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Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The first case of Legionnaires' disease recognized in Pennsylvania since the Philadelphia epidemic of 1976 was that of a 53-year-old emphysematous man who had extensive unilateral pneumonia accompanied by high fever, hypoxemia, and disorientation. His illness progressed despite treatment with cephalothin, but he recovered coincident with the administration of gentamicin and erythromycin. The diagnosis was established serologically by a 32-fold rise in antibody titer to the agent of Legionnaires' disease. Similar illness did not affect others in his community, and infection in four family members was excluded clinically and serologically.
JAMA 1978 Feb 13
PMID:Sporadic Legionnaires' disease. 34 Jul 16

Thirty-two confirmed and 24 highly probable cases of Legionnaires' disease occurred in Vermont between May 1 and Oct 15, 1977. Confirmed cases had positive results for direct fluorescent antibody testing of lung tissue or fourfold rise in antibody titer. Highly probable cases had one elevated titer (greater than or equal to 1:256) and a compatible illness. Forty-eight (86%) had underlying chronic disease, and 22 (39%) were immunocompromised. Prominent early symptoms were fever, cough, chills, and malaise. All but one patient had verified pneumonia. Courses ranged from a pneumonia not requiring hospitalization to respiratory failure necessitating support with mechanical ventilation. Seventeen patients died. Although the clinical presentation was variable, rapid development of high fever and leukocytosis together with negative cultures of lower respiratory tract secretions strongly suggested the diagnosis in an epidemic setting.
JAMA 1978 Jul 14
PMID:Legionnaires' disease in Vermont, May to October 1977. 35 Dec 19

The cases of six patients with Philadelphia Legionnaires' disease were studied during the acute phase and throughout the following year. This multisystems disease process developed abruptly with symptoms of chills, fever, myalgias, and headache. The unusual clinical association of fever with relative bradycardia was noted frequently. Pneumonia developed after the first few days and rapidly progressed to life-threatening respiratory failure despite penicillin and cephalosporin therapy. Improvement occurred within 48 hours after tetracycline or chloramphenicol was administered. No permament sequelae were noted on the one-year follow-up examination, and no secondary cases of infection occurred.
JAMA 1978 Sep 08
PMID:Legionnaires' disease. Clinical findings and one-year follow-up. 68 92

In 1981, sixteen cases of nosocomial legionellosis occurred among 456 patients admitted to a new hematology-oncology unit (35 per 1000 admissions). Monoclonal antibody typing and restriction endonuclease plasmid analysis identified a unique strain (09,04) of Legionella pneumophila serogroup 1 isolated from both patients and water outlets. Continuous hyperchlorination of the hot and cold water began in January 1982, and chlorine levels of 3 to 5 mg/L have been maintained most recently. Water samples have been consistently negative for Legionella for more than five years. Four sporadic cases of nosocomial legionellosis have occurred in the hematology-oncology unit during the same period (one per 1000 admissions) associated with a different strain of L pneumophila serogroup 1 (09,00). The environmental reservoir(s) of L pneumophila serogroup 1 in these cases has not been identified. Levels of trihalomethanes (potential carcinogens) were high (greater than 100 micrograms/L) when chlorine levels of hot water exceeded 4 mg/L. Some corrosion damage to the water distribution system has occurred: the average number of leaks per month increased steadily from zero in 1982 to 5.2 in 1986. The chlorinator installation costs were +75,800, and annual operation expenses were +12,500. Continuous hyperchlorination is a promising but still experimental technique for control of nosocomial legionellosis. In our experience, epidemic disease has been controlled, but sporadic cases have continued to occur.
JAMA
PMID:Legionnaires' disease associated with a hospital water system. A five-year progress report on continuous hyperchlorination. 335 31

Two patients with sporadic community-acquired legionnaires' disease are described. Legionella pneumophila was isolated from sputum specimens, and seroconversion of antibody titers was demonstrated for both patients. Legionella pneumophila was also recovered from the residential water supply of both patients. In each case, the serogroup of the environmental organism matched that of the infecting organism. In one patient, serogroup 3 was isolated--a rare cause of legionnaires' disease, and in the second case, monoclonal antibody testing confirmed that the serogroup 1 organisms isolated from sputum and residential water supply samples were identical. The incubation period of legionnaires' disease is presumed to be up to two weeks. Because of medical problems, both patients had been confined to their homes for the entire two weeks before the onset of symptoms. This is the first report that links acquisition of community-acquired legionnaires' disease to contaminated water supplies within the homes of susceptible patients.
JAMA 1987 Mar 06
PMID:Legionnaires' disease acquired within the homes of two patients. Link to the home water supply. 354 26

