological situation in Irkutsk and Shelekhov is stable. Her cause of death, officially, is pneumonia of unknown cause.

The broken test tube came from her. It is what she reportedly told the medical staff who admitted her, and it reached the public through Russian media rather than through any official channel.

So the official position is not that there was an accident. The official position is that nothing happened. Hold that next to the children’s hospital being closed for three weeks and you have the actual story of the past week. Plague has still never been publicly lab-confirmed in this case. Meanwhile the governor of Irkutsk Oblast, Igor Kobzev, met with Russia’s chief public health officer about “reports of a suspected case of a particularly dangerous infectious disease,” and the head of neighboring Buryatia said out loud that the death was linked to plague before his statement was quietly amended to something softer.

Two different words that look identical

Worth separating, because it explains some of the panic.

“Plague” means a specific bacterium, Yersinia pestis, which causes bubonic, septicemic and pneumonic disease and which has a known treatment. “Plague” also means, in ordinary English, any catastrophe that sweeps through a population. When a headline says plague in Russia, a sizable fraction of readers are not picturing a gram-negative coccobacillus that responds to doxycycline. They are picturing 1348.

Both meanings are legitimate. Only one of them is a diagnosis.

Could a broken tube really do this?

This is the question I find most interesting clinically, and the honest answer is that it is a stretch.

Simon Clarke, a cellular microbiologist at the University of Reading, put it about as well as it can be put: “an awful lot must have gone wrong for a lab worker to be infected by a broken test tube.” Work with a select agent happens inside layered containment. Biosafety cabinets, directional airflow, respiratory protection, procedures that assume breakage will eventually happen because over enough years it does. A tube hitting the floor inside a functioning cabinet is a cleanup problem, not an exposure. For that breakage to seed a fatal pneumonia, she likely had to be outside containment, or the containment had to be failing, or she inhaled a bolus at close range before anything could capture it.

Which brings up the thing I keep coming back to.

If she broke that tube on September 25 and knew it, she should have been on post-exposure prophylaxis within hours. The CDC’s recommendation is seven days of monotherapy: doxycycline 100 mg every 12 hours, or ciprofloxacin 500 to 750 mg every 12 hours, with levofloxacin and moxifloxacin now also first-line. That is it. Oral pills, generic, sitting in any pharmacy in the world including the one inside an anti-plague institute. Given promptly, the odds she ever became symptomatic drop toward nothing.

She presented on September 29.

I do not know whether she was offered prophylaxis and declined it, or reported the break late, or reported it immediately to someone who decided it did not warrant treating, or was treated and failed. Any of those is possible. What I would say plainly is that the four-day gap, not the bacterium, is the most likely reason a healthy 28-year-old died. Untreated pneumonic plague kills most of the people it infects, and it kills them fast. The treatment window is measured in hours after symptoms start, not days. Once you are four days past an inhalational exposure and presenting with pneumonia, antibiotics are being asked to do something they are not very good at.

That is a boring explanation. It is also the one that requires nothing unusual to be true.

Was it resistant? Was it modified?

Here is where I think the public conversation is making an understandable mistake.

You do not need an engineered organism to explain a fast death. You need a late diagnosis, which we appear to have. Adding a modified pathogen to the story explains something that is already explained.

That said, drug-resistant plague is not hypothetical, and this is the fact I would most want people to walk away with. In 1995 a patient in Madagascar with ordinary bubonic plague yielded an isolate called IP275, the first multidrug-resistant Y. pestis ever found. It carried a self-transmissible plasmid, pIP1202, conferring resistance to at least eight drugs used in plague treatment and prophylaxis, streptomycin and tetracycline and chloramphenicol and the sulfonamides among them. Nobody built it. The plasmid backbone turned out to be nearly identical to resistance plasmids from Salmonella Newport and from a fish pathogen, meaning Y. pestis had picked it up from the enormous reservoir of resistance circulating in agricultural bacteria.

