[Initial management of community acquired pneumonia]

There continue to be major controversies in the management of community-acquired pneumonia, concerning either investigations, decision to hospitalize and antibiotic therapy. All authores agree that a chest radiography must be obtained in all cases, and two sets of blood cultures for hopitalized patients but there is controversies about other microbiological tests. Decision to hospitalize must be based on clinical judgement but can be helped by Fine's predictive rule. Initial therapy is almost always empiric, antibiotic selection being primarily based on disease severity

[Sleep apnea syndrome]

Sleep Apnea Syndrome is an understimated disease. We describe its diagnostic criteron and principal epidemiologic data. After a brief rememory about sleep and respiration, its physiopathologic consequences [especially respiratory, cardio-vascular and cerebral] were detailed. The diagnostic of its different clinical presentations is suspected clinically but confirmed by polysomnography. His treatment, usually based on the CPAP, permits to prevent its complications

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