Bacteremic Pneumococcal Pneumonia in the Elderly

Murphy, Timothy F.; Fine, Basil C.

doi:10.1097/00000441-198410000-00004

Cited by 39 publications

(9 citation statements)

References 20 publications

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“…Pneumococcal pneumonia is an increasingly important disorder among the elderly. The high rate of invasive pneumococcal disease and the high mortality associated with pneumococcal pneumonia (30-40%) emphasize the need for an effective vaccine (Murphy & Fine 1984). Protection against pneumococcal infection is primarily dependent on antibodies, complement and proper functioning of phagocytic cells.…”

Section: Alternative Strategiesmentioning

confidence: 99%

Immunogenicity and immunochemistry ofStreptococcus pneumoniae capsular polysaccharides

Dam

Fleer

Snippe

1990

Antonie van Leeuwenhoek

139

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Section: Alternative Strategiesmentioning

confidence: 99%

Immunogenicity and immunochemistry ofStreptococcus pneumoniae capsular polysaccharides

Dam

Fleer

Snippe

1990

Antonie van Leeuwenhoek

139

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“…While atypical presentation of pneumonia in the elderly has become standard teaching in geriatric medicine, there are many unanswered questions 7 . Research has been plagued by methodologic problems including varying inclusion criteria, inconsistent definitions, and retrospective design 3 , 6 , 8 , 9 . Accordingly, this prospective study was designed to describe the presenting symptoms of community‐acquired pneumonia in a group of elderly veterans.…”

mentioning

confidence: 99%

Clinical Aspects of Pneumonia in the Elderly Veteran

Harper¹,

Newton²

1989

J American Geriatrics Society

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While atypical presentation of pneumonia in elderly patients is thought to be common, its incidence and factors predisposing to it are unknown. This study documents presenting symptoms of pneumonia in 48 patients, aged 65 or older, admitted to the medical service at a Veterans Administration Medical Center. Seventeen subjects (35%) had a classic constellation of symptoms which included both fever and cough. A chief complaint suggestive of pneumonia, defined as cough, fever, or shortness of breath, occurred in 27 subjects (56%). Five subjects (10%) had no symptoms suggestive of pneumonia even with a detailed history. Absence of a classic constellation of pneumonia symptoms correlated with advanced age (P = .0045), cognitive impairment at admission (P = .022), and baseline functional impairment (P = .028). Neither nutritional status as measured by serum albumin nor medical status as measured by number of medical problems and number of medications predicted an atypical presentation of pneumonia. Nineteen subjects (39%) did not have a documented fever, and 15 subjects (31%) did not have a leukocytosis. Absence of fever or leukocytosis did not correlate with age, number of medical problems, number of medications, cognitive status, functional status, or serum albumin. We conclude that a classic constellation of symptoms, signs and laboratory findings is frequently absent but some suggestive symptom is usually present in this population of elderly veterans with community-acquired pneumonia. Patients with advanced age, cognitive impairment at admission, and baseline functional impairment are most likely to have an atypical presentation of pneumonia.

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“…Since 1981, three other studies of pneumococcal bacteremia have provided information concerning nosocomial infection. Murphy and Fine 7 reviewed 29 cases of pneumococcal pneumonia and bacteremia in patients 60 years of age or older at a teaching hospital in Boston; 10%) of these cases were due to nosocomial infection. Ruben et al 8 reviewed 72 episodes of pneumococcal bacteremia at a teaching hospital in Pittsburgh between Jan 1975 and Dec 1980.…”

Section: Discussionmentioning

confidence: 99%

“…Finkelstein et al 9 reported a mortality rate of 12% in 187 patients; however, all had community‐acquired bacteremia. Murphy and Fine 7 found a mortality rate of 31% due to pneumococcal bacteremia in an exclusively elderly (greater than or equal to 60 years of age) population of 29 patients. Esposito 1 reported a 13% mortality in 39 patients of all ages with community‐acquired bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal Bacteremia

Chang

Mylotte

1987

J American Geriatrics Society

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Eighty-nine episodes of pneumococcal bacteremia were reviewed over a 66-month period at a Veterans Administration Medical Center. Forty-one percent of these episodes were nosocomial in origin, and 59% of the patients were elderly (60 years of age or older). Nosocomial infection occurred more often in the elderly (55%) compared to those less than 60 years of age (32%; P less than 0.05). Within the elderly group, those older than 75 years of age had a higher rate of nosocomial bacteremia than those 60 to 75 years of age (76 versus 44%; P less than 0.05). The clinical presentation of the elderly and younger groups was not significantly different. All but one patient had serious underlying diseases. Eighty-three percent of the episodes were due to pneumonia, and penicillin alone was prescribed for only 21% of all cases. The mortality rate directly due to the bacteremia was 22%, while the overall mortality during the hospitalization was 47%. In the elderly, the percentage of deaths due to infection was similar to the younger group, but overall mortality during the hospitalization was significantly higher in the elderly (74 versus 26%; P less than 0.01). Physicians showed poor recognition of the significance of pneumococcal disease, as demonstrated by inclusion of the diagnosis of pneumococcal infection or bacteremia in only 27% of the discharge summaries and by predischarge vaccination of only 7% (6 of 82) of those without previous pneumococcal vaccination. In conclusion, the rate of nosocomial pneumococcal bacteremia was high in a predominantly elderly male population; it may be appropriate to consider a hospital-based vaccine program in similar populations.

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Bacteremic Pneumococcal Pneumonia in the Elderly

Cited by 39 publications

References 20 publications

Immunogenicity and immunochemistry ofStreptococcus pneumoniae capsular polysaccharides

Immunogenicity and immunochemistry ofStreptococcus pneumoniae capsular polysaccharides

Clinical Aspects of Pneumonia in the Elderly Veteran

Pneumococcal Bacteremia

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