Resistant plague already happened, once, by accident, in a patient in 1995. That is a better reason to pay attention than anything anyone has alleged about Irkutsk. We already live with the mature version of this problem in drug-resistant tuberculosis, and nobody had to engineer that either.

As for whether this particular organism was modified: there is no public evidence of it, and there is one piece of evidence against the scenario people fear most. If this were a highly transmissible engineered strain, those 197 contacts would be the first sign. As of the Rospotrebnadzor statements, they were not showing signs of illness. No secondary cases have surfaced publicly. A pathogen built to spread does not stop at one person.

The institute, and the thing that is actually true about it

The Irkutsk Anti-Plague Research Institute of Siberia and the Far East traces to a plague laboratory set up in Irkutsk in 1923 and was formally established in its current form on June 5, 1934. Its job, for ninety years, has been surveillance and containment of plague and other dangerous infections across Siberia and the Russian Far East. Plague is genuinely endemic in Central Asian rodent populations. An institute like this is the reason outbreaks there stay small.

And yes, the Soviet anti-plague network has a documented connection to Biopreparat, the covert Soviet offensive biological weapons program that weaponized plague, anthrax and tularemia. Igor Domaradskiy, one of Biopreparat’s founders, had previously run the anti-plague institutes at Irkutsk and Rostov-on-Don. That is history, not allegation.

What does not exist is any public evidence that the Irkutsk lab is developing plague as a weapon today, or that this death is connected to an offensive program. A facility with a Cold War lineage working on a pathogen endemic to its own region is not, by itself, a weapons story.

Running the conspiracy theories down

These deserve a real answer rather than a wave of the hand, so here they are, from least to most plausible.

It was deliberately released. No. There is no reason to release a weapon into your own closed city, kill one of your own technicians, and quarantine your own children’s hospital.

It is an engineered superbug and the contacts are already dying in secret. This requires 189 hospitalized people, their families and the staff of five medical facilities to all stay silent. Irkutsk has a population over 600,000 and functioning messaging apps. Containment of information at that scale fails, and it fails fast.

It is not plague at all, it is something worse they will not name. Possible in principle, and it is the theory I can least firmly rule out, because no confirmatory testing has been published. But the response fits plague. The duration of the quarantine fits plague. An institute that works with Y. pestis having a Y. pestis accident is the least exotic available explanation.

There is a much bigger outbreak than they are admitting. Partially plausible, and I would not be shocked. Not because of anything specific to Irkutsk, but because this is a system that denied the test tube ever broke while sealing hospitals. Under-reporting is the house tendency.

An ordinary lab-acquired infection, recognized late, in a bureaucracy whose first instinct is denial. This is almost certainly what happened. Every observed fact fits it: the four-day delay, the speed of death, the aggressive contact tracing, the official denial, the walked-back statement from Buryatia, the pneumonia-of-unknown-cause diagnosis that nobody has updated. Boring, tragic, and entirely consistent.

Can we believe them?

On the specifics, no. On the response, mostly yes.

Watch what a government does rather than what it says. Russia’s words say stable and nothing happened. Russia’s actions say particularly dangerous infection, and they committed real resources to a real containment operation. When those two diverge, believe the resources.

The US State Department’s comment struck me as about right: “Many details have not been confirmed. We encourage Russian authorities to share accurate information quickly and openly,” alongside the observation that plague “is a known disease and is treatable with common antibiotics.” The CDC says it is monitoring. President Trump said his administration is looking at it very strongly and that “anybody that has that kind of a problem, we’re always willing to help,” which, whatever else you think of it, is the correct posture toward an outbreak in a country you are not friendly with.

Clarke’s line about what actually controls an outbreak is the one worth keeping: transparency, rapid diagnosis, effective contact tracing. Russia is doing two of the three.

Is this the next COVID?

No, and I want to be specific about why, because “no” by itself has stopped persuading anyone and I understand why.

A lot of people came out of 2020 believing that COVID began in a laboratory. Whether or not that is what happened, and it remains genuinely unresolved, that belief is the reason a Siberian lab accident in 2026 lands differently than it would have landed in 2015. People are not being irrational. They are pattern-matching to the last five years, and they have been told before that there was nothing to see.

