[Clinical aspects of 27 cases of severe primary infectious lung diseases]

The authors report 27 cases of severe primary pulmonary infections which resulted in acute respiratory failure and which were treated in a Respiratory Medicine Intensive Care Unit. A bacteriological specimen (blood culture, transtracheal aspiration, fibroscopy, pleural tap) and/or a serological examination permitted the responsible agent to be identified in 20 of the 27 cases (74%). Apart from antibiotics and symptomatic treatments, 13 patients also received oxygen therapy and 14 other patients were intubated and ventilated. In the first group, 3 patients died (24%) and in the second group, the mortality was much higher, with 9 deaths out of 14 patients (64%). The authors present the clinical features, the frequency of the various micro-organisms isolated, the therapeutic modalities and various prognostic factors. Although repeated early specimens usually provide bacteriological diagnosis and therefore appropriate antibiotic therapy, the prognosis of these conditions, at the stage of acute respiratory failure remains serious and is probably related to risk factors linked with predisposition. The exact nature and the relative importance of these risk factors still needs to be determined.