Adult community acquired pneumonia in Assiut University Hospital

Abstract EN

Community-acquired pneumonia (CAP) is a common infectious disease that is "\ associated with significant morbidity and mortality in both developing and developed - countries.

Due to the delayed results of many diagnostic tests, the antibiotic treatment ;* for CAP empirically relies on epidemiologic data regarding the causative pathogens in t a particular geographic area.

Most studies showed that Streptococcus pneumoniae 1 remains the primary cause of CAP.

The incidence of other microbial pathogens varies ' both seasonally and geographically.

The present study was designed to evaluate the bacteriological profile of CAP in Assiut, Egypt.

Patients and Methods: One hundred and one adult patients; with community acquired pneumonia were admitted to Assiut University Hospital from March 2002 to October 2003 were enrolled in this study.

In all the patients sputum culture, Bronchoalveolar Lavage (BAL) and Protective Specimen Brush (PSB) cultures as well as serological studies for the detection of specific IgM antibodies for Legionella, Mycoplasma pneumoniae, Chlamydia pneumoniae, coxiella, influenza A virus, influenza B virus, Para influenza virus and Respiratory syncytial virus by indirect immunofluorescence technique were done.

Results: Causative organisms were identified in 95 patients (94%), in 6 patients we could not detect organisms by different techniques.

The most frequent identified organisms in Sputum were S.

pneumoniae (45%), Coagulase Negative Staphylococcus (CoN staph) (30.9%) and Staph, aureus ( 16.9%).

In BAL S.

pneumoniae (23.7%), Staph, aureus (18.6%) and CoN staph (16.9%) and in PSB S.

pneumoniae (36.8%), Staph aureus (14.4%)and Klebsiella pneumoniae (9.2%).

For atypical microrganism and viral infection the most commen pathogen were Legionella Spp.

(35.1%), Mycoplasma pneumoniae (21.4%), Chlamydia Pneumoniae in (14.2 %) and Influenza A (14.3%).

Conclusion: PSB and BAL cultures are more specific and useful for detection of the underlying pathogen than sputum examination.

Strept.

pneumonia is the most common implicated pathogen in CAP, followed by atypical pathogens.

Serological examination must be done for detection of atypical pathogens as they represent about 25% of CAP cases.

There is significant impact of age, smoking and comorbidity on the severity of CAP.

Malnutrition is considered an important risk factor for the development of CAP