So, the differences that matter.

Yersinia pestis is a bacterium. SARS-CoV-2 is a virus. That distinction is not academic: we have had effective antibiotics against plague since the 1940s, every pharmacy stocks doxycycline, and treatment is cheap and oral. There was no equivalent for COVID in February 2020, which is why the whole fight there moved to vaccination instead of treatment.

Pneumonic plague spreads through respiratory droplets during close, sustained contact. It is not the long-range airborne spreader that COVID turned out to be. It does not do silent asymptomatic transmission for a week before anyone feels sick. It announces itself, violently, within a few days.

And it has never been good at sustained human-to-human chains in the modern era. In the United States, we average about seven plague cases a year, mostly in the rural Southwest from fleas and infected animals. Arizona had a fatal pneumonic case in Coconino County in July 2025, written up in MMWR, the county’s first since 2007. The last documented person-to-person transmission of pneumonic plague in the United States was in 1924, in Los Angeles. A century, with the organism present in our own rodents the entire time.

A pathogen that cannot start a chain cannot start a pandemic.

So should you buy N95s?

No.

Not for this. If you already own a box, you did not waste your money, and if you live where I do, wildfire season is a far better argument for keeping them than Irkutsk is. But buying respirators this week as a response to a plague death 5,000 miles away is spending money and worry on the wrong thing.

If you want a useful response to this story, here is one. Know whether you could get a doctor on the phone within 24 hours of getting sick. That is the variable that killed Darya Shipilova, four days of it, and it is the only variable in this entire story that you personally have any control over. The antibiotics work. Getting to them in time is the whole game.

I say that as someone who practices entirely by video, so treat it as the interested opinion that it is.

The Bottom Line

A 28-year-old technician at a Siberian plague institute broke a tube on September 25, went to the hospital on September 29, and was dead within about two days. Russia says there was no accident and no plague while quarantining five medical facilities and tracking 197 contacts. The most likely explanation needs no engineering and no conspiracy: a laboratory exposure that should have been met with seven days of doxycycline within hours, met instead with four days of delay. Plague remains treatable, remains bad at spreading between people, and has not caused person-to-person transmission in this country since 1924. Watch for confirmatory testing and for secondary cases among the contacts. Those are the two things that would change my read. Skip the N95s.

