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

A patient with Legionnaires' disease developed consolidated pneumonia with severe hypoxemia and mental confusion; his condition improved with therapy with positive end-expiratory pressure, steroids, and chloramphenicol. The retrospective diagnosis was made by a fourfold rise in indirect fluorescent antibody titers. The chest x-ray films showed bilateral alveolar infiltrates and air bronchograms.
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PMID:Legionnaires' disease. A sporadic case. 34 Jan 53

A review of the medical records of 123 persons with Legionnaires' disease hospitalized in the 1976 Philadelphia epidemic showed that the manifestations of infection ranged from mild grippe to a severe pneumonia that also involved other organ systems. Early in the illness, constitutional symptoms predominated. Fever, malaise, myalgia, rigors, confusion, headache, and diarrhea were usually followed by nonproductive cough and dyspnea. Physical examination showed few abnormalities other than rales. Moderate leukocytosis with left shift, elevated erythrocyte sedimentation rate, elevation of serum levels of liver enzymes, and hematuria and proteinuria were characteristic. Chest radiograph showed patchy, often nodular, areas of consolidation. Progression of pneumonia led to respiratory failure and the need for mechanical ventilatory assistance for 19 patients; renal failure, primarily after shock, occurred in 18 persons. Twenty-six patients died. Treatment with erythromycin or tetracycline resulted in the lowest case-fatality ratios, but the associations were not statistically significant.
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PMID:Legionnaires' disease: clinical features of the epidemic in Philadelphia. 43 27

An analysis of seven sporadic cases of Legionnaires' disease confirmed clinical features recorded during epidemics and identified aspects of the illness either unreported or not emphasized. Four patients had central nervous system abnormalities. Mental status changes included somnolence, obtundation, delirium, disorientation, and confusion. Three patients experienced visual hallucinations, and one patient without pneumonia had a grand mal seizure with residual memory deficit. Two patients had disseminated intravascular coagulation with thrombocytopenia, elevated split fibrin products, and prolonged partial thromboplastin and prothrombin times. Four patients had severe hypoxia; one patient had an exudative pleuritis. One patient whose treatment included erythromycin had radiologic improvement of his pneumonia despite deteriorating ventilatory function that led to death. The concept of Legionnaires' disease as a severe, diagnostically perplexing pneumonic illness is valid but too narrow. The emerging spectrum is that of a multisystem disease that, besides the lungs, often involves the central nervous system and can be accompanied by disseminated intravascular coagulation.
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PMID:Sporadic cases of Legionnaires' disease: the expanding clinical spectrum. 43 28

Early diagnosis of Legionnaires' disease is difficult because other pathogens cause a similar clinical picture and microbiologic tests are usually only of retrospective value. Since May 1977, 17 patients with sporadic cases of Legionnaires' disease have been admitted, all previously well, the diagnosis being made with standard serologic or bacteriologic criteria. From the clinical, laboratory, and radiologic findings, we propose criteria that may enable the clinician to make a diagnosis earlier in many cases, differentiating them from other pneumonias. Within 24 hours of admission, any three of the following four features are strongly suggestive of Legionnaires' disease: [1] prodromal "viral" illness, [2] dry cough or confusion or diarrhoea, [3] lymphopenia without marked neutrophilia, [4] hyponatremia. Two thirds of cases had at least three of these features, and no false-positive diagnoses would have been made in other pneumonias that were serologically negative for Legionnaires' disease if these proposed criteria had been applied diagnostically. In the next few days the diagnosis is very likely if microbiologic tests are negative and if there is radiologic extension, abnormal liver function test results, or hypoalbuminemia.
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PMID:Early clinical differentiation between Legionnaires' disease and other sporadic pneumonias. 43 29

Sera of 24 patients with an unexplained pneumonia were tested for the presence of antibodies against the Legionnaires' disease bacterium. Fifteen patients had positive serology. The series comprised 12 male and three female patients ranging in age from 17 to 66 years (mean, 51.1 years). All of the patients had a high fever, little or no sputum production, and radiographic evidence of pneumonia. The radiographic abnormalities ranged from a patchy infiltrate to extensive consolidation. In eight patients with confirmed Legionnaires' disease, severe confusion was one of the most striking signs. A variety of antibiotics had no clear effect on the duration of the illness in these cases, although the severity seemed to be influenced. Two of the patients died, and in three the course was protracted. All cases were sporadic. Eight patients had been infected abroad and seven in the Netherlands, two of whom were on immunosuppressive therapy and were infected in a hospital.
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PMID:Sporadic cases of Legionnaires' disease in the Netherlands. 43 30

