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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the features of 51 cases of hospital-acquired Legionella pneumophila pneumonia (HLP), diagnosed in our hospital during a period of about 5 years. Mean age was 64.6 years, and the male:female ratio 1.6. 29% of HLP involved patients who were not admitted to the hospital at the time of diagnosis. The monthly distribution showed a maximal incidence in July and August. Only 6% of cases involved patients without underlying diseases. The most common underlying diseases were chronic obstructive lung disease (COLD) (37%), heart disease (29%) and immunosuppressant therapy (29%). 21% of the patients with renal transplant had HLP. The only constant clinical feature was fever of 37.8 degrees C or higher. During the first 24-48 hours of illness, respiratory symptoms were not present in 41% of cases, and thoracic abnormalities in the physical examination were not present in 31%. The laboratory abnormalities were nonspecific and with incidence rates lower than 50%. In 41% of patients there was hypoxemia (60 mmHg or lower) with FiO2 of 0.21. The most common radiological finding was the initial unilateral and unilobar involvement. Pleural effusion and cavitation developed in 20% and 4%, respectively. Overall mortality rate was 12%. In the 43 patients treated early with intravenous erythromycin, mortality rate was 7%. We think that the relatively low incidence of severe underlying immunosuppression and the inclusion of hospital-acquired pneumonia in our institution influenced the low mortality rate of the present study, in contrast with other series of hospital-acquired legionellosis.
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PMID:[Nosocomial legionellosis: study of 51 cases]. 279 35

It has recently been recognized that neonates may develop pneumonia as a result of Legionella pneumophila. The objective of this study is to characterize the epidemiology, risk factors, diagnosis, clinical features, and outcome of neonatal legionellosis. Review of the literature revealed nine cases of neonatal Legionella infection. Five neonates were term infants and four were preterm. Eight had potential risk factors such as prematurity, congenital heart disease, bronchopulmonary dysplasia, or corticosteroid therapy. Diagnosis was proven by culture in all cases. The main presentation was acute respiratory distress requiring mechanical ventilation. In six infants, the infection had a fatal outcome, including five who were not treated with erythromycin. All the cases were nosocomial, and environmental Legionella was documented in five cases. As has been noted in adults and children with Legionella, early recognition and institution of appropriate therapy are the most important determinants of the prognosis.
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PMID:Legionella pneumonia in neonates: a literature review. 973 Jan 99

Five sporadic cases of nosocomial Legionnaires' disease were documented from 1989 to 1997 in a hospital in northern Italy. Two of them, which occurred in a 75-year-old man suffering from ischemic cardiopathy and in an 8-year-old girl suffering from acute leukemia, had fatal outcomes. Legionella pneumophila serogroup 6 was isolated from both patients and from hot-water samples taken at different sites in the hospital. These facts led us to consider the possibility that a single clone of L. pneumophila serogroup 6 had persisted in the hospital environment for 8 years and had caused sporadic infections. Comparison of clinical and environmental strains by monoclonal subtyping, macrorestriction analysis (MRA), and arbitrarily primed PCR (AP-PCR) showed that the strains were clustered into three different epidemiological types, of which only two types caused infection. An excellent correspondence between the MRA and AP-PCR results was observed, with both techniques having high discriminatory powers. However, it was not possible to differentiate the isolates by means of ribotyping and analysis of rrn operon polymorphism. Environmental strains that antigenically and chromosomally matched the infecting organism were present at the time of infection in hot-water samples taken from the ward where the patients had stayed. Interpretation of the temporal sequence of events on the basis of the typing results for clinical and environmental isolates enabled the identification of the ward where the patients became infected and the modes of transmission of Legionella infection. The long-term persistence in the hot-water system of different clones of L. pneumophila serogroup 6 indicates that repeated heat-based control measures were ineffective in eradicating the organism.
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PMID:Multiple types of Legionella pneumophila serogroup 6 in a hospital heated-water system associated with sporadic infections. 1036 84