Pneumonia comunitară la vârstnici - particularităţi clinice

Abstract

Introducere. Pneumonia comunitară este una din patologi- ile frecvent întâlnite, cu complicaţii severe la pacienţii vârstnici. în Republica Moldova, pe parcursul ultimilor 10 ani, se observă o creştere a incidenţei pneumoniei comunitare de la 19.177 - la 23.022 cazuri, indicele morbidităţii crescând de la 4 - la 5,9 la 1.000 populaţie. Scopul lucrării. Evaluarea particularităţilor clinice ale pneumoniei comunitare la pacienţii vârstnici. Material şi metode. S-a efectuat un studiu retrospectiv al fişelor medicale a pacienţilor cu pneumonii comunitare trataţi in SCM „Sfântul Arhanghel Mihail". Lotul I - 30 pacienţi, vârsta - 75±3,3ani, lotul II-19 pacienţi, vârsta - 37±2,5ani. Rezultate. La tineri: 90% - debut acut, febră înaltă, frisoane, tuse umedă cu expectoraţii mucopurulente; la vârstnici: 100% dispnee, stare generală gravă - 76%, 60% - subfebrilitate, 10% - afebrili, 80% - tuse uscate, 94% - astenie, 80% fatigabilitate. Investigaţii de laborator la vârstnici vs tineri: leucocitoză - 42% vs 85%, proteina C reactivă - 40% vs 100%, fibrinogenul - 35% vs 52%, LDH - 30% vs 73%, hipercolesterolemia - 61% vs 15%, glicemia a jejun crescută - 45% vs 1,4%. Concluzii. La pacienţii vârstnici pneumonia comunitară are un debut insidios, cu o simptomatologie slab exprimată, cu predominarea simptomelor clinice generale - astenie, fatigabilitate, confuzie, susţinute de un răspuns inflamator slab exprimat. Debutul, particularităţile evolutive clinice şi paraclinice ale pneumoniei comunitare la persoanele vârstnice pot fi explicate prin răspunsul imun precar, determinat de vârstă şi comorbidităţi.

Introduction. Community-acquired pneumonia is one of the frequently encountered pathologies, with severe complications in elderly patients. In the Republic of Moldova, during the last 10 years, there is an increase in the incidence of community-acquired pneumonia from 19,177 to 23,022 cases, the morbidity index increasing from 4 to 5.9 per 1,000 population. The purpose of the work. Evaluation of clinical features of community-acquired pneumonia in elderly patients. Material and methods. A retrospective study of the medical records of patients with community-acquired pneumonia treated in St. ArchanghelMihail MCH was carried out. Ith group - 30 patients, age - 75±3.3 years, IIth group -19 patients, age -37±2, 5 years. Results. In young people: 90% -acute onset, high fever, chills, wet cough with mucopurulent expectoration; in the elderly: 100% dyspnea, serious general condition - 76%, 60% - subfebrile, 10% - afebrile, 80% - dry cough, 94% - asthenia, 80% fatigue. Laboratory investigations in the elderly vs young patients: leukocytosis - 42% vs 85%, C-reactive protein - 40% vs 100%, fibrinogen - 35% vs 52%, LDH- 30% vs 73%, hypercholesterolemia - 61% vs 15%, hyperglycemia -45% vs 1.4%. Conclusions. In elderly patients, community-acquired pneumonia has an insidious onset, with a weakly expressed symptomatology, with the predominance of general clinical symptoms - asthenia, fatigue, confusion, supported by a weakly expressed inflammatory response. The onset, clinical and paraclinical evolutionary peculiarities of community-acquired pneumonia in the elderly can be explained by the poor immune response, determined by age and comorbidities.