Pneumopathies bacteriennes du suiet age' a propos de 41 cas

Bacterial pneumonia in the elderly have frequently an atypical clinical presentation and a poor prognosis. We have restrospectively studied cases of bacterial pneumonia of the elderly recorded in the Sfax Hospital pulmonary medicine department between January 1993 and December 1994. Cases were selected on the following criteria: age over 65 years, acute respiratory tract infection with parenchymal infltrate on chest radiographs, negativity of search for acid fast bacilli on sputum. We founded 41 cases that fulfiled this criteria. Ages ranged from 65 to 89 years [median: 74]. Sex-ratio was 2/1 [27 men, 14 women]. 55% of patients were smokers and 68% had an associated pathology. Clinical features were often atypicals: fever was recorded in only 58% of cases, and extra-respiratory symptoms were common [confusion 27% of cases, diarrhea and vomiting 12%]. Chest radiographs showed unilobar infiltrate in 73% of cases. Pattern was of pneumonic type in 56% of cases. A pleural effusion occured in 17% of cases. Thoracocentesis revealed sterile, sero-fibrinous, parapneumonic effusion in all cases. Mortality rate was 8%. Antibiotic treatment must cover Streptococcus pneumoniae and Haemophilus influenzae, this bacteria being the most frequently encountered pathogens. So co-amoxyclav or cefuroxime seems to be the most appropriate choice