title: [Adult respiratory distress syndrome, a manifestation of severe pneumococcal infection].
abstract: A retrospective study analyzing the case notes of 49 hospitalized adults, either in intensive care (n = 26) or in thoracic medicine units (n = 23), for acute bacteriologically proven pneumococcal pneumonia based on samples obtained other than by sputum examination. The mortality was 54% in intensive care and 17% in the thoracic medicine unit. This significant difference may be explained in part by a respiratory distress syndrome in whom there were adequate criteria on admission for 7 patients in the intensive care group. Among these latter only one patient had had a splenectomy. The others did not have underlying disorders (three were chronic alcoholics); 7 patients were shocked on admission, four with a leukopenia less than 5,000/mm3 and six had a thrombocytopenia less than 100,000/mm3; finally 6 had a temperature of less than 38 degrees C. 7 patients died in less than four days (mean 2 days) in a clinical context of refractory hypoxemia. The significance of the respiratory distress syndrome is probably very different from the usual pneumonia; it seems rather to be an integration of the toxins induced by the pneumococcus. Its presentation can be particularly misleading as regards the diagnosis; the prescription of antibiotics once a diagnosis is obtained would seem insufficient by itself in this context to obtain a cure.
authors.affiliation: Service de Réanimation médicale et maladies infectieuses, Centre Hospitalier Régional Pontchaillou, Rennes.
authors.forename: P H
authors.initials: PH
authors.lastname: Thoreux
authors.forename: R
authors.initials: R
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Camus
authors.forename: J
authors.initials: J
authors.lastname: Bousser
authors.forename: P
authors.initials: P
authors.lastname: Delaval
authors.forename: C
authors.initials: C
authors.lastname: Michelet
authors.forename: F
authors.initials: F
authors.lastname: Cartier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002642:Chick Embryo; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D013921:Thrombocytopenia / Q000209:etiology
vernacular_title: Le syndrome de détresse respiratoire de l'adulte, manifestation de l'infection pneumococcique grave.