[Community acquired pneumonia. Reliability of the criteria for deciding ambulatory treatment]. / Neumonía adquirida en la comunidad. Fiabilidad de los criterios para decidir tratamiento ambulatorio.

To determine whether criteria for not admitting community-acquired pneumonia (CAP) patients diagnosed in the emergency room are appropriate, and to characterize the symptoms, etiology and course of CAP. This one-year prospective, protocol study of immunocompetent CAP patients diagnosed in the emergency room of our hospital enrolled patients not considered to require hospital admission according to the recommendations of the Spanish Society of Respiratory Disease (SEPAR). Medical histories, chest X-rays and blood analysis were obtained for all patients. Blood cultures were analyzed for antibodies against Legionella pneumophila, Mycoplasma pneumoniae, Coxiella burnetii, Chlamydia pneumoniae, Chlamydia psittaci and influenza virus types A and B. The patients received erythromycin for 14 days and were regularly checked by the pulmonologist in the outpatient clinic until signs and symptoms had disappeared. One hundred six patients were enrolled. Mean age was 36 +/- 13 years. Only 3 patients had to be admitted to hospital, after which outcome was good. The main symptoms were fever (106, 100%) and cough (83, 78%). In 46 (43.4%) chest sounds were normal. Microbiologic diagnoses were achieved for 28 (26.4%) and Coxiella burnetii was the agent most often found (19, 17.9%). Outcome was good in all cases, with faster disappearance of symptoms than of radiological signs. The SEPAR criteria for admitting patients with CAP are appropriate. The clinical symptoms of such patients are non specific, a noteworthy finding being that many patients had normal chest sounds. Coxiella burnetii was the most common causative agent. Both clinical and radiological outcomes were excellent.

[Pneumonia in alcoholic patients: the clinical and etiological characteristics]. / Neumonía en pacientes alcohólicos: características clínicas y etiológicas.

Twenty-four alcoholic patients with community-acquired pneumonia were studied for 2 years in order to define clinical signs and etiology. Blood cultures and serological profiles were done for all patients in addition to standard blood analyses. All had an invasive procedure -transthoracic puncture with an ultrafine 25G needle (20 patients) or telescopic catheter with bacteriologic brush (4 patients). When we were unable to obtain a good sputum sample (5 patients), a culture was grown. The patients' mean age was 48 and 83% had an acute clinical profile (< or = 7 days with symptoms) with "typical" signs. The X-rays showed an alveolar pattern in all patients, with cavitation in 29%. Etiological diagnosis was reached in 17 (71%) cases, with St. Pneumoniae (25%), anaerobic microorganisms (20%) and C. burnetii (12.5%) being the germs found most frequently. The invasive techniques were more useful (54%) than the blood cultures (17%) or sputum cultures (4%), and they were well tolerated and uncomplicated. Empirical antibiotic treatment was modified for 12 patients (50%). Seventeen percent required intensive care treatment and mortality was 12.5%.

[Clinical and etiological features of community-acquired pneumonia in the elderly]. / Características clínicas y etiológicas de la neumonía adquirida en la comunidad en ancianos.

BACKGROUND: The aim of the present study was to know the clinical and etiologic features of community-acquired pneumonia (CAP) in elderly patients requiring hospital admission. METHODS: A prospective study of 36 consecutive patients aged over 70 years, admitted to a general hospital was performed. Standard analytical determinations, blood cultures, and serologic studies were performed in all patients using invasive techniques: aspirative transthoracic puncture (ATP) with ultrafine needle in 35 (97%) cases, and telescopic catheter (TC) in 1 case. RESULTS: The mean age was 79 years (range: 71-90). Twenty-two patients had received antibiotic treatment prior to admission (61%) and 17 (47%) presented chronic debilitating diseases. The clinical characteristics of CAP were "typical" with acute presentation in most. Fifteen cases (42%) were etiologically diagnosed and the most frequently isolated agents were Streptococcus pneumoniae (22%) and Haemophilus influenzae (8%). Empiric treatment was changed on the basis of isolations in 7 cases (19%). Eight patients died (22%). CONCLUSIONS: According to our results community-acquired pneumonia in the population studied: 1) generally showed an acute presentation with "typical" characteristics, carrying a high mortality rate (22%), 2) is of bacterial etiology, with S. pneumoniae and H. influenzae being the most frequently isolated microorganisms, 3) the use of ATP in community-acquired pneumonia offers a high diagnostic effectiveness, good tolerance and low risk of complications.