Sources

Hospitals in Irkutsk impose quarantines after an employee at an anti-plague institute dies. Meduza, October 5, 2026. https://meduza.io/en/feature/2026/10/05/hospitals-in-irkutsk-impose-quarantines-after-an-employee-at-an-anti-plague-institute-dies-russia-s-public-health-agency-says-she-died-of-pneumonia-and-the-epidemiological-situation-remains-stable
Nearly 200 People Under Observation After Irkutsk Lab Worker Dies From Plague. The Moscow Times, October 2, 2026. https://www.themoscowtimes.com/2026/10/02/nearly-200-people-under-observation-after-irkutsk-lab-worker-dies-from-plague-a93857
Siberian Anti-Plague Institute Staff Isolated After Worker’s Death. RFE/RL. https://www.rferl.org/a/russia-plague-warning-siberia-irkutsk-laboratory/33870385.html
Plague outbreak in Russia, expert comment by Dr Simon Clarke. University of Reading, 2026. https://www.reading.ac.uk/news/2026/Expert-Comment/Plague-outbreak-in-Russia-expert-comment
Russia plague: What we know about the suspected case reportedly linked to a lab worker’s death. CNBC, October 5, 2026. https://www.cnbc.com/2026/10/05/russia-plague-suspected-case-irkutsk.html
State Department monitoring reported fatal case of pneumonic plague. ABC News, October 2026. https://abcnews.com/US/state-department-monitoring-reported-fatal-case-pneumonic-plague/story?id=136992734
Russian plague lab researcher dies as nearly 200 monitored: here’s what we know. Forbes, October 5, 2026. https://www.forbes.com/sites/siladityaray/2026/10/05/russian-plague-lab-researcher-dies-as-nearly-200-monitored-heres-what-we-know/
Russian lab worker dies of suspected plague in Siberia; US monitoring case. Al Jazeera, October 5, 2026. https://www.aljazeera.com/news/2026/10/5/russian-lab-worker-dies-of-suspected-plague-in-siberia-us-monitoring-case
Has plague returned to Siberia? Panic in Russia after death of lab worker. Euronews, October 4, 2026. https://www.euronews.com/2026/10/04/has-plague-returned-to-siberia-panic-in-russia-after-death-of-lab-worker
The Siberian lab at the centre of a plague scare: its history, work and what it actually does. ThePrint. https://theprint.in/theprint-essential/the-siberian-lab-at-the-centre-of-a-plague-scare-its-history-work-and-what-it-actually-does/3063082/
Recommended antimicrobial pre- and post-exposure prophylaxis for plague. Centers for Disease Control and Prevention, 2021. https://www.cdc.gov/plague/resources/PlagueProphyTreatmentTable_2021-P.pdf
Nelson CA, et al. Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response. MMWR Recomm Rep, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312557/
Welch TJ, et al. Multiple Antimicrobial Resistance in Plague: An Emerging Public Health Risk. PLoS One, 2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819562/
Notes from the Field: Fatal Pneumonic Plague, Coconino County, Arizona, July 2025. MMWR, volume 75. https://www.cdc.gov/mmwr/volumes/75/wr/mm7538a2.htm
Biopreparat, background on the Soviet biological weapons program. https://en.wikipedia.org/wiki/Biopreparat

A free-range brown hen standing in a sunny pasture

H5N1 Bird Flu: What Every Patient Should Know Today

On January 10, 2025September 29, 2026 By Dr. Scott RennieIn Infectious DiseaseLeave a comment

As physicians, we try to keep an eye on infectious diseases that might pose broader risks. H5N1, also called highly pathogenic avian influenza or bird flu, remains one of those, and the virus mainly infects birds but has crossed into humans with severe outcomes. The first human cases were seen in Hong Kong in 1997. Since then, human infections have been sporadic, usually tied to direct contact with infected poultry or contaminated environments, and unlike seasonal influenza, it doesn’t spread efficiently from person to person.

WHO’s cumulative count puts the case fatality rate at about 52 percent, 463 deaths among 888 confirmed cases worldwide since 2003, in data current as of March 2024. Human cases identified in the United States during the 2024 dairy and poultry outbreak ran far milder than that historical average, and many were mild. But the potential for severe disease is still there.

Recent Human Cases

In the United States, poultry wasn’t the only exposure route. In March 2024, transmission from cows to humans was confirmed, and cats were infected too, after drinking raw milk from infected cows. Between March 28 and October 31, 2024, there were 45 human cases in six states, all in adults, 25 linked to infected cows and 20 to poultry. By January 2025, there had been about 90 reported human cases nationwide.

A common thread was inconsistent use of protective equipment, and infection rates ran higher when gloves, masks, and goggles weren’t used consistently. Among those infected during the March-October window, 71 percent reported wearing gloves, 60 percent eye protection, 47 percent face masks, and only 36 percent reported both eye protection and masks together. PPE seemed to make a real difference, but adherence was incomplete.

Symptoms

The most common presentation was conjunctivitis. About 93 percent of patients developed viral pink eye, and fever was reported in about half, with headaches and muscle aches close behind. Sore throat, cough, and fatigue were less frequent. Diarrhea and nausea were rare. The median duration of symptoms was four days. Severe disease can still progress quickly to respiratory failure, multi-organ involvement, and death, though fatality figures reflect real biases in surveillance and reporting, since mild and subclinical infections are the ones most likely to go undetected.

Diagnosing H5N1

Diagnosis depends on history and testing. Exposure to poultry, cows, or contaminated settings should raise suspicion in anyone with severe flu-like illness. Nasopharyngeal or conjunctival swabs are typically used. PCR testing is the gold standard. Culture is rarely done. Biosafety concerns. Serology is sometimes used for retrospective surveillance.

