From Pneumoniae to ongoing Cryptogenic Organising Pneumoniae (COP): the story of my father

Blogpost by Marica Micallef

In one of my previous blogs, I stated that my dad had a Klebsiella pneumoniae which was mistakenly diagnosed as Covid19. Due to this wrong diagnosis, my father’s lungs did not improve by a fraction. He ended in ITU.  In the first six weeks in ITU, the Klebsiella Pneumoniae (caused by bacteria and not by a virus) developed into an ongoing Cryptogenic Organising Pneumoniae (COP). How do I know?  My dad was diagnosed with this condition between 11^th and 18^th November, after one of the many chest x-rays which were done on him.

This term Cryptogenic Organising Pneumoniae was coined in 1983 by Davison. In short, Davison explained it as a form of lung disease. Therefore, this disease existed before Corona Virus, which started in 2019. In 1985, Epler et al. came up with a detailed description of the COP disease, under the term BOOP.  So, this type of pneumonia kept on being studied. 

Did our local medical staff study it? And didn’t they learn how to recognise it from x-rays and other methods? I am sure that before 2019, no one said that COP was caused by Covid19! Cryptogenic Organizing Pneumonia is believed to be a consequence of an injury in the alveoli The alveoli are where the lungs and the blood exchange oxygen and carbon dioxide during the process of breathing in and breathing out. In COP, pieces of tissue block the alveolar lumen and bronchioles, which result in a respiratory failure. Organizing pneumonia may arise as a consequence of an identifiable cause and it should be diagnosed only after excluding any other possibilities! So, what caused the alveolar injury in my dad? What caused his lungs to fail? What it important here is that my Dad did not enter hospital with a respiratory failure. Therefore, he definitely did not have COP when he entered hospital! And surely he did not have Corona virus since dad was negative when he was in ITU.

The exact cause of Cryptogenic Organizing Pneumonia is UNKNOWN.  The SUGGESTIONS which were put forward as to what causes it are: toxic gases (can these be the damaging gases that the ventilator pumped into my dad for 6 weeks?), medications, (and dad was given many intravenously) and radiation therapy (well after 6 weeks of continuous x-rays, the medical staff at hospital decided to stop for a while doing x-rays because we were told that they can be harmful).  I also suspect that the ventilator multiplied the bacteria which dad had in his lungs.

In a recent scientific study (2018) by Blot et. al., it was found out that the ventilator contributes to bacterial dissemination in patients with bacterial pneumonia, meaning that the bacteria which my dad had in his lungs was growing in number to a massive extent thanks to the ventilator, turning it into Ongoing Cryptogenic Organizing Pneumonia. After conducting experiments, Blot arrived to the conclusion that if a healthy person is subjected to the continuous use of the ventilator, there is a high risk of developing “severe pneumonia with greater concentrations of bacteria in the lungs, higher rates of systematic dissemination, higher levels of circulating inflammatory mediators and decreased survival”. 

COP symptoms are unique from those of other lung diseases in that they are present for weeks and during which antibiotics frequently fail in curing the presumed bacterial pneumonia. So why was my dad given a lot of antibiotics which were failing in curing him?

My questions remain: if the ventilator and all the medicine given intravenously should have healed my dad, how come they failed? How come the Klebsiella Pneumoniae developed into ongoing CRYPTOGENIC ORGANISING PNEUMONIAE? If COP can be diagnosed via blood tests which will show a rise in the white cell count and in inflammatory markers (the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP), how come this was not detected by hospital before loads of blood tests were carried out on my dad? Why did the lungs’ state degenerate to this point of no return, with the staff telling us there is nothing they can do anymore, since this damage is irreversible?