Mycoplasmal pneumonia, tularemic pneumonia, Q fever pneumonia, psittacosis, and Legionnaires' disease are the most frequently encountered treatable atypical pneumonias. Mycoplasmal pneumonia, the most common, is often accompanied by nonexudative pharyngitis, conjunctivitis, or otitis. The nonproductive cough is characteristic. Tularemic pneumonia is characterized by substernal chest pain, bloody pleural effusion, and bilateral hilar adenopathy. Although the clinical presentation is mild, roentgenographic findings are impressive. Q fever pneumonia resembles psittacosis but is less serious; it may be accompanied by subacute bacterial endocarditis, hepatitis, or both. Psittacosis is characterized by prominent headache, bloody sputum, and relative bradycardia. Tetracycline is the drug of choice for either. In Legionnaires' disease, pneumonia is accompanied by prominent extrapulmonary symptoms. The most important diagnostic clues include diarrhea and mental confusion. Relative bradycardia and laboratory abnormalities are also helpful. Erythromycin is the drug of choice unless doubt exists as to the diagnosis.
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PMID:The atypical pneumonias: a diagnostic and therapeutic approach. 47 55

Even if they represent only a minor percentage of all respiratory infections, acute pulmonary infections are the leading mortality cause from infectious diseases. Epidemiologic data amongst hospitalized patients with acute infections reveal mean mortality figures of 20%. The adequate assessment of severity criteria is fundamental so that patients can be oriented towards suitable hospitalized units. Risks factors to be considered are: other illnesses, age (greater than 60 years), breathing frequency greater than 30/min, diastolic blood pressure less than 60 mmHg, confusion, a PaO2 less than 60 Torr, a leukocytosis greater than 30,000 or less than 4,000/mm3, albuminemia less than 35 g/l and blood urea greater than 7 mmol/l. The association of these factors increases the risk of complications and mortality in a linear way. By contrast, the type of responsible organism is not relevant. Five microorganisms are responsible for 80 to 90% of documented acute pulmonary infections: pneumococci, Mycoplasma pneumoniae, Haemophilus influenzae, Legionella pneumophila, Myxovirus influenzae. However, direct examination of bacteriologic smear allows for a proper identification of the infectious agent in only 15% of cases. The clinician can therefore use epidemiologic, clinical and radiological findings to propose an oriented, though probable, antibiotic treatment. In these conditions, the initial treatment remains the association of an A type penicillin with an inhibitory effect on beta-lactamases and of a macrolide (or, eventually, of a fluoroquinolone) until results of bacteriologic investigations is known. No data is available to suggest the use of new third generation oral cephalosporins in the first intention treatment of acute severe pulmonary infections due to their low and inconsistent effect on pneumococcus.
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PMID:[Severe community-acquired pneumopathy. What initial antibiotics to use?]. 158 29

A 10 month prospective study of all adults admitted to Waikato Hospital with community acquired pneumonia was performed to assess aetiology, mortality, hospital stay, and the value of a prognostic index based on that obtained from a British Thoracic Society study. The 92 patients in the survey had a mean age of 56 (range 13-97) years. A microbiological diagnosis was established in 72%; Streptococcus pneumoniae (33%), Mycoplasma pneumoniae (18%), and influenza A virus (8%) were the most common microorganisms. Other causative organisms were Legionella pneumophila (4 cases), Staphylococcus aureus (3), Klebsiella pneumoniae (2), Haemophilus influenzae (2), Nocardia brasiliensis (1), and Acinetobacter calcoaceticus (1). Chlamydia sp, influenza B virus and adenovirus were each found in one case; all were cultured on nasopharygeal aspirates. Aspiration was considered to be the underlying cause in five patients, two with epilepsy and one with pseudobulbar palsy. Five of the six deaths that occurred were in patients over 75 years of age and the other was 69. In four of the six the established causative organisms were Chlamydia sp (1), K pneumoniae (1), and S aureus (2). Patients had a 16 fold increased risk of death if they had two or more of the following on admission: a respiratory rate of 30/minute or more, diastolic blood pressure of 60 mm Hg or less, and either confusion or a plasma urea concentration greater than 7.0 mmol/l.
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PMID:Community acquired pneumonia: aetiology and prognostic index evaluation. 190 34

A case of Legionnaires' disease is described in a 63 year old man who presented with pneumonia and confusion. Eleven days after admission he became acutely hypotensive and attempts at resuscitation failed. Post-mortem examination revealed spontaneous splenic rupture and massive hepatocellular necrosis--an outcome that has not previously been associated with Legionnaires' disease.
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PMID:Spontaneous rupture of the spleen in Legionnaires' disease. 209 39

A case report is presented of a young man admitted to a general hospital with leukocytosis, elevated temperature, right lower lobe infiltrate, and confusion. A diagnosis of rhabdomyolysis, acute renal failure, and Legionnaire's disease was made. The patient subsequently had a respiratory arrest and died on the 29th hospital day. This triad is currently an enigma in the field of internal medicine. The diagnosis of each entity is elusive, and in many cases must be made by the astute clinician. Diagnostic features along with early intervention measures and their expected outcomes are discussed. Recognition of the interrelationship of these diseases, risk factors, and vague clinical presentations might allow further prospective intervention methods and diagnostic procedures to be undertaken to avoid the fatal consequences seen in this disease triad.
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PMID:Legionnaire's disease and acute renal failure: a case report and literature review. 307 72


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