Monitoring and Management

Close surveillance is essential for people exposed to infected birds or animals, with daily checks for fever and respiratory symptoms during the incubation period, about 10 days, recommended. Public health reporting remains critical for containment.

Treatment relies on antivirals like oseltamivir or baloxavir if started early, and severe cases often require oxygen therapy or mechanical ventilation, with supportive care for complications like ARDS central to management.

Human-to-Human Spread

What keeps H5N1 from being a global pandemic threat is the lack of efficient human-to-human spread. There have been family clusters and caregiver cases, mostly in the mid-2000s, where limited transmission was suspected, including a mother in Thailand caring for her sick daughter and family members in Indonesia in 2006, cases that involved close, unprotected exposure where the virus didn’t transmit beyond those immediate contacts.

H5N1 lacked the genetic adaptations that would make it easily transmissible like seasonal flu or COVID-19, and the concern was that mutations or reassortment with human influenza strains could change that, which is why surveillance continued.

Where the Risk Stands

As of early 2025, the risk to the general public remained low, with most cases stemming from direct animal exposure and person-to-person spread limited. For clinicians, though, awareness matters: we need to consider H5N1 in patients with severe respiratory illness who also have a relevant exposure history. For patients, the focus should be on minimizing contact with infected poultry, avoiding raw milk, and following public health guidance on protective measures.

H5N1 was still circulating in birds, and occasionally in other animals, and it occasionally infected people, though it was not, at that point, spreading widely between humans. The threat was real but contained. The critical piece remains vigilance: watching for changes that would signal the virus adapting toward easier human spread.

Human Metapneumovirus (hMPV): What You Need to Know

On January 10, 2025September 29, 2026 By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Human metapneumovirus, or hMPV, doesn’t get the same attention as influenza or COVID-19, but it’s worth understanding. It was first identified in 2001, though genetic studies suggest it has circulated for decades, and it’s a member of the Paramyxoviridae family, the same family that includes RSV.

Transmission is through respiratory droplets. That means coughing, sneezing, or close contact with an infected person is usually how it spreads, and anyone can get it, though young children, older adults, and people with weakened immune systems are most vulnerable to severe illness.

Where It Shows Up

hMPV is found worldwide. It circulates throughout the year but tends to spike in late winter and spring in temperate regions, and improved diagnostics over the last two decades have shown just how common it is. Clusters show up in schools, childcare centers, nursing homes, and hospitals. Often alongside influenza and RSV activity.

In the United States, the CDC tracks it as part of routine respiratory surveillance, and globally, WHO lists it as one of several viruses contributing to seasonal surges of respiratory illness.

Symptoms and Overlap

The symptoms of hMPV are familiar. Patients may have fever, cough, sore throat, congestion, fatigue, and sometimes wheezing, and in healthy people, illness usually resolves within one to two weeks. In infants, older adults, or immunocompromised patients, the disease can progress to bronchiolitis or pneumonia.

The overlap with RSV, influenza, and COVID-19 makes it nearly impossible to identify clinically without testing, and in practice, we often don’t test unless patients are hospitalized or part of an outbreak under investigation.

Why It Matters

Most patients recover with supportive care. But hMPV deserves attention for a few reasons: high-risk populations can become severely ill enough to need hospitalization. Unlike flu or COVID-19, there’s no vaccine and no specific antiviral, so care stays supportive: oxygen, fluids, symptom management. And hMPV adds to the seasonal burden on the system overall, and when it circulates alongside RSV and flu, pediatric and ICU beds can fill fast.

Current Reports

China had reported more cases the previous winter, mostly among children under 14 in northern provinces. The increase triggered heightened monitoring at the time, though local health authorities noted the pattern was typical for the season and not as severe as the same period the year before. The WHO emphasized that hMPV is a known virus, not a new or emerging threat, and said it did not represent a global health emergency.

