What Is Pope Francis Suffering From?

'Assuming he has a sensitive bug, which is responsive to antibiotics, it may not necessarily be the worst-case scenario.'

Pope Francis, 88, head of the Catholic Church, is suffering from polymicrobial respiratory tract infection, as well as pneumonia.

What exactly is this complex-sounding polymicrobial respiratory tract infection (PM RTI)? And how did the Pope, sitting in the seclusion of the Vatican, acquire it?

Vaihayasi Pande Daniel/Rediff.com asked Dr Lancelot Pinto, epidemiologist and consultant pulmonologist and respirologist attached to the P D Hinduja Hospital and Research Centre, Mumbai, to explain why the Pope is seriously ill.

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Polymicrobial respiratory tract infection is the reason the Pope has been hospitalised. What kind of disease is that?

When people have a pneumonia, for example it's typically because of a pathogen. It's due to the commonest pathogen, something called streptococcus.

Similarly, if somebody has an underlying lung disease like COPD (chronic obstructive pulmonary disease), very often you can be colonised. There are bacteria which constantly live in your lungs.

In a disease like COPD, you have something called pseudomonas, which is a common bug, which lives in the lungs and will periodically increase in size and the quantum and cause an infection, which needs antibiotics and you suppress it, and then after, sometimes it rises up again.

(Like in these two cases) usually you are talk about lung infections in terms of a solitary bug.

So: If somebody had a pneumonia, you ask what was the organism? Was it an influenza pneumonia? Was it a streptococcal pneumonia? Was it a pseudomonas pneumonia?

But what can also happen is you can have a host of bacteria, which are isolated (identified) simultaneously, in which case you would call it polymicrobial.

Polymicrobial could potentially extend -- and fungus could be growing side by side with bacteria, growing side by side with a virus, for example.

If you have a healthy immune system -- ordinarily we are reasonably immune to fungi, because with every breath we take in, we are taking in fungi.

If you keep a bread slice outside in the open, fungus grows on it, which means there is fungus constantly in the air.

Humans have the ability to fight fungus.

If somebody is on steroids, their immunity is suppressed. Or if somebody has diabetes and their sugars are really high. These can be fertile grounds for fungi to grow.

If your immunity is suppressed, then you can grow a fungus in your lungs as well.

When they say the Pope has a polymicrobial infection, it would suggest that when they tried to sample it, either in a sputum -- I don't know if he's undergone a bronchoscopy, for example -- they found more than one bug. They found multiple bugs.

IMAGE: Dr Lancelot Pinto. Photograph: Kind courtesy Dr Lancelot Pinto

How did the pope get exposed to bacteria or is it a function of his age? He lost part of his right lung and he had/had pneumonia. But it's not so much to do with the environment, as to do with the person?

Yes, it's a constant fight between the host and the organism. The organisms are everywhere. It's the immunity of the host that protects him/her most of the times.

Not even till maybe a decade or so ago, it was believed that the lung is a reasonably sterile organ, as opposed to the gut. The gut is full of microorganisms. It was presumed that the lung is sterile.

We now recognise that that's not the case. The lung has a biome (a community of organisms), just as the gut has a biome. And that biome stays non-disruptive, while the host's immunity is fine.

The moment the host immunity drops, either because of age, or because of medication or because of immunosuppressive conditions, these bacteria start thriving and multiplying.

In an elderly person, who has a pneumonia, we don't usually attribute the pneumonia to the virulence of the bug. We don't say, 'Oh, my God, this bug was so strong, therefore the person got a pneumonia'.

It's usually spoken of in terms of: 'This person's immunity was so low, therefore the person got pneumonia'. Which is, which is why you don't hear of clusters of pneumonia in a family, for example.

If it was so transmissible and infectious, everybody would get a pneumonia. But what's protecting everybody, who inhales it, is their own immunity.

The person with the lowest immunity is in whom it manifests as a pneumonia very often.

The Pope, he's 88. And most pneumonias typically occur in people above 60, which is why our pneumonia vaccine recommendations are also for 60 or 65, depending on the country which you're in.

Under the age of 65, your probability of a pneumonia is low, unless you're an infant -- at the two ends of the age spectrum are where pneumonia tend to be the most common.

And that, again, is purely a reflection of the fact that your immunity is low at these ends of the spectrum.

It's got nothing specifically to do with the bug. It's the fight between the bug and the immune system.

The bug wins when you get a pneumonia.

Fungus is everywhere. But it's not as if there is more bacteria in the air in India?

Exactly. Number one, when we talk about transmission being very rapid and quick, we're mostly speaking about viruses, because viruses transmit very easily.

The other situation in which we talk about transmission is tuberculosis. But again, even with a disease like TB, it's not like if one person in the house has TB, everybody gets TB.

There is a strong function of your immune system, which keeps it in check.

It's not like India has more bugs. The population density of India might be more, which is why probabilistically, your chance of catching something is higher, just because the sheer proximity to other people is more in India.

Once it enters your system, the probability of having a pneumonia, or not, depends on your immune system. Doesn't depend on the bug, for bacteria, at least.

So basically, the precautions for not getting PM RTI and bacterial diseases of the lungs, are just about having a good immune system and precautions like don't smoke, exercise etc?

And getting vaccinated. We believe in adult vaccination. And there is data to suggest that it reduces the severity of it, if you do get it.

The vaccine for pneumonia is against the commonest organism, which is streptococcus, the strep pneumoniae, which is also called the pneumococcus.

Vaccines are available, which are recommended for those above 60 in India.

They are readily available?

Yes, yes, they are. It's part of standard recommendations.

Whether it's the infectious disease societies or the chests societies in India, they always recommend vaccination to people above the age of 60.

What does the prognosis look like for the Pope? He's elderly and he already has various incapacities.

If you do get bugs, the probability of them being resistant in India is higher than the West. That's being attributed to the indiscriminate use of antibiotics here.

Assuming he has a sensitive bug, which is responsive to antibiotics, it may not necessarily be the worst-case scenario.

He may fight it with a combination of the right antibiotics and his immune system. But of course, the older you get, the higher the probability that the pneumonia might cause severe disease, might cause fatal disease, for that matter.

Feature Presentation: Ashish Narsale/Rediff.com