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)

There are alarming reports about high counts of Legionella and Pseudomonas in the aerosol of inhalation-rooms. We therefore investigated 14 institutions (6 kurhauses, 5 hospitals and 3 sanatoria for children) in Schleswig-Holstein, each of them at least five-fold. For that purpose the inhalant (seawater as a rule) was investigated for the total bacterial number and the number of Legionella. Cfu/m3 air were determined at the aerosol outlet and a qualitative search for Legionella was done in the piping. In addition bacterial numbers in the air at the breathing-levels of patients were measured in order to be able to assess health hazards by germs of other patients. Detected bacterial numbers (10(1) - > 10(4)) were basically subject to the handling of the equipment and the type of apparatus used. Predominantly Staphylococci and Bacilli were found and above all when the first row of investigations was carried out large numbers of Pseudomonas, Aeromonas and others occurred. Legionella could not be detected. As a whole the investigations showed that properly maintained room-inhalators pose no higher risk of infection. These facilities, however, might be contaminated at any time and there is a certain--even though comparatively low--risk of infection due to germs exhaled by other patients. Patients, which are predisposed to infections of the respiratory tract--f.i. patients suffering from mucoviscidosis or patients with lowered resistance--should therefore generally use single inhalators.
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PMID:[The danger of infection in inhalation rooms]. 129 May 66

The sputum pharmacokinetics and clinical efficacy of ciprofloxacin in lower respiratory tract infections is reviewed. Following intravenous administration, ciprofloxacin penetrates rapidly into bronchial tissue; the elimination half life is between 3 and 4 h and a dose dependency is seen. Following oral intake, the time to reach maximal concentrations is approximately two hours and after a dose of 750 mg the concentration may reach 1.7 mg/l in patients without cystic fibrosis and range from 0.5 to 3.4 mg/l in cystic fibrosis patients. Coadministration of ciprofloxacin increases serum levels and decreases total body clearance of theophylline. In controlled comparative clinical trials, ciprofloxacin has been found to have similar clinical efficacy as amoxycillin, ampicillin, cefalexin, doxycycline, co-trimoxazole, imipenem-cilastatin and ceftazidime for the treatment of a range of lower respiratory tract infections. Ciprofloxacin has been found to be superior in clinical efficacy to cefaclor. Experimental animal models suggest a role for ciprofloxacin in infections caused by Legionella pneumophila and Mycoplasma pneumoniae. The clinical and bacteriological efficacy of ciprofloxacin is less pronounced in lung infections caused by Pseudomonas aeruginosa, but is comparable to the combination of beta-lactams and aminoglycosides. Development of resistance is frequently observed during ciprofloxacin treatment of Ps. aeruginosa. Because of the availability of other oral and effective agents, ciprofloxacin is not recommended for empirical treatment of community acquired lower respiratory infections, but should be reserved for infections caused by multiply resistant organisms.
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PMID:Clinical efficacy of ciprofloxacin in lower respiratory tract infections. 266 11

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

Respiratory deterioration accounts for the morbidity and mortality observed in patients with cystic fibrosis. The role of Legionella in this deterioration was determined in a 2-year prospective study of 49 patients with cystic fibrosis and 19 sibling controls. Sera were obtained from participants on enrollment and at quarterly intervals. Legionella antibodies were measured in parallel using an indirect fluorescent assay. No seroconversions were observed. Eleven of 49 patients with cystic fibrosis (22%) were seropositive compared to none of 19 siblings (P less than 0.05). Six of the 11 patients demonstrated high titers (greater than or equal to 1:512) that persisted throughout the study. Absorption with pools of various Pseudomonas species reduced the antibody titers such that only 3 remained positive after absorption. Legionella was not found to be an important cause of clinical deterioration during this study. The results of the absorption studies suggest that high titers to Legionella in this population are due to cross-reacting antibodies.
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PMID:False positivity of Legionella serology in patients with cystic fibrosis. 310 25

Bronchopulmonary infections continue to be the major determinant of morbidity and mortality in patients with cystic fibrosis (CF). The basic pathogenesis of disease includes abnormal secretions and impaired mucociliary clearance. Colonization of the tracheobronchial tract with bacteria is then associated with a cycle of infection, inflammation and airway obstruction eventually leading to respiratory insufficiency. Early clinical features include persistent cough and failure to thrive. Hyperinflation and bronchial thickening are early radiographic changes suggestive of CF. Staphylococcus aureus is commonly the initial respiratory pathogen. Subsequently, Hemophilus influenzae and Pseudomonas aeruginosa colonize the respiratory tract. In addition, respiratory viruses and other pathogens such as Legionella and mycoplasma are implicated in the etiology of pulmonary infections. The culture of respiratory secretions such as sputum are important guidelines to the etiology of pulmonary infection in CF. The laboratory must be aware of the pathogens that are typical of this disease and use appropriate techniques and media. In large part, advances in treatment in CF over the past two decades are due to the availability of increasingly potent antibiotic agents. However, effective treatment must be multifaceted and include a variety of nonantimicrobial therapies. Different approaches to the antibiotic therapy of pulmonary infection in CF, including prevention, suppression, and definitive treatment are discussed. In addition to traditional antibiotic therapy, a variety of newer methods of therapy in CF are discussed. These include oral antipseudomonal antibiotics, corticosteroid therapy, aerosolized antibiotics, and continuous antimicrobial prophylaxis.
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PMID:Pulmonary infections in children with cystic fibrosis. 331 17

