[Respiratory pathology associated with pneumococcus]

Pneumococcal pneumonia is the leading cause of death due to infectious diseases in industrialized countries. Risk factors are mainly elderly and comorbidities. Increasing prevalence of multiresistant strains to antibiotics is a major problem for public health. Lobor consolidation remains the most frequent pattern, nevertheless less frequent than in the pre-antibiotic era; it's not significantly predictive of pneumococcal etiology. Extra-respiratory complications are more frequent in bacteremic pneumonia. Signs and symptoms are not different in HIV positive patients. There are no clinical predictive signs of penicillin-resistant pneumococcal pneumonia; nevertheless some risk factors have been identified: young age(particularly children in day-care centers), elderly patients, previous eéta-lactam treatment, nosocomial acquisition, prior hospitalization. Biologic diagnosis tools (blood cultures, sputum culture) are now completed by antigen-detection tests, particularly urinary antigen test. Most active béta-lactams on in vitro resistant strains (penicillin, amoxicillin, céfotaxime, ceftriaxone) remain the first line treatment. Mortality is near 12-15% cases among hospitalized patients, 95% of deaths concerning more than 60 years patients. Outcome is not significantly affected by drug resistance. Pneumococcal vaccination is a very important prevention among elderly and patients with underlying chronic medical conditions. Pneumococcal vaccine in France is largely ignored by general practitioners.