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

Pneumonia due to Legionella has been identified in a small percentage of patients suffering from acquired immune deficiency syndrome (AIDS), with and without coexisting Pneumocystis carinii pneumonia. On chest radiographs Legionella typically produces focal parenchymal opacities and confluent lobar consolidation. The authors describe a case of cavitating Legionella pneumonia, which occurred in a 38-year-old man who had AIDS. The main differential diagnoses are an unusual presentation of P. carinii pneumonia and fungal infection. The authors also emphasize the increasing recognition of bacterial pneumonia with atypical radiologic features in AIDS patients.
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PMID:Legionella lung cavitation. 232 18

Legionellae are ubiquitous aquatic organisms. They are unique among the agents commonly responsible for bacterial pneumonia in humans in that they are not part of the normal human flora but are acquired from environmental sources. Prospective studies have shown that legionellae consistently rank among the top three bacteria as etiologic agents of community-acquired pneumonia. The clinical presentation of Legionnaires' disease is not distinguishable from that of other bacterial pneumonias. Culture of respiratory secretions using selective media, combined with one or more rapid diagnostic methods (direct fluorescent antibody staining, radiolabelled DNA probe, or urinary antigen detection) provides a specific diagnosis in the vast majority of cases. Sporadic cases have been linked to legionella colonization of water systems in homes and the work setting. Antibiotics commonly used in the therapy of community-acquired pneumonias, such as beta-lactam agents, are ineffective. Specific therapy with erythromycin reduces mortality to less than 10%.
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PMID:Community-acquired Legionnaires' disease. 265 33

Legionnaires' disease is an acute bacterial pneumonia caused by Legionella pneumophila and related subtypes. In endemic areas legionnaires' disease accounts for between 2% and 15% of community-acquired pneumonias in adults admitted to hospital. The diagnosis of this disease may be difficult and therefore a high index of suspicion should exist. The clinical features of legionnaires' disease are reviewed.
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PMID:Legionnaires' disease. A clinical review. 267 39

Laboratory techniques for the diagnosis of pneumonia are discussed. Gram's stain and culture of the sputum are still the most useful techniques for the diagnosis of bacterial pneumonia. Antigen detection can provide a rapid diagnosis and contribute to the initial choice of therapy in infections caused by Haemophilus influenzae, Legionella pneumophila, Chlamydia psittaci and Pneumocystis carinii.
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PMID:Laboratory diagnosis of pneumonia. 267 80

We compared clinical, radiological and laboratory data from 32 cases of community-acquired pneumonia due to Legionella pneumophila, with 37 cases of pneumococcal pneumonia (PP). This study revealed few clinical differences between the two types of pneumonia: in our experience Legionnaire's disease presents like a "typical" bacterial pneumonia. Given the difficulty of making a diagnosis on clinical data alone, we propose early aetiological diagnostic measures and recommend that the choice of initial treatment be based not only on the features at the time of presentation, but also on a consideration of the epidemiology of different types of pneumonia in a given area.
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PMID:Pneumonia due to Legionella pneumophila and pneumococcal pneumonia: similarities and differences on presentation. 270 42

In a one-year prospective study of 106 adults (mean age, 60 years) who were admitted to hospital with community-acquired pneumonia, an aetiological diagnosis was made in 82 (77%) patients. Streptococcus pneumoniae was considered to be responsible for 44 (42%) and respiratory viruses for 19 (18%) infections. Other aetiological agents that were found in a smaller number of patients included Haemophilus influenzae (9% of patients), enteric Gram-negative bacilli (8% of patients), Staphylococcus aureus (3% of patients), Legionella spp. (3% of patients), Mycobacterium tuberculosis (3% of patients), Mycoplasma pneumoniae (8% of patients) and Chlamydia psittaci (5% of patients). The mortality was 10% and was related significantly to increasing age and to coexisting heart and lung disease. Antibiotic treatment that was commenced before admission to hospital and investigations were undertaken reduced significantly the isolation rate of susceptible bacterial pathogens. The Gram-stained smear of sputum was valuable in establishing a tentative diagnosis of bacterial pneumonia. The most-useful tests in making an early diagnosis proved to be those which detected pneumococcal and mycoplasmal antigens, blood cultures and culture of sputum for appropriate bacterial pathogens.
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PMID:A prospective hospital study of the aetiology of community-acquired pneumonia. 273 13