What To Watch For

For physicians, it comes down to clinical awareness. If a patient has unexplained respiratory illness, especially if they’re very young, older, or immunocompromised, consider hMPV in the differential. For patients, the message is simple: good hygiene matters, and wash hands, avoid close contact when sick, and stay home if you’re symptomatic. These are the same steps that help reduce spread of other respiratory viruses.

hMPV doesn’t carry the same weight as influenza or COVID-19, but it plays a consistent role in seasonal respiratory disease, and understanding it helps us manage patients more effectively and prepare for the extra strain it can place on hospitals during peak months.

What’s Causing My Abdominal Pain? Common Causes Explained

On February 28, 2012August 30, 2026 By Dr. Scott RennieIn GastrointestinalLeave a comment

Patients who present to the clinic or urgent care with abdominal pain can be some of the most challenging, because of the many different causes. The job of your primary care or urgent care provider is to determine whether the pain is requiring immediate surgical evaluation. Medical providers must try to determine which patients can safely be observed and their symptoms treated and which patients require further investigation by a specialist such as a surgeon. This is difficult because abdominal pain is often non-specific and presents with other symptoms very commonly. Triage: We must urgently investigate abdominal pain in many patients. Some patients require assessment of their airway, breathing and circulation followed by appropriate resuscitation. Patients who may need surgery must be transferred to a facility where they can receive that care where appropriate nursing care, laboratory, surgical consultation, and radiology facilities are available. Patients who are having less severe pain or signs on exam may require consultation or referral for further management. Helpful information from patients: 1) Time course of pain 2) Location of pain 3) Radiation of pain 4) Factors that make the pain worse or better (such as foods or antacids) 5) Associated symptoms including fever, chills, weight loss, nausea, vomiting, diarrhea, constipation, blood in the stools, jaundice, change in stool or urine color or diameter of the stools. 6) Past medical history, including history of abdominal surgeries 7) Family history of bowel disorders 8) Alcohol intake 9) Medications – including Tylenol, aspirin, and ibuprofen/aleve 10) Menstrual and contraceptive history in women Surgical abdomen: Usually defined as a condition with rapidly worsening course without surgical intervention. Obstructions of the intestines and peritonitis (inflammation/irritation of the inner wall of the abdomen that covers most abdominal organs) are reasons for referral to a surgeon. Sometimes tests will be ordered such as an abdominal radiograph, CBC, comprehensive metabolic panel with liver enzymes, lipase, a urine analysis and pregnancy test (in women of childbearing potential). Other things we consider in determining the cause of the abdominal pain are the location of the pain and changes in where the pain radiates as well as how rapidly the pain gets worse. Some possible causes of abdominal pain are many – gallstones or gallbladder dysfunction, peptic ulcer, hiatal hernia, pneumonia, heart attack, pancreatitis, heartburn, lactose intolerance, celiac sprue, pregnancy (including ectopic), endometriosis, sickle cell disease, appendicitis, ovarian cyst or torsion, UTI, kidney stones, constipation, colitis, diverticulitis, pelvic inflammatory disease, gastroenteritis, intestinal ischemia (decreased blood flow to the intestines), diabetic ketoacidosis, kidney infection, abdominal aortic aneurism, or even trauma. Treatment: Is tailored to address the cause of the pain. If no cause can be found at your doctor’s office, the goal is to determine whether it is safe for you to go home with medications to help with the pain, and testing done as an outpatient or whether you need to be transferred to the hospital where further workup can be done immediately. I hope that you have found this information useful. Wishing you the best of health,

The Doctor Says You Have Bronchitis: Is That Really Bad?

