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

Fifty patients with either malignant (n = 25) or infectious/inflammatory (n = 25) chest lesions had lung aspirations using ultrathin needles, 24 to 25 gauge. The procedure's overall sensitivity was 87%, and the specificity was 100%. The diagnostic yield was 90% (9/10) from peripheral malignant coin lesions, 100% (3/3) from malignant cavities, and 42% (5/12) from infected, nonmalignant cavities. Antimicrobial therapy probably contributed to poor microbiologic results in the latter group. Twenty-two of the patients previously had flexible fiberoptic bronchoscopy with negative results. In this select group, a diagnosis was established in 45% (10/22): 7 had malignant lesions, 2 had anaerobic lung abscesses, and 1 had histoplasmosis. In patients with infectious diseases, a variety of bacterial, mycobacterial, and fungal infections were confirmed including the diagnosis of Legionella pneumophila in 2 patients. A definitive diagnosis was obtained in 6 of 8 immunosuppressed patients who presented with indeterminate infiltrates on chest radiographs. Complications were minimal, although 21 patients (42%) had COPD, and 13 patients (26%) had moderate to severe hypoxemia (PaO2, 40 60 torr). Mild hemoptysis occurred in 2 patients (4%), and pneumothorax occurred in 4 patients (8%) of whom 2 required chest tube insertion. When compared with other studies using large gauge needles (18 to 22 gauge), ultrathin needle aspiration of the lung produced fewer complications, while maintaining an exceptionally good diagnostic yield.
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PMID:Ultrathin needle aspiration of the lung in infectious and malignant disease. 745 76

When a single case of legionnaires' disease is reported, it should be investigated to check whether or not it is linked to other cases or part of an outbreak. The investigation includes confirmation of the diagnosis, tracing the patient's movements during the incubation period, and reporting the case to the National Surveillance Scheme for Legionnaires' Disease at the PHLS Communicable Disease Surveillance Centre. If no common factors are identified between the cases and other cases reported previously, no further action is usually required, unless it is suspected that the infection was acquired in hospital. In these circumstances, the individual case and the hospital's water maintenance programme should be reviewed, and a search made for associated cases, because hospital patients are particularly susceptible to infection. Further steps may be necessary if the link with the hospital is confirmed.
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PMID:Investigating a single case of Legionnaires' disease: guidance for consultants in communicable disease control. 752 75

Due to the 1992 Barcelona Olympic Games some modifications were introduced in the epidemiologic surveillance system for infectious diseases in place in the city, in order to expand its coverage and shorten its timeliness in detecting outbreaks and investigating cases. These modifications were introduced for a group conditions (hepatitis, meningococcal disease, legionnaire's disease and food outbreaks), selected on the basis of incidence, time of the year, previous experience in other settings, and likelihood of outbreak occurrence. In the June-August 1992 period (Olympic period), no increases in the incidence of selected conditions were observed when compared to the same period in 1986 to 1991. Major changes were observed in the source of food outbreak reporting, with a large increase in outbreaks reported by emergency room departments. There was an increase in the number of domestic foodborne outbreaks and a reduction in those related with restaurants. Timeliness in the detection of cases was shortened. The use of similar modifications can be useful for epidemiologic surveillance systems in other comparable settings or occasions.
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PMID:[An evaluation of the epidemiological surveillance system for infectious diseases in the Barcelona Olympic Games of 1992]. 759 4

Salmonellae possess the ability to adhere to and invade macrophages and in so doing trigger a number of intracellular events that are associated with cellular activation. As an initial approach to defining the mechanisms by which invasive salmonellae alter macrophage function, we have explored the impact of Salmonella infection on the production of human immunodeficiency virus (HIV) in U1 cells, a promonocytic cell line latently infected with the virus. Infection of U1 cells with a pathogenic strain of Salmonella enteritidis resulted in a marked induction of macrophage activation and HIV production. The stimulatory effect of salmonellae was mediated by signals other than lipopolysaccharide. Salmonella mutants with specific defects in invasion or intracellular survival were markedly less effective in the induction of HIV production. In contrast to S. enteritidis, strains of Yersinia enterocolitica, Legionella pneumophila, and Escherichia coli did not induce HIV production. However, all of these bacteria induced comparable levels of gene expression mediated by the HIV long terminal repeat. The results of this study are consistent with the notion that invasive salmonellae possess the ability to activate the macrophage by at least one mechanism that is not shared with several other species of gram-negative bacteria. Furthermore, the expression of this unique property is maximal with Salmonella strains that are not only invasive but also capable of prolonged survival within the macrophage. Our results indicate that the U1 cell line may be a very useful model system with which to examine the biochemical pathways by which internalized salmonellae modulate the activation state of the macrophage.
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PMID:Regulation of macrophage activation and human immunodeficiency virus production by invasive Salmonella strains. 772 90

