array:22 [ "pii" => "S0025775301721409" "issn" => "00257753" "doi" => "10.1016/S0025-7753(01)72140-9" "estado" => "S300" "fechaPublicacion" => "2001-01-01" "aid" => "72140" "copyright" => "Elsevier España, S.L.. Todos los derechos reservados" "copyrightAnyo" => "2001" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Clin. 2001;117:441-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3811 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 3479 "PDF" => 324 ] ] "itemSiguiente" => array:18 [ "pii" => "S0025775301721410" "issn" => "00257753" "doi" => "10.1016/S0025-7753(01)72141-0" "estado" => "S300" "fechaPublicacion" => "2001-01-01" "aid" => "72141" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Clin. 2001;117:446-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3875 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 3475 "PDF" => 393 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Objetivación de la gravedad mediante el sistema APACHE-III aplicado en España" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "446" "paginaFinal" => "451" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Severity assessment by APACHE III system in Spain" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Guillermo Vázquez Mata, M. del Mar Jiménez Quintana, Ricardo Rivera Fernández, Manuel Bravo, Eduardo Aguayo de Hoyos, John Zimmerman, David Wagner, William Knaus" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Vázquez Mata" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "del Mar Jiménez Quintana" ] 2 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Rivera Fernández" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Bravo" ] 4 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Aguayo de Hoyos" ] 5 => array:2 [ "nombre" => "John" "apellidos" => "Zimmerman" ] 6 => array:2 [ "nombre" => "David" "apellidos" => "Wagner" ] 7 => array:2 [ "nombre" => "William" "apellidos" => "Knaus" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775301721410?idApp=UINPBA00004N" "url" => "/00257753/0000011700000012/v1_201307291705/S0025775301721410/v1_201307291705/es/main.assets" ] "es" => array:14 [ "idiomaDefecto" => true "titulo" => "Neumonías adquiridas en la comunidad en pacientes mayores de 60 años. Incidencia de gérmenes atípicos y evolución clinicorradiológica" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "441" "paginaFinal" => "445" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco Javier Álvarez Gutiérrez, Alberto García Fernández, Teresa Elías Hernández, José Romero Contreras, Beatriz Romero Romero, José Castillo Gómez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Álvarez Gutiérrez" ] 1 => array:2 [ "nombre" => "Alberto" "apellidos" => "García Fernández" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Elías Hernández" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "Romero Contreras" ] 4 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Romero Romero" ] 5 => array:4 [ "nombre" => "José Castillo" "apellidos" => "Gómez" "email" => array:1 [ 0 => "fag01se@nacom.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Enfermedad Pulmonar Obstructiva Crónica e Infecciones Respiratorias. Centro de Especialidades Dr. Fleming. Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Hospital Universitario Virgen del Rocío. Sevilla" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Avda. Alcalde Manuel del Valle, Edificio Cónsul, portal 6, 1.° A. 41008 Sevilla" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Community acquired pneumonia in patients older than 60 years. Incidence of atypical agents and clinical-radiological progression" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-09-05" "fechaAceptado" => "2001-01-22" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec222687" "palabras" => array:3 [ 0 => "Neumonía adquirida en la comunidad" 1 => "Anciano" 2 => "Tratamiento" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec222688" "palabras" => array:3 [ 0 => "Community acquired pneumonia" 1 => "Elderly" 2 => "Treatment" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron de forma prospectiva 75 pacientes mayores de 60 años con neumonías adquiridas en la comunidad (NAC) seguidos de forma ambulatoria, evaluando la incidencia de gérmenes atípicos, las características clinicorradiológicas, su evolución y los datos diferenciales con neumonías de pacientes más jóvenes.</p> <span class="elsevierStyleSectionTitle">Método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realizaron protocolos de evaluación clinicorradiológica en la primera visita, y durante el seguimiento en dos revisiones más. El diagnóstico etiológico se efectuó por serología (en la primera visita y a las tres semanas).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyó inicialmente a 85 pacientes mayores de 60 años, de los que fueron seguidos un total de 75 casos no hospitalizados. Además, se incluyó en el estudio comparativo a 216 pacientes con edad igual o menor de 60 años, controlados de forma ambulatoria en el mismo espacio temporal. En el primer grupo la incidencia de gérmenes atípicos fue del 33,3%, siendo el patógeno más frecuente <span class="elsevierStyleItalic">Coxiella burnetii</span> (13,3%), seguido de virus y <span class="elsevierStyleItalic">Legionella pneumophila</span>. No se diagnosticó ningún caso debido a Mycoplasma pneumoniae. La forma de presentación radiológica más frecuente fue la condensación alveolar (85%). En el análisis comparativo entre las dos poblaciones (mayores o menores de 60 años), encontramos escasas diferencias clínicas (disnea más frecuente en población mayor, escalofríos en población más joven) y en semiología respiratoria (crepitantes más frecuentes en población mayor), no hallando diferencias en el resto de los datos clinicorradiológicos o de laboratorio. La evolución clínica y radiológica fue satisfactoria, siendo necesario el ingreso hospitalario en sólo dos casos (2,7%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Encontramos un elevado número de casos debidos a gérmenes atípicos en las nac de pacientes mayores de 60 años. con seguimiento ambulatorio, la evolución clinicorradiológica ha sido satisfactoria en la mayoría de ellos, por lo que no consideramos la edad un factor fundamental para decidir la hospitalización.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Seventy five patients older than 60 years with a community acquired pneumonia followed up in an outpatient clinic, were prospectively studied in order to determine the incidence of atypical agents, clinical-radiological characteristics, progression and the differences with pneumonia in younger patients.</p> <span class="elsevierStyleSectionTitle">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical-radiological evaluation protocols were activated in the first visit and in two subsequent controls. Etiological diagnosis was made by means of serology (in the first visit and three weeks later).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Initially, 85 patients older than 60 years were included of which 75 non hospitalized were fully followed up. Also, in the comparative study, 216 outpatient clinic patients 60 years old or younger were followed up during the same period. In the first group the frequency of atypical agents was 33.3%. The most frequently isolated bacteria was <span class="elsevierStyleItalic">Coxiella burnetii</span> (13.3%) followed by virus and <span class="elsevierStyleItalic">Legionella pneumophila</span>. No case of <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> was diagnosed. The most frequent radiological onset was alveolar infiltrate (85%). The comparative study between the two populations (older or younger than 60 years), found few clinical differences (dyspnea more frequent in older, feverish chill in younger) and auscultation (crackles more frequent in older). We did not find differences remaining clinical-radiological or laboratory data. Most patients presented a favourable clinical and radiological progression. Only 2 patients needed hospital admission (2.7%).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In outpatient clinic patients older than 60 years with community acquired pneumonia a high number of «atypical» agents have been found. The clinical-radiological evolution was satisfactory for wost of them. 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Journal Information
Neumonías adquiridas en la comunidad en pacientes mayores de 60 años. Incidencia de gérmenes atípicos y evolución clinicorradiológica
Community acquired pneumonia in patients older than 60 years. Incidence of atypical agents and clinical-radiological progression
Francisco Javier Álvarez Gutiérrez, Alberto García Fernández, Teresa Elías Hernández, José Romero Contreras, Beatriz Romero Romero, José Castillo Gómez
Corresponding author
Unidad de Enfermedad Pulmonar Obstructiva Crónica e Infecciones Respiratorias. Centro de Especialidades Dr. Fleming. Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Hospital Universitario Virgen del Rocío. Sevilla