Oral quinolones such as ciprofloxacin are promising agents in the treatment of serious bronchopulmonary infections due to susceptible gram-negative micro-organisms such as Haemophilus influenzae, Branhamella catarrhalis, Klebsiella pneumoniae and even Pseudomonas aeruginosa. Their moderative activity against Streptococcus pneumoniae may limit the use of these agents in the treatment of acute exacerbations of chronic bronchitis and in the empiric management of community-acquired bacterial pneumonia. Further prospectively designed studies are needed to address this issue. The ability of quinolones to effectively penetrate bronchial mucosa and to be concentrated within macrophages may afford additional advantage to these agents. They should not be used as a sole agent in the treatment of aspiration pneumonia nor anaerobic pleuropulmonary disease. Quinolones are very active in experimental models of Legionnaire's disease and deserve further clinical study. Ciprofloxacin is a promising alternative to standard parenteral drugs in the management of Pseudomonas aeruginosa infections in adults with cystic fibrosis. The potential for drug interactions with theophylline must be kept in mind for patients on both of these drugs.
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PMID:Role of fluoroquinolones in lower respiratory tract infections. 292 Apr 82

Mixed bacterial pneumonia caused by organisms other than anaerobes has been infrequently reported. We describe six cases and review the literature. Two patients had co-infection with S pneumoniae and L pneumophila. Two were infected with S pneumoniae and K pneumoniae and the others simultaneously harbored M tuberculosis and N asteroides. The first two sets of patients had bacteria isolated from usually sterile sites (blood and lung), while the latter harbored repeatedly isolated organisms not usually felt to be part of the normal respiratory flora. Mixed infection may help explain the substantial mortality still seen from pneumonia. This is especially true if Legionella, mycobacteria, or Nocardia species are encountered where routine smears and cultures may not aid in the diagnosis. Poor clinical response to specific antibacterial therapy in pneumonia should trigger further investigation for other potential pathogens.
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PMID:Community-acquired pneumonia caused by mixed aerobic bacteria. 309 44

This article provides a review of Legionnaire's Disease, a bacterial pneumonia caused by Legionella species, and of Pontiac Fever, the flu-like illness caused by these microorganisms. The authors draw on their personal experience with major human outbreaks of Legionnaire's Disease and with animal models of Legionella pneumonia. Emphasis is placed on the sources in nature from which legionellosis is acquired, the means of dissemination of bacteria, the epidemiology of human infections, the pathogenetic mechanisms of disease and host defense, the clinical manifestations, and the treatment.
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PMID:Legionnaires' disease: respiratory infections caused by Legionella bacteria. 331 85

Protected transbronchial needle aspiration (PTBNA) of pneumonic lung theoretically could bypass dislodged upper respiratory tract flora, a potential source of contamination of protected specimen brush (PSB) cultures. To evaluate the usefulness of PSB and PTBNA in establishing the etiology of pneumonia, we prospectively studied 20 patients with acute bacterial pneumonia not receiving antibiotics. After informed consent, patients had fiberoptic bronchoscopy under fluoroscopy to localize the pneumonia, and specimens were obtained by the PSB. The protective plug of a specially devised needle for PTBNA was pneumatically dislodged and aspiration was performed within the infiltrate under fluoroscopy. Quantitative cultures were plated immediately for aerobes, anaerobes, and Legionella. Greater than 4 X 10(3) organisms/brush or 1 X 10(4) organisms/ml needle aspirate were considered to be consistent with infection. The results using PSB and PTBNA were compared in 15 of 20 patients in whom a definitive diagnosis (positive blood or pleural fluid culture) or presumptive diagnosis (expectorated sputum culture, clinical characteristics, and response to specific therapy) was established. The PSB and PTBNA cultures on uninfected control subjects (n = 5) being bronchoscoped for other reasons were negative. The PSB and PTBNA were each diagnostic in 2 of the 5 patients with definitive diagnoses. In the group with a presumptive diagnosis (n = 10), PSB was diagnostic in 7 of 10 and PTBNA in 9 of 10. The overall (definitive plus presumptive) diagnostic yield was 60% for PSB and 73% for PTBNA. Multiple organisms were isolated in high concentrations in 53% of the patients. The most common organisms recovered in addition to the primary pathogen was alpha hemolytic streptococci.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Protected transbronchial needle aspiration and protected specimen brush in the diagnosis of pneumonia. 363 29


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