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

In general practice Community-acquired Pneumonia (CAP) is most often treated on an empyrical basis. Therefore, it is of the utmost importance to know the epidemiology of respiratory pathogens in order to give some guidelines for the empirical management of CAP. At present in cases of mild and moderate severity, ampicillin or amoxycillin, preferably in association with sulbactam and clavulanic acid respectively, and macrolides are the antibiotics of first choice. The latter can be an alternative to beta-lactams when Legionella, Mycoplasma and Chlamydia are the suspected etiologic agents or when patients are allergic to penicillins. They can also be used in combination with beta-lactams when etiological diagnosis is extremely uncertain. The course and severity of the disease, a chest radiograph, the results of microbiological and other laboratory examinations will determine the choice of further antibiotic treatment and other therapeutic measures, if necessary.
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PMID:Guidelines for the management of community-acquired pneumonia in adults. Italian Society of Pneumology. Italian Society of Respiratory Medicine. Italian Society of Chemotherapy. 774 21

This study was designed to evaluate the efficacy of a 3 day course of azithromycin in low to moderately severe community-acquired pneumonia. Forty patients with low to moderately severe community-acquired pneumonia (29 males, 11 females, mean age 46 +/- 17 yrs; 20 pretreated with betalactams for 2-10 days with no results before admission to hospital; 18 with evidence of co-morbidity) were enrolled in an open, randomized study with azithromycin, 500 mg q.d. oral therapy for 3 days, versus clarithromycin, 250 mg b.i.d. oral therapy for 10 +/- 2 days. The aetiology of pneumonia was identified in 18 patients by serology (nine Mycoplasma pneumoniae, four Chlamydia pneumoniae, five Legionella pneumophila; one patient with chlamydial infection also had Klebsiella pneumoniae bacteraemia). A presumptive aetiological diagnosis was obtained with sputum culture in three other patients (one Haemophilus influenzae, two Haemophilus parainfluenzae), all strains were sole isolates with 10(8) Colony forming units (CFU), and with Gram stain in one patient with Streptococcus pneumoniae. All patients in the azithromycin group (one after a second 3 day course), and all but two (of those available for evaluation) of the clarithromycin group were cured. Defervescence occurred after 2.6 +/- 1.6 days, and chest roentgenogram cleared after 8.9 +/- 3.3 days, with no difference between the two groups. Tolerance was good, and there were no withdrawals from therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy of a three day course of azithromycin in moderately severe community-acquired pneumonia. 778 84

Although the frequency of community-acquired pneumonia caused by Streptococcus pneumoniae continues to be high, studies show that Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila are the etiologic agents in 20% to 40% of community-acquired pneumonia in adults. The clinical presentation of pneumonia caused by these organisms may be indistinguishable from pneumonia due to S pneumoniae. Separation of cases of pneumonia due to S pneumoniae as typical and that caused by M pneumoniae, C pneumoniae, or L pneumophila as atypical is unwarranted and unhelpful in planning therapy. As many as 35% to 50% of patients do not have an etiologic agent identified. Community-acquired pneumonia can have high morbidity and mortality in patients who are older, have underlying lung disease, diabetes mellitus, or other comorbid conditions, or who have decreased immune function regardless of the specific etiologic agent. In choosing appropriate empiric antimicrobial therapy in hosts who are not immunocompromised, erythromycin and other macrolide antibiotics have the advantage of being effective against a wide range of pathogens likely to be encountered, including S pneumoniae, M pneumoniae, and L pneumophila, and of having some benefit against C pneumoniae. In other patients, the selection of antibiotic therapy can be based on age, clinical suspicion, epidemiologic data, and laboratory test results. Antimicrobial therapy can be directed at specific organisms when and if they are identified.
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PMID:Community-acquired pneumonia in adults. 781 49