On February 20, 2012September 11, 2026 By Dr. Scott RennieIn RespiratoryLeave a comment

Patients frequently come into the clinic with bronchitis, especially during the winter months. Often, they are not sure what bronchitis is or how to treat it. Here is some information about bronchitis and how it is treated that will hopefully answer some of these questions. Bronchitis: Inflammation/swelling of the bronchi (large tubes that carry air to the lungs). There are two types of bronchitis. The first type is acute (sudden onset) which is the most common reason for patients to come to the clinic and the second type is chronic (long-standing). Acute bronchitis occurs with a viral infection such as a common cold – sometimes called a “chest cold.” When to see a medical provider: Fever (temperature greater than 100.4 degrees F or 38 degrees C), cough that lasts greater than 10 days, chest pain with coughing, difficulty breathing, or coughing up blood, a barking cough that makes it hard to speak, cough accompanied by unexplained weight loss. Symptoms of acute bronchitis: The most common symptom of acute bronchitis is a nagging cough. Some people cough up mucus that may be clear, yellow or green. Fever is uncommon. Chest discomfort, fatigue, and wheezing can be present. Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks. Causes of acute bronchitis: The most common cause is a viral infection of the upper airway. Less likely, it can also be caused from a bacteria called Bordetella pertussis which causes “whooping cough.” Treatment of acute bronchitis: Relieve the symptoms of sore throat and congestion. Antibiotics do not help acute bronchitis caused by a virus. Antiviral agents are useful in some cases when the cause is influenza. Do not smoke, drink plenty of fluids and rest. Symptoms usually go away within 7 to 10 days if you do not have a underlying lung disorder. A dry, hacking cough can linger for a number of months however. Although no specific treatment exists – there are several available options to reduce symptoms: 1) Non-steroidal anti-inflammatory medication such as ibuprofen or naproxen 2) Heated, humidified air can help improve symptoms of nasal congestion and cough 3) Cough suppressant medications have not shown to be helpful for most patients 4) Inhaler medications, commonly used for patients with asthma can sometimes be helpful to reduce bronchospasm/wheezing. Complications: Pneumonia can develop from either acute or chronic bronchitis. Prevention: Do not smoke, get a yearly flu vaccine and a pneumonia vaccination as directed by your doctor, reduce exposure to air pollution, wash your hands (and your children’s hands) frequently. Chronic bronchitis: A cough that occurs on most days of the month for at least three months of the year during 2 consecutive years. Preventing the spread to others: Hand washing is very important. Alcohol-based rubs are a good alternative if no sink is available. Use a tissue to cover your mouth hen sneezing or coughing and promptly throw away the tissue immediately. I hope that you have found this information useful. Wishing you the best of health,

Pneumonia: Viral, Bacterial or Walking? Am I at Risk?

On February 17, 2012August 30, 2026 By Dr. Scott RennieIn RespiratoryLeave a comment

