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Community-acquired pneumonia: some etiological, clinical, paraclinical and evolutional particularities


Author: Blaja-Lisnic Natalia
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2009
Scientific adviser: Sergiu Matcovschi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 25 March, 2009
Approved by NCAA on the 23 April, 2009

Abstract

Adobe PDF document0.34 Mb / in romanian

Thesis

CZU 616.24-053.9-02

Adobe PDF document 0.94 Mb / in romanian
131 pages


Keywords

Community-acquired pneumonia, elderly, pathogen, phlegm analyzis, immunoenzymatic analyzis, clinical and evolutive particularities, the index of leucocyte intoxication, cellular immunity, monoclonal method, the variant of antigenic expression, the immunoregulatory index, humoral immunity, the prognosis

Summary

The study included 238 patients with community-acquired pneumonia (CAP): 149 old persons with the mean age of 73 ± 0.45 years old and 89 patients younger than 65 years old with the mean age of 73 ± 0,45 years old. On bacteriological analyses, the positive diagnosis was obtained in 80.6% in the elderly and in 78.8% in the younger patients with CAP. Streptococcus pneumoniae (37.3%) remain to be the main pathogen, followed by St. aureus (24%), Str. pyogenes (17.3%) and Moraxella catarhalis (2.7%). Immunoenzymatic analysis showed that Chlamidia pneumoniae is uncharacteristic pathogen for pneumonia development in old people. The incidence of Mycoplasma Pneumoniae is practically the same in both groups. The clinical picture of CAP is less expressive in the old people, dyspnoea (85.9%), fatigability (98%), nausea (5.4%), general status alteration (100%), passive position (34.2%) and tachypnoea (65,8%) being more typical than for the patients from the comparison group. The debut of the illness is less expressive. In the presence of Streptococcus Pneumoniae the symptoms are similar to the pneumonia in the younger adults. Percussion and auscultation changes practically are the same in both groups. The mean value of leucocytes in the studied groups falls into the normal limits. Very seldom, a leucocytosis can be seen; leucopenia, practically, was not observed. The values of lymphocytes exhibit a tendency to lymphocytopenia in patients from the main group. The mean values of the inflammation markers are a little higher in the younger patients, but the percentage of CRP and fibrinogen increase does not differ very much in both groups. The increased plasmatic levels of the CRP in old patients are more typical for the CAP with Streptococcus Pneumoniae as well as for the cases with severe evolution. The fact that urea was higher in the old people reflects the expressed intoxication syndrome which is conditioned by the kidney function worsening in the presence of some infection (like pneumonia in our case). The radiological exam does not reveal some differences in the bothe age groups. According to our data the old patients with CAP recover more slowly than the younger patients. After the treatment some symptoms like cough, fatigability can persist. For older patients the period of normalisation of some paraclinical indices such as leucocytes, SRE, CRP, urea is longer than in the younger patients with CAP, the signs of pulmonary condensation denote an incomplete resolution. The changes in immune status reflect decreasing of cellular immunity and modifications in humoral immunity values, the decreased regulatory function of infections in the presence of associated pathologies. The clinical manifestations and the evolution of CAP correlate with the immunity changes. The prognosis of the disease depend on the CAP severity, the localization and the paraclinical indices values.