A three-year epidemic of legionnaires' disease in a hospital was dramatically curtailed following hyperchlorination of the potable water supply. The hypothesis that potable water was the source for the outbreak was further supported by isolation of Legionella pneumophila (the agent of legionnaires' disease) from the hospital water supply, observation that a sudden upsurge had occurred in the number of cases following a peculiar manipulation of the hospital water system, and documentation of a 30-fold increase in concentration of organisms in the water when this manipulation was artificially recreated. Thus, potable water may be an important source of epidemic legionnaires' disease and continuous hyperchlorination a method of control.
JAMA 1985 Mar 08
PMID:Potable water as a source of Legionnaires' disease. 396 71

Fourteen of 23 female members of a church group experienced an acute self-limited illness characterized by chills, fever, chest pain, cough, and nausea, consistent with the diagnosis of Pontiac fever. All 14 affected women had used a whirlpool located in the women's locker room during a racquetball party. Legionella pneumophila serogroup 6 was isolated from the women's whirlpool. Nine of 14 cases showed a seroconversion to heat-fixed antigen prepared from the L pneumophila serogroup 6 isolate. Aerosol size studies show that the whirlpool aerator produced water droplets small enough to travel deep into the tracheobronchial tree but large enough to transport L pneumophila. This outbreak demonstrated that Pontiac fever may be associated with L pneumophila serogroup 6, that whirlpools can serve as a reservoir for these organisms, and that seroconversion can occur in the absence of illness.
JAMA 1985 Jan 25
PMID:An outbreak of Pontiac fever related to whirlpool use, Michigan 1982. 396 86

Investigation of a recent outbreak of nosocomial legionnaires' disease--initially thought to be due to the documented presence of Legionella pneumophila in the hospital potable water--showed that aerosols from one or more cooling towers were the actual source of infection. From June 27 to Aug 25, 1983, nosocomial legionnaires' disease developed in 15 persons at a hospital in Rhode Island. Twelve (80%) of 15 case-patients occupied rooms in building 1, unit B, compared with eight (28%) of 29 control patients (odds ratio = 10.8; 95% confidence interval = 1.4 to 85.6). Subsequent investigation demonstrated that water in a cooling tower located 100 ft upwind of unit B was heavily contaminated with L pneumophila, serogroup 1, subgroup 1, 2, 4, 5. The same strain was isolated from nine of the patients and from the make-up water for the tower. Active surveillance during the ten months following decontamination of the cooling tower identified no additional cases of nosocomial legionnaires' disease, although the hospital potable water had not been treated. While recommendations have been made for controlling nosocomial legionnaires' disease by heating or hyperchlorination of hospital potable water, this outbreak demonstrates the importance of an adequate epidemiologic-environmental investigation in choosing the appropriate control strategy.
JAMA 1985 Jul 26
PMID:Nosocomial Legionnaires' disease. Epidemiologic demonstration of cooling towers as a source. 400 80

A prospective clinical study of 40 cases of legionnaires' disease combined with serial laboratory examinations enabled us to present an update as well as new recommendations concerning the use of diagnostic tests for legionnaires' disease. Transtracheal aspirate specimens are the optimal specimen for recovery of Legionella pneumophila by culture as well as the most sensitive method for early diagnosis. In addition, with recent improvements in culture media and methodology, L pneumophila can now be readily isolated from sputum. Examination of respiratory specimens by direct immunofluorescence (DFA) is useful, but the sensitivity is much less than that of culture. The yield from DFA examination directly correlates with the number of L pneumophila recoverable by cultural methods; thus, the DFA test result may be negative in an early or mild case of legionnaires' disease. Antibody titers were elevated in 27% of cases within one week of onset of pneumonia and may, therefore, be useful in early diagnosis in selected patients.
JAMA 1983 Oct 21
PMID:Diagnosis of Legionnaires' disease. An update of laboratory methods with new emphasis on isolation by culture. 635 66

We studied the prevalence of serum antibodies to Legionella pneumophila in patients with cystic fibrosis (CF) by indirect immunofluorescence. Thirty-two (29.4%) of 109 patients with CF had a titer of 1:256 or higher, the level presumptive of previous infection, compared with (1) three (11.5%) of 26 patients without CF but with chronic suppurative bronchitis of childhood, (2) three (1.7%) of 178 age-matched persons without pulmonary disease, (3) zero of 22 parents and normal siblings, and (4) zero of 113 adult patients with chronic pulmonary diseases. (Addition of patients with CF who had a titer of 1:128 or higher would raise the prevalence of serum antibodies to L pneumophila in patients with CF to 43.2%.) Fifteen of 32 patients with CF who had antibody titers of 1:256 or higher to L pneumophila (46.9%) had titers of 1:1,024 or higher. Using a standard scoring system, the clinical condition of patients with CF who exhibited antibodies to L pneumophila was worse than that of patients with CF who lacked antibodies to L pneumophila. We conclude that patients who suffer from CF exhibit a high prevalence of antibodies to L pneumophila by the conventional indirect immunofluorescent test. The clinical importance of this single epidemiologic observation awaits further clarification.
JAMA 1982 Nov 12
PMID:Serum antibodies to Legionella pneumophila in patients with cystic fibrosis. 675 43


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