Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In February 1979 a 51 year old man fell will in Munich, displaying symptoms of an influenza-like illness which developed into pneumonia. The patient died eight days later of circulatory collapse which failed to respond to treatment, accompanied by high temperature, leucopenia and agranulocytosis. Typical rods detected in the lung tissue and histological sections by immunofluorescence indicated the possibility of a Legionella pneumophila infection. The pathogen isolated from the lung tissue on CYE agar was identified as L. pneumophila, serogroup I. The diagnosis was confirmed by the CDC, Atlanta. This is the first time this organism has been isolated in Central Europe from a case with a fatal outcome.
 ...
PMID:[Legionnaires' disease in Germany (author's transl)]. 47 55

A 55-year-old woman with rheumatoid arthritis in overlap with polymyositis received sulfasalazine for control of synovitis. Cholestatic jaundice, fever, urticaria and agranulocytosis developed after 20 days of treatment and culminated in fatal adult respiratory distress syndrome secondary to Legionella pneumophila. The increasing use of sulfasalazine in the therapy of rheumatoid arthritis mandates that the clinician be aware of this idiosyncratic drug reaction.
 ...
PMID:Cholestasis and fatal agranulocytosis complicating sulfasalazine therapy: case report and review of the literature. 288 Sep 97

The risk of opportunistic infection in the renal transplant patient is due to an interaction between two major factors: the epidemiologic exposures (particularly within the hospital environment) and the net state of immunosuppression. The net state of immunosuppression is determined by the nature, dose, and duration of the immunosuppressive therapy being administered; the presence or absence of granulocytopenia and technical factors that could compromise the primary mucocutaneous barriers to infection; such metabolic factors as uremia, hyperglycemia, and the state of nutrition; and, finally, the immunomodulating effects of such viruses as CMV, the hepatitis viruses, and HIV. The major types of opportunistic infection to which the renal transplant patient is susceptible are the following: the viruses of the herpes group and papovaviruses; bacteria such as L monocytogenes, N asteroides, and Legionella; such fungi as Candida, Aspergillus, C neoformans, and the Mucoraceae; and protozoans such as P carinii, S stercoralis, and T gondii.
 ...
PMID:Opportunistic infections in renal allograft recipients. 305 19

Two children with legionellosis complicating a relapse of acute lymphoblastic leukemia are reported. A 5-year-old boy with pneumonia had Legionella pneumophila cultured from a tracheal aspirate following a rapid deterioration in his respiratory status and intubation. This child had severe and irreversible granulocytopenia and died in spite of therapy with erythromycin and rifampin added five days later. Combination antimicrobial therapy is suggested for immunosuppressed children with legionellosis if resolution of neutropenia is not readily anticipated. Culture of Legionella sp from respiratory tract secretions or sputum, as reported for the first time in the pediatric literature, should be attempted in all children in whom this infection is suspected. A 13-year-old boy with pneumonia recovered in spite of therapy with antimicrobial agents not proven to be effective against the legionellae. Clinical improvement coincided with increase in absolute granulocyte count. A retrospective diagnosis was made when seroconversion to Legionella micdadei (less than 1:16 to 1:1,024) was determined during a survey of unselected sera from 255 hospitalized children. This is the first documented case of Pittsburgh pneumonia described in a child.
 ...
PMID:Legionellosis in children with leukemia in relapse. 658 11

A patient undergoing examination for moderately severe renal insufficiency had fulminant five-lobed pneumonia caused by Legionella pneumophila. Her clinical course was complicated by granulocytopenia. Bone marrow aspiration showed notable inhibition of myelopoiesis, involving all stages of maturation. The presence of a serum inhibitor of granulopoiesis was demonstrated by in vitro bone marrow culture. Normal bone marrow cultured in the presence of serum from two normal control subjects yielded 69 +/- 5.2 (mean +/- SE) and 61 +/- 5 granulocyte colonies. When the patient's serum was substituted for normal human serum only 14.3 +/- 2.3 colonies were formed. Each of the drugs to which she had been exposed was tested in the in vitro system, using therapeutic concentrations, and none showed significant suppression of granulocyte colony formation. These observations indicate that legionnaires' disease was associated with a serum factor that notably inhibited the growth of granulocyte colonies in this patient.
 ...
PMID:Myelosuppression in Legionnaires' disease. 709 51

The authors report on their institution's experience with 53 lung biopsies, including 26 open, 22 transbronchial, and five trephine air drill biopsies, performed in immunocompromised patients with roentgenographic pulmonary infiltrates. Open biopsy was far more likely to provide a specific etiologic diagnosis (81%, P less than 0.001) than transbronchial biopsy (32%), or trephine biopsy (20%). Infection (17 biopsies), neoplastic disease, (7) or drug-related pneumonitis (2) were identified most frequently. Patients with myeloproliferative disease, granulocytopenia, or those who had not received prior immunosuppressive therapy were most likely to have a nondiagnostic biopsy (P less than 0.05 for each factor). The overall complication rate of biopsy procedures was 15% and was comparable with all three methods. Survival in this series was not significantly lower if a specific etiologic diagnosis could not be established, but correlated with the respiratory rate (less than 20 per minute), pO2 (greater than 60 torr), and the roentgenographic pattern (other than bilateral diffuse disease) at the time of biopsy (P less than 0.05 for each factor). There were 18 cases (34%) in which a clearcut etiologic diagnosis would not be established at the time of biopsy; based on serologic tests performed ex post facto, 2 of 12 of these cases (17%) were Legionnaire's disease. Lung biopsies were helpful in the management of the majority of the cases, although nondiagnostic biopsies continue to be a problem. The authors propose an approach to the management of compromised patients with pulmonary infiltrates.
 ...
PMID:Lung biopsy in immunocompromised patients: one institution's experience and an approach to management of pulmonary disease in the compromised host. 727 48

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with major morbidity and attributable mortality. Strategies to prevent VAP are likely to be successful only if based upon a sound understanding of pathogenesis and epidemiology. The major route for acquiring endemic VAP is oropharyngeal colonization by the endogenous flora or by pathogens acquired exogenously from the intensive care unit environment, especially the hands or apparel of health-care workers, contaminated respiratory equipment, hospital water, or air. The stomach represents a potential site of secondary colonization and reservoir of nosocomial Gram-negative bacilli. Endotracheal-tube biofilm formation may play a contributory role in sustaining tracheal colonization and also have an important role in late-onset VAP caused by resistant organisms. Aspiration of microbe-laden oropharyngeal, gastric, or tracheal secretions around the cuffed endotracheal tube into the normally sterile lower respiratory tract results in most cases of endemic VAP. In contrast, epidemic VAP is most often caused by contamination of respiratory therapy equipment, bronchoscopes, medical aerosols, water (eg, Legionella) or air (eg, Aspergillus or the severe acute respiratory syndrome virus). Strategies to eradicate oropharyngeal and/or intestinal microbial colonization, such as with chlorhexidine oral care, prophylactic aerosolization of antimicrobials, selective aerodigestive mucosal antimicrobial decontamination, or the use of sucralfate rather than H(2) antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semirecumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of VAP. Measures to prevent epidemic VAP include rigorous disinfection of respiratory equipment and bronchoscopes, and infection-control measures to prevent contamination of medical aerosols. Hospital water should be Legionella-free, and high-risk patients, especially those with prolonged granulocytopenia or organ transplants, should be cared for in hospital units with high-efficiency-particulate-arrestor (HEPA) filtered air. Routine surveillance of VAP, to track endemic VAPs and facilitate early detection of outbreaks, is mandatory.
 ...
PMID:The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. 1642 68