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

Ever since the 1976 Philadelphia epidemic and the isolation of the causative organism by MacDade in 1977, numerous clinical, epidemiological and bacteriological papers have stressed the significance of the "new" causative organisms responsible for serious cases of pneumonia. On the basis of knowledge available at present, the Legionellaceae family accounts for these bacteria. There are five different species in the genus Legionella: L. pneumophila, L. micdadei, L. bozemannii, L. dumoffii and L. gormanii. L. pneumophila occurs most frequently and has six serogroups (Serogroups 1-6), the first of which is the most important. Legionelloses, the diseases caused by these organisms, occur epidemically, endemically or sporadically. In clinical terms, these are acute cases of pneumonia which occur especially frequently in older persons and immunocompromised hosts. The course is severe in such patients. There is increased lethality. Erythromycin, rifampicin and cefoxitin are the most effective antibiotics. After the culture has been made in the suitable milieu and the material obtained by pulmonary aspiration has been inoculated into guinea pigs, the bacteriological diagnosis is made by direct immunofluorescence. The serological diagnosis is based on evidence of serological changes demonstrated by the indirect immunofluorescence test.
Infection 1982
PMID:[Diseases of the lungs caused by legionella species (author's transl)]. 710 22

The authors report on their institution's experience with 53 lung biopsies, including 26 open, 22 transbronchial, and five trephine air drill biopsies, performed in immunocompromised patients with roentgenographic pulmonary infiltrates. Open biopsy was far more likely to provide a specific etiologic diagnosis (81%, P less than 0.001) than transbronchial biopsy (32%), or trephine biopsy (20%). Infection (17 biopsies), neoplastic disease, (7) or drug-related pneumonitis (2) were identified most frequently. Patients with myeloproliferative disease, granulocytopenia, or those who had not received prior immunosuppressive therapy were most likely to have a nondiagnostic biopsy (P less than 0.05 for each factor). The overall complication rate of biopsy procedures was 15% and was comparable with all three methods. Survival in this series was not significantly lower if a specific etiologic diagnosis could not be established, but correlated with the respiratory rate (less than 20 per minute), pO2 (greater than 60 torr), and the roentgenographic pattern (other than bilateral diffuse disease) at the time of biopsy (P less than 0.05 for each factor). There were 18 cases (34%) in which a clearcut etiologic diagnosis would not be established at the time of biopsy; based on serologic tests performed ex post facto, 2 of 12 of these cases (17%) were Legionnaire's disease. Lung biopsies were helpful in the management of the majority of the cases, although nondiagnostic biopsies continue to be a problem. The authors propose an approach to the management of compromised patients with pulmonary infiltrates.
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PMID:Lung biopsy in immunocompromised patients: one institution's experience and an approach to management of pulmonary disease in the compromised host. 727 48

In August and September 1978, an outbreak of Legionnaires' disease occurred in Memphis, Tennessee. Of the 44 ill, 39 had been either patients, employees, visitors, or passers-by at one Memphis hospital (Hospital A) during the 10 days before. Assuming an incubation period of between two and 10 days, the onset of cases correlated precisely with the use of Hospital A's auxiliary air-conditioning cooling tower. L. pneumophila was recovered from two samples of water from the tower. Infection appeared to have occurred both outside and within the hospital. A significant association was demonstrated between acquisition of Legionnaires' disease and prior hospitalization in those areas of Hospital A that received ventilating air from air intakes near the auxiliary cooling tower. Tracer-smoke studies indicated that contaminated aerosols from the tower could easily reach these air intakes, as well as the street below, where four passers-by had been before they contracted Legionnaires' disease. This represents a common-source outbreak in which the source of L. pneumophila infection and airborne transmission were identified.
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PMID:An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower. 735 28

During the last three years many cases of Legionnaires' disease have been reported. Several cases reported had underlying disorders such as immunity deficiencies, or were undergoing immunosuppressive therapy. In this report we describe a previously healthy young man who acquired Legionnaires' disease and recovered after ampicillin-gentamicin treatment. During recovery he developed a lower leg thrombosis followed by pulmonary embolism.
Infection 1980
PMID:Case of Legionnaires' disease with deep venous thrombosis. 741 78

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

A case of pneumonia due to Legionella bozemanii--only the 20th culture-proven case reported so far--progressed with cavitation 9 days after the initiation of intravenous therapy with erythromycin. Review of all 20 reported cases revealed a similar propensity toward radiographic progression (25%) and cavitation (25%) during therapy. A slow response to long courses of erythromycin was the rule (35% of cases). In two instances, long courses of intravenous erythromycin failed and the patient died. Pleural effusion was reported in 60% of patients, including two with empyema. Overall mortality was high (40%). Although mortality was only 21% among patients who lived long enough to receive adequate courses of erythromycin, all three such patients who died had received erythromycin alone. Combination therapy with erythromycin and rifampin proved more effective in terms of survival. Infections due to non-pneumophila Legionella may be overlooked because of the organisms' special serological and culture requirements.
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PMID:Legionella bozemanii cavitary pneumonia poorly responsive to erythromycin: case report and review. 774 38

According the European Working Group on Legionella Infections the disease continues to occur sporadically or in small outbreaks, usually in connections with the survival of legionellae in hot water supply systems. It appears mostly as a nosocomial infection or as a travel associated disease. The introduction of laboratory diagnostic methods allowed us to approach this problem in our country. Detection of anti-legionella antibodies in the serum was performed by means of microagglutination and indirect immunofluorescence reaction. During 1985-1994 twenty-one sporadic cases, mostly pneumonias, could be diagnosed. As etiologic agents L. pneumophila 4, 12, 3, 2 and 1 besides legionella-like organisms L. bozemanii and less often L. micdadei and L. dumoffii were determined. In contrast to the general believe that mostly L. pneumophila 1 is involved in human cases, in our group of patients other serologic groups of L. p. and other species of legionellas were involved. The limited number of investigations does not allow us a real picture on the occurrence of legionelloses and their etiological structure in our country. It is expect that the widening of diagnostic examinations and an increased interest of clinicians to clarify etiologically acute suspect infections will contribute to a better knowledge of the medical importance of this disease. (Tab. 1, Ref. 15.).
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PMID:[Legionellosis in Slovakia]. 788 68

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


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