I have many patients who come to the urgent care this time of year due to cough and fever and they are worried about the possibility of pneumonia. This is a valid concern, as pneumonia is a common illness and can lead to grave disability and even death. Here are some questions they I often get asked and some information. This is for informational use – please see a physician if you are worried about the possibility of pneumonia. What is pneumonia? Community acquired pneumonia as an illness with symptoms that might be present such as cough (sometimes with mucus), fever, shaking chills, shortness of breath (may only occur when climbing stairs), and occasionally with confusion (especially in the elderly), excess sweating and clammy skin, headache, loss of appetite, low energy, and sharp or stabbing chest pain that gets worse when you breath deeply or cough. When I listen your lungs, I am listening for “crackles” which sound like scratchy sounds that sound similar to that produced by rubbing strands of hair together close to your ear. Sometimes I will order a blood test called a CBC to check white blood cell count, chest x-ray, CT scan of the chest, and even a culture of the mucus you cough up to determine if there are bacteria present. What causes pneumonia? Pneumonia can be caused by viruses or bacteria. The most common pneumonia-causing germ in adults and young kids is Streptococcus pneumonia (pneumococcus). Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, Mycoplasma pneumonia and Chlamydophila pneumonia. Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well. Viruses are also a common cause of pneumonia, especially in infants and young children. What factors/conditions increase my chance of getting pneumonia? Cerebral palsy, chronic lung disease (such as COPD, bronchiectasis, cystic fibrosis), cigarette smoking, difficulty swallowing (due to stroke, dementia, Parkinson’s disease, or other neurological condition), immune system problem, impaired consciousness, living in a nursing facility (such as a nursing home), other serious illnesses (such as heart disease, liver cirrhosis, or diabetes), recent surgery or trauma or recent cold, laryngitis or flu. How do you decide whether I need antibiotics and which antibiotic to use? The choice of antibiotic is often determined by multiple factors including the patients age (certain germs are found more commonly in certain age groups), findings on chest x-ray and symptoms of the patient. Chest x-ray in typical bacterial pneumonia (ie. pneumococcus or Streptococcus pneumonia usually confirms lobar involvement. In contrast, in atypical pneumonia, chest x-ray shows more diffuse involvement (source – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795279/). If the pneumonia is caused by a virus, the antibiotic will obviously not affect the viral lung infection. What is pneumoncoccus (Streptococcus pneumonia)? In countries like the United States, pneumococcus remains the most common and important disease-causing organism in infants. Although exact numbers are difficult to obtain, it is estimated that pneumococcus infection is responsible for more than one million of the 2.6 million annual deaths due to acute respiratory infection in children younger than 5 years. Children younger than 5 years, particularly aged 2 years or younger are at an increased risk of disease. In addition, absence of breastfeeding, exposure to cigarette smoke, daycare attendance, and lack of immunization with the pneumococcal conjugate vaccine further increase the risk of disease. Adults older than 55-65 years are the next most commonly affected age group worldwide. As in the United States, the most common cause of Community Acquired Pneumonia (CAP) in Europe is S pneumoniae infection, affecting approximately 100 per 100,000 adults each year. Pneumococcus is usually treated with a medication such as penicillin/amoxicillin. What is atypical pneumonia (walking pneumonia)? Atypical pneumonia refers to pneumonia caused by certain bacteria including Legionella, Mycoplasma and Chlamydophila. Atypical pneumonia is most common in young adults and children. Pneumonia due to mycoplasma and chlamydophila bacteria is usually mild. The antibiotics used to treat atypical pneumonia include: Azithromycin, Clarithromycin, Erythromycin, Fluroquinolones and Tetracyclines. What are the most common bacteria causing pneumonia in children? That depends on the age of the child. 1) Newborns (0 – 30 days): Group B Streptococcus, Listeria, E-Coli, Klebsiella pneumonia 2) Young infant (1 – 3 months): S. pneumonia, S. aureus, and H. influenza 3) Infants, toddlers and preschool-aged children: Viruses remain the most common cause for approximately 90% of all pneumonias. RSV(Respiratory Syncytial Virus) is the most common viral pathogen. 4) School-aged children and young adolescents: Mycoplasma pneumonia is the most frequent cause among older children. 5) Older adolescents: Mycoplasma pneumonia is the most common cause of community-acquired pneumonia during the teenage and young adult years. 6) Immunocompromised children: Children with cystic fibrosis are especially prone to develop infections with S. aureus, P. aeruginosa, B. cepacia and other multi-drug resistant organisms. How is pneumonia spread? Most of the time the infection is carried in the upper respiratory tract of the person infected. It is spread by airborne or direct exposure to respiratory droplets from the infected person. Illness among casual contacts is infrequent. How soon after exposure do symptoms occur? The incubation period may vary, but is generally 1 to 3 days. Is there a vaccine to help prevent infections? Yes, there are two different vaccines. One primarily for adults and one for children. The vaccine for adults had been available for many years and is called Pneumovax. The pediatric vaccine is called Prevnar and is only for use in children under 5 years of age. Who should receive the adult vaccine? All adults 65 years of age or older. All persons 2 years of age or older with: chronic illness such as diabetes, heart or lung diseases, anatomic or functional asplenia, immunocompromised conditions (due to disease, cancer, chemotherapy or steroids), HIV infected individuals. Who should receive the childhood vaccine? All children less than 24 months of age. All children aged 2 to 5-6 yrs with high risk medical conditions. I hope that you have found this information useful. Wishing you the best of health,

Dr. Scott Rennie

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