COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS - A STUDY COMPARING CLINICAL-FEATURES AND OUTCOME IN AFRICA (REPUBLIC-OF-GUINEA) AND EUROPE (FRANCE)

Background - Community acquired pneumonia is the most common cause of death from infectious disease both in western and developing countries . A study was carried out in Conakry, Republic of Guinea and Tours, Fr ance in order tea compare signs, symptoms, severity of illness, risk f actors, community patients admitted to hospital. Methods - The study w as performed in the cities of Conakry and Tours over the same one year period. Patients with nosocomial pneumonia, tuberculosis, and those w ho were HIV positive were excluded. Data were recorded on the same for ms in both centres. A severity score was calculated according to Ameri can 'Thoracic Society criteria. Follow up was evaluated at days 2, 7 a nd 15. Results - A total of 333 patients (218 from Conakry, 115 from T ours) were included in the study with a diagnosis of community acquire d pneumonia, with or without lung abscess or pleural effusion. Mean ag e was higher and pre-existing illness rate, dehydration, agitation, an d stupor were more frequent in patients in Tours. Respiration rates of >30 breaths/min and the incidence of crackles were identical in the t wo centres. Fever above 39 degrees C, initial shock, chest pain, and h erpes were significantly more frequent in Conakry. Initial chest radio graphic abnormalities were similar in the two groups, ranging from uni lateral pleuropulmonary involvement (89% and 83% in Conakry and Tours, respectively) to diffuse patchy parenchymal disease. Parapneumonic ef fusion was present in 17% and 16% of the patients of Conakry and Tours , respectively. Pneumonia was considered to be severe in 33% and 42% o f the patients, respectively. In Conakry first line antibiotic therapy was penicillin alone (2 million units a day) for 197 patients (90%) a nd second line antibiotic therapy was prescribed for 25 patients (12%) . In Tours first Line therapy consisted of a single antibiotic (amoxic illin, third generation cephalosporins) for 65 patients (57%) and seco nd line antibiotic therapy was prescribed for 55 patients (48%). The c linical outcome was and clinical outcome was similar in Conakry and To urs: 88% and 85% of patients, respectively, were afebrile or clinicall y cured at day 15. The mortality rate was similar (6% and 8%, respecti vely). Conclusions - The problems encountered in the management of com munity acquired pneumonia are quite different in western and developin g countries. This study shows that low doses of penicillin can cure 90 % of African patients with pneumonia as effectively as more aggressive treatments in European patients who are both older and have greater c o-morbidity. Although pneumococci with reduced penicillin sensitivity occur in western countries, this does not seem to be the case in black Africa. For these reasons, low doses of penicillin or amoxicillin rem ain good first line treatment.