Abstract
Aim: To study the manifestations and outcome of pneumonia in elderly from a rural background in India.
Methods: Retrospective analysis of clinical, radiological and laboratory features and treatment outcome of severe community-acquired pneumonia among eldely who were managed in a multispecialty hospital in rural India during preceding 2 years.
Results: 28 cases in this study included 22 males and 6 females in the age group of 72 to 88 years. 16 cases had comorbidities- COPD in 8, diabetes in 5 and chronic liver disease in 3. Etiology included streptococcus pneumoniae in 11, staphylococcus aureus in 5, H. influenzae in 3 and klebsiella pneumoniae in 2 cases. In 7 cases definitive organism could not be isolated. Only 6 had typical features of fever, chest pain, cough, pulmonary consolidation and neutrophil leucocytosis. Extrapulmonary features misleading initial diagnosis were predominant in the remaining cases. All of them had altered mental status and profound general weakness with minimal and non specific chest findings. 4 had pain abdomen and loose motions as presenting features. Among cases with atypical presentation 8 had leucopenia while the remaining had neutrophil leucocytosis.18 cases required hospitalisation of more than 3 weeks and only 14 responded to therapy.Pneumococcal-fluoroquinolone resisance was observed in 2 cases.16 cases required mechanical ventilation and among them only 2 survived. Ventilatory associated lung injury was present in 3 cases. Non responders had severe sepsis with ARDS and multiorgan failure.
Conclusion: Pneumonia in elderly is an enigma, often caused by common pathogens and is associated with atypical features, complicated course and poor treatment outcome.
- © 2011 ERS