The problems associated with the Wakefield salmonella and the Stafford Legionnaires' disease outbreaks and the recommendations of the Acheson Committee formed in response led to the creation of the position of Consultant in Communicable Disease Control (CCDC) within the District Health Authorities. The reality of the position as implemented differs from that envisaged by the Acheson Committee and has resulted in ambiguities about the role of the CsCDC, the source of their support, and the range of their responsibilities. This paper, by an American invited to review the position, outlines the history of the position, the current status of CsCDC, and the barriers to effective performance of the position. It ends with a series of recommendations for improving disease control within England by solidifying the position, establishing its role in disease control within the National Health Service and recommending an educational/training pathway to attract and prepare physicians for the position.
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PMID:Communicable disease control in England; recommendations from an American. 757 13

Infection with Legionella is often encountered in immunosuppressed patients, especially in recipients of renal allografts. From January 1985 until April 1993 14 cases of nosocomial legionella pneumonia were diagnosed (four by culture, 10 by serological methods) on the surgical transplantation unit of Innsbruck University Hospital. All isolates from patients and from the building's hot water were found to be Legionella pneumophila serogroup 1. They were indistinguishable from each other by monoclonal antibody subtyping and restriction fragment length polymorphism pattern and thus indicated a series of infections originating from the same source during a period of more than 8 years. Repeated efforts to control Legionella by raising the temperature in the hot water lines failed to bring permanent success. Replacing the central hot water supply with small electric water heaters installed in the patient rooms on the transplant ward now seems to have reduced the incidence of legionellosis on this unit. However, further infections occurring in transplant patients in other surgical departments in the same building indicate that a major renovation of the whole surgical building's hot water system is necessary.
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PMID:Legionella pneumonia in transplant recipients: a cluster of cases of eight years' duration. 791 85

Legionella usually causes pneumonia, but occasionally is in the differential diagnosis of "culture negative endocarditis" which sometimes involves prosthetic heart valves. Legionella prosthetic valve endocarditis is nearly always due to Legionella pneumophila and its clinical presentation is indistinguishable from other causes of prosthetic valve endocarditis. Diagnosis of Legionella prosthetic valve endocarditis is by recovery of the organism from the blood, demonstration or isolation of the organism from the prosthetic heart valve, or by persistently high Legionella titers which are extremely elevated in prosthetic valve endocarditis compared to Legionella pneumonia. We believe this is the first case reported of prosthetic valve endocarditis caused by Legionella micdadei, and the first case of Legionella prosthetic valve endocarditis with microscopic hematuria.
Infection
PMID:Legionella micdadei prosthetic valve endocarditis. 792 21

We report two cases of pneumonia caused by Legionella cincinnatiensis, a species previously identified as a pathogen in only one other instance. Both infections occurred in renal transplant recipients who were receiving only moderate doses of immunosuppressive drugs several years after transplantation; both patients had no recent episodes of rejection. Their clinical courses varied from mild symptoms to multisystem organ failure and death. Species identification by direct fluorescent antibody testing was misleading; initial results revealed infection due to Legionella longbeachae for one patient and infection due to Legionella dumoffii for the other patient. Slide agglutination testing eventually identified both isolates as L. cincinnatiensis. Infection with Legionella species, including L. cincinnatiensis, should be considered not only in the first months after transplantation but also later in the posttransplantation period as either a nosocomial or community-acquired infection.
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PMID:Pulmonary infection due to Legionella cincinnatiensis in renal transplant recipients: two cases and implications for laboratory diagnosis. 801 20

Infection is a serious cause of morbidity and mortality in the cardiac transplant patient. Early infections within the first month after transplantation are usually caused by nosocomial pathogens, such as Pseudomonas aeruginosa, Staphylococcus aureus, Enterococci, and members of Enterobacteriaceae and include pneumonia, urinary-tract and would infections, and bacteremia associated with the use of intravascular devices. Late infections, usually occurring after the first month and within the first year of transplantation, are commonly caused by cytomegalovirus, Pneumocystis carinii, Legionella, and fungi. Because cardiac transplantation has become a well-established treatment for patients with end-stage heart disease, more physicians will be treating these patients and will need to be familiar with the types of infectious complications associated with transplantation.
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PMID:Cardiac transplantation and related infections. 801 80

Legionella pneumophila is an intracellular pathogen replicating in human macrophages during the course of infection of the lungs. Infection by legionellae often leads to severe pneumonia, termed Legionnaires' disease. Genetic approaches to identify the factors responsible for L. pneumophila pathogenicity started with the construction of genomic libraries in Escherichia coli. Various L. pneumophila-specific genes were cloned in E. coli K-12 by identification using functional assays, antibody screening and hybridization ('reverse genetics'). By disrupting the genes via allelic exchange, mutants have been created to assess the influence of the factors on pathogenicity. Among the cloned genes, only for the gene product of the mip gene, encoding a 24-kDa surface-associated protein (macrophage infectivity potentiator) unequivocal evidence for its contribution to pathogenicity could be provided. Two hemolytic factors that have been cloned do not seem to play a role in L. pneumophila pathogenicity. Genetic systems for transposon mutagenesis of the L. pneumophila genome (Tn5, Tn903dIIlacZ, MudphoA), including Tn phoA shuttle mutagenesis, have been established and specifically adapted to identify mutants which displayed an impaired capability to multiply inside macrophages and with a reduced in vivo virulence. Furthermore, by complementation of avirulent mutants, genetic loci could be identified which restored the virulence.
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PMID:Genetic approaches to study Legionella pneumophila pathogenicity. 804 98


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