The traditional classification of community-acquired pneumonia into typical and atypical pneumonia to facilitate successful empirical treatment is no longer optimal. An accurate prediction of cause and adequate empirical therapy cannot be provided with this approach in severely ill patients. There is an increasing spectrum of recognized treatable pathogens presenting as community-acquired pneumonia including Legionella species, Chlamydia pneumoniae, and Pneumocystis carinii in addition to the traditional community pathogens. The variability of presentation in severely ill or compromised hosts makes clinical prediction of cause inadequate. A more rational approach may involve the classification of patients by the severity of illness and underlying disease with little or no microbiological workup in mild illness unless the results will contribute to the epidemiological surveillance of resistance because these investigations have not been shown to affect outcome in this setting. Etiologic diagnosis should be more aggressively sought and the microbiology laboratory can be best used by providing the efficient and rapid diagnosis of this expanded range of pathogens in more severely ill patients. The mounting antimicrobial resistance of common pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus will require not only a critical review of empirical therapy, but an increased emphasis on epidemiological monitoring of resistance by laboratories and effective communication with clinicians.
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PMID:Community-acquired pneumonia: the future of the microbiology laboratory: focused diagnosis or syndromic management? 783 39

The authors studied nursing home residents serologically to determine whether atypical organisms were causes of radiologic pneumonia. The study was conducted at the Wisconsin Veterans Home, a facility with on-site microbiology and x-ray. Over one year, serologic examinations for Legionella, Mycoplasma, and Chlamydia were conducted for the residents who had pneumonia. Cultures and mortality were reviewed. Fifty-six episodes were studied (mean resident age 78 years). There was no fourfold titer change. Seventeen quality sputum specimens revealed Streptococcus pneumoniae (5), normal flora (4), Hemophilus influenzae (4), Moraxella catarrhalis (3), Staphylococcus aureus (1), and beta-hemolytic Streptococcus, not group A (1). The two-month mortality was 21%. This study did not result in serologic confirmation of atypical organisms' causing pneumonia. Antibiotic choice should be based on coverage of prevalent organisms, including Hemophilus influenzae, Moraxella, and Staphylococcus, as well as clinical features.
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PMID:Pneumonia in a nursing home. 785 75

A collaborative retrospective study based on serologic diagnosis was conducted to assess the etiological role sustained by privileged pathogens in Italy. The results obtained indicate the Mycoplasma, Chlamydia and Legionella are important etiologic agents of lower respiratory tract infections in Italy since they account for about 31% of the cases taken into consideration in this survey. We found a high incidence of M. pneumoniae (12.3%), C. pneumoniae (10.5%) and L. pneumophila (8.3%). These results are in line with similar figures reported in the recent literature. While the data gathered in our survey do not allow us to clarify the nature of the agents involved in the etiology of the majority (70%) of the respiratory infections occurring in Italy, it seems safe to assume that after Streptococcus pneumoniae and Haemophilus influenzae, the privileged pathogens represent the most common cause of lower respiratory tract infections.
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PMID:Incidence of lower respiratory tract infections caused by Mycoplasma, Chlamydia and Legionella: an Italian Multicenter Survey. 786 Nov 96

Lower respiratory disease is a major source of morbidity in military recruits, with hospitalization rates for pneumonia more than 30 times that of the non-recruit population. The etiologic agent remains unknown in over 75% of cases. This study prospectively examined the etiology of pneumonia among recruits at Naval Training Center, San Diego, California. Recruits presenting with cough, fever, or shortness of breath and pulmonary infiltrates on chest X-ray were eligible for enrollment. A standardized scoring form and focused physical exam were completed on each subject. Sputum specimens were obtained for Gram's stain and culture, DNA probing for Legionella and Mycoplasma species, and direct fluorescent antibody staining for Legionella. Acute and convalescent serologies were performed for adenovirus, influenza A and B, Mycoplasma pneumoniae, Chlamydia group, and respiratory syncytial virus. Of 110 eligible patients, 100 consented to enrollment and 75 patients completed the study. Etiologic diagnoses were obtained in 40 of the patients (53%). M. pneumoniae, Haemophilus influenzae, and viruses accounted for the majority of infections. Mixed infections were seen in six patients. Forty-seven percent of patients had no diagnosis established. Pneumonia in this series of military recruits was frequently caused by M. pneumoniae and H. influenzae. Fifty percent of cases were undiagnosed with routinely available laboratory methods. Further studies are warranted to more clearly define the etiologic agents of recruit pneumonia and the utility of prophylactic measures.
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PMID:Pneumonia in military recruits. 787 Mar 17

