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

During the 2-year period 1977 through 1979, 26 patients with Legionnaires' disease were seen at the Mayo Clinic and affiliated hospitals. The patients ranged in age from 17 to 81 years with a median of 51 years. Twelve (46%) were immunologically compromised. Most of the other patients had underlying chronic tobacco bronchitis. Hectic fever, cough, and diarrhea were common symptoms. Chest radiographs showed patchy perihilar infiltrates that often progressed to consolidation. Diagnosis was made by indirect fluorescent antibody testing in 15 patients (58%), but in no case was the test diagnostic during the first week of illness. In seven patients the diagnosis was established by positive direct flourescent antibody testing of lung tissue, in two cases by culture of lung tissue, and in one case each by direct fluorescent antibody positivity of sputum or bronchial washing. Of the 26 patients, 3 (12%) required hemodialysis for acute renal failure and 5 (19%) died. A favorable clinical response to therapy with erythromycin was noted. The differential diagnosis of Legionnaires' disease must include other bacterial pneumonias, as well as mycoplasma, psittacosis, Q fever, and viral pneumonia. For critically ill patients, open-lung biopsy may be necessary to provide a rapid diagnosis. Current evidence suggests that erythromycin alone or in combination with rifampin is the treatment of choice. A 3-week course of therapy is recommended in order to prevent relapse.
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PMID:Legionnaires' disease: a review of the epidemiology and clinical manifestations of a newly recognized infection. 735 52

Four severe cases of Legionnaires' disease are described. In addition to multilobar pneumonia with respiratory failure, involvement of the central nervous, cardiovascular, renal, hepatic and coagulation systems had occurred. Adult respiratory distress syndrome complicated respiratory management. Early development of acute renal failure was associated with a poor prognosis. Erythromycin was the most commonly used antibiotic. Review of stored pathological material from patients who died from unidentified pneumonias enabled confirmation of the existence of Legionnaires' disease in Australia in 1974.
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PMID:Legionnaires' disease in South Australia. Four case reports. 739 74

We describe two patients with Legionnaires' disease (LD) and acute renal failure not associated with hypotension or therapy with nephrotoxic antibiotics. The first patient ran a fulminant course unresponsive to erythromycin therapy and intensive supportive care including mechanical assisted ventilation and peritoneal dialysis. The second patient recovered after erythromycin therapy and hemodialysis. The clinical course of both patients and the renal pathology of the first patient were compatible with acute tubular necrosis. LD is a disease with many extrapulmonary manifestations. The pathogenic mechanism of acute renal failure in LD is presently unknown.
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PMID:Legionnaires' disease with acute renal failure. 742 65

A 45-year-old man developed symptoms of pneumonia while on holiday in Spain. On his return home, a diagnosis of Legionnaires' disease was confirmed, complicated by acute renal failure, He was treated with dialysis and spontaneous recovery of renal function began on day 19.
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PMID:Acute renal failure complicating Legionnaires' disease. 746 81

Acute renal failure in Legionnaires' disease is rare, but the mortality rate is high [1-3]. Although the actual pathogenesis is not clear, the renal pathology discloses either acute tubulointerstitial nephritis or acute tubular necrosis in most cases [3]. We report two cases of Legionnaires' disease complicated by acute renal failure. One patient was completely healthy before, and the other had underlying gouty arthritis and diabetes mellitus. Their renal function was normal before these episodes. The diagnosis of Legionella infection was proved by the indirect fluorescent antibody test on paired sera. After erythromycin treatment, both patients survived. One patient required long-term maintenance hemodialysis, and the other recovered to only mild azotemia after a follow-up period of 5 months. Including our cases, only 55 patients have been reported to have Legionella-induced acute renal failure. This is a rare and serious complication of Legionnaires' disease. Early recognition and treatment is mandatory.
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PMID:Legionnaires' disease with acute renal failure: report of two cases. 761 43

Ten patients from a rehabilitation center were admitted to hospital with serious respiratory infections within ten weeks. An outbreak of Legionnaire's disease was suspected based on the epidemic and atypical manifestation of pneumonia and could be proven microbiologically. Pulmonary and extrapulmonary complications included respiratory failure, lung abscess, transitory renal impairment in five patients and acute renal failure requiring dialysis in one, tetraparesis caused by peripheral neuropathy and acute psychosis. Three patients died despite immediate institution of therapy with erythromycin. Legionella pneumophila serogroup 1 