Infections of the respiratory tract are among the most common causes for antibiotic prescribing. Their diagnosis within the community is generally limited to clinical criteria, and microbiological information is frequently lacking. Hospitalised patients with respiratory tract infections are more likely to undergo diagnostic sampling, but difficulties remain in reliably defining a microbial aetiology, thereby providing a confident basis for antibiotic selection. In considering the role of the cephalosporins in the treatment of respiratory tract infections, over 500 published articles have been reviewed. The pharmacokinetic considerations are discussed and the limitations of existing methodology are emphasised. Individual agents are reviewed by site of sepsis and conclusions are drawn from both comparative and non-comparative studies and in relation to currently recommended regimens. Although oral cephalosporins are widely used to treat upper respiratory tract infections, none is considered ideal, especially where Haemophilus influenzae is pathogenic. In the case of lower respiratory tract infections the beta-lactamase stable parenteral cephalosporins have become widely used to treat pneumonia in hospitalised patients, especially where Gram-negative enteric bacilli are of aetiological importance. However, the lack of activity of these drugs against Legionella spp., Mycoplasma pneumoniae and Coxiella burnetii must be emphasised. Another area of increasing use is in the treatment of infective exacerbations in patients suffering from cystic fibrosis of the lungs where Pseudomonas aeruginosa is pathogenic; ceftazidime in particular has proved a useful alternative to earlier antipseudomonal penicillin antibiotics.
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PMID:Treatment of respiratory tract infections with cephalosporin antibiotics. 331 1

Ninety patients with serious infections, including 61 with septicaemia, pneumonia, peritonitis or meningitis, were treated with ceftazidime. Of these patients, 85.6% were clinically cured (73.3%) or improved (12.2%) by the antibiotic. In this study, 57.7% had infections due to Escherichia coli (24.7%), Klebsiella sp. (14.5%) and Pseudomonas sp. (18.5%). Two children with cystic fibrosis and Pseudomonas pneumonia and an adult with Legionella pneumonia responded well to ceftazidime treatment. Seventy patients had fever before treatment and most of them became apyrexial in less than 2 to 3 days. Ceftazidime was given either intramuscularly (42 patients) or intravenously (48 patients), in a dose of 1 g tds in 71 patients or 2 g tds in severe infections in 11 patients, or reduced to suit the renal function (7 patients) or in paediatric doses (2 children). Blood ceftazidime levels were measured in eight patients with normal renal function. The average level one hour post dosing was 45.2 mg/l and the average trough level was 8.1 mg/l. Six patients were suffering from variable degrees of renal insufficiency (serum creatinine 149 to 668 mmol/l). Their average blood level 1 h post-dosing was 68.8 mg/l. In a patient with meningitis, the CSF level was 2.4 mg/l 2 h after a 1 g dose. These levels are several times the ceftazidime MIC values for most clinical bacterial isolates. Ceftazidime is a valuable and safe alternative to aminoglycoside therapy.
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PMID:Ceftazidime: a new approach in the treatment of moderate and severe infections. 635 15

From January to April 1980 46 young adults with cystic fibrosis were studied for evidence of infection with a wide variety of microorganisms, including viruses and Legionella pneumophila. Two groups of patients were investigated: a "deteriorated" group of 24 patients who had experienced an increase in lower respiratory tract symptoms and fall in lung function values in the course of one month before the start of the study and a "stable" group of 22 patients with no such deterioration. All serological tests were repeated at one month and then one year after the beginning of the study. A fourfold rise in titres of antibodies to various viruses, Mycoplasma pneumoniae, and Coxiella burnetii was obtained in seven (29%) of the deteriorated group but in only one (4.5%) of the stable group (p less than 0.05). One other patient showed a fourfold rise in L pneumophila antibody titre (on the basis of the indirect fluorescent antibody test), which was accompanied by a respiratory illness consistent with legionnaires' disease. Eight of the 46 patients (17.4%) had demonstrable titres of antibody against L pneumophila (1/32 or above).
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PMID:Importance of viruses and Legionella pneumophila in respiratory exacerbations of young adults with cystic fibrosis. 642 78

A "new pneumonia" is named legionnaires' disease after a gramnegative bacillus - Legionella pneumophila, unknown until 1977. Sofar it has been observed mostly in older male patients, rarely in children and never before in Germany. The legionnaires' disease in our patient, a five and half years old boy with cystic fibrosis caused a severe dyspnea and multilobular pulmonary densifications on the chest X-ray film. The diagnosis was verified by the rise of the titer in the indirect immune fluorescence test and the success of the therapy with erythromycin.
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PMID:[Legionnaires' disease in cystic fibrosis]. 674 54

We studied the prevalence of serum antibodies to Legionella pneumophila in patients with cystic fibrosis (CF) by indirect immunofluorescence. Thirty-two (29.4%) of 109 patients with CF had a titer of 1:256 or higher, the level presumptive of previous infection, compared with (1) three (11.5%) of 26 patients without CF but with chronic suppurative bronchitis of childhood, (2) three (1.7%) of 178 age-matched persons without pulmonary disease, (3) zero of 22 parents and normal siblings, and (4) zero of 113 adult patients with chronic pulmonary diseases. (Addition of patients with CF who had a titer of 1:128 or higher would raise the prevalence of serum antibodies to L pneumophila in patients with CF to 43.2%.) Fifteen of 32 patients with CF who had antibody titers of 1:256 or higher to L pneumophila (46.9%) had titers of 1:1,024 or higher. Using a standard scoring system, the clinical condition of patients with CF who exhibited antibodies to L pneumophila was worse than that of patients with CF who lacked antibodies to L pneumophila. We conclude that patients who suffer from CF exhibit a high prevalence of antibodies to L pneumophila by the conventional indirect immunofluorescent test. The clinical importance of this single epidemiologic observation awaits further clarification.
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PMID:Serum antibodies to Legionella pneumophila in patients with cystic fibrosis. 675 43


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