The new macrolide derivatives, such as roxithromycin, clarithromycin or azithromycin, respectively, extend the spectrum of activity in antimicrobial chemotherapy. Their direct antibacterial activities are more or less similar to that of erythromycin, i.e., besides gram-positive cocci and rods the gram-negative cocci are likewise susceptible to these drugs. This holds true for aerobes as well as anaerobes. Especially the cell wall deficient bacteria, such as chlamydias, rickettsias, mycoplasmas, are generally rather susceptible. Among the gram-negative aerobic rods some genera are susceptible, for example Bordetella, Haemophilus or Legionella, whereas the Enterobacteriaceae are practically resistant, because their cell wall is rather impermeable. In a few examples, i.e. mycobacteria other than tuberculosis and certain protozoa, such as Toxoplasma, the new macrolides exert a definite greater activity than erythromycin. In particular, the property of the new derivatives to be highly accumulated within host cells, especially within phagocytes, renders these drugs extremely effective against intracellular pathogens, such as Mycobacteria, Legionella, Chlamydia, Listeria, Toxoplasma. Consequently, these new derivatives definitely improve and extend the indications for macrolide antibiotics.
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PMID:[Macrolides, a group of antibiotics with a broad spectrum of activity]. 795 64

The application of monoclonal antibodies and DNA probes in the clinical microbiology laboratory has resulted in an array of rapid diagnostic tests. The immunofluorescent assay or enzyme-linked immunoassay is widely used in the rapid diagnosis of bacteria eg Group A streptococcus, Legionella pneumophila, Mycoplasma pneumoniae, Bordetella pertussis; parasites eg Chlamydia tachomatis, Cryptosporidium species; and fungi eg Pneumocystis carinii. The BACTEC system was first introduced to detect bacteraemia pathogens. It has been further developed to detect Mycobacterium species in clinical specimens and this has greatly reduced turn-around time in the laboratory diagnosis of Mycobacterium species. The discovery of the polymerase chain reaction has led to hopes of using it as a potential diagnostic tool in the microbiology laboratory.
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PMID:Update of the rapid diagnosis of infectious diseases. I: Bacteria, fungi and parasites. 799 14

In a retrospective analysis of lower respiratory tract infections in an ex-injection-drug users community, we found an outbreak (April to July 1991) of Chlamydia pneumoniae infection. The epidemic occurred in a group of 26 community members (23 men and 3 women, mean age, 28.9--3 years) living and working together, who underwent acute and convalescent serologic tests for Mycoplasma pneumoniae, Legionella pneumophila, cytomegalovirus, adenovirus, Coxiella burnetii, and Chlamydia pneumoniae. All subjects were submitted to chest radiograph, while sputum and blood cultures were performed in symptomatic patients. Antibodies to C pneumoniae were determined by a microimmunofluorescence test. Among all subjects studied (13 HIV-1 positive and 13 HIV-1 negative), 11 (8 HIV-positive and 3 HIV-negative) developed pneumonia, 2 (1 HIV-positive and 1 HIV-negative) developed pharyngitis, and 2 (1 HIV- positive and 1 HIV-negative) developed flu-like syndromes sustained by C pneumoniae; in 4 subjects (2 HIV-positive and 2 HIV-negative) suffering from flu-like syndrome, no causal agents were found. Seven subjects (one HIV-positive and six HIV- negative) remained asymptomatic without any evidence of infection. The prevalence of antibodies to C pneumoniae in HIV-1-positive subjects observed in a sample of community members was significantly higher than in HIV-1-negative subjects. C pneumoniae seems to be involved in respiratory tract infections in HIV-1-infected subjects. Our data suggest that C pneumoniae should be included in the diagnostic approach of respiratory infections in HIV-infected subjects.
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PMID:Outbreak of Chlamydia pneumoniae infection in former injection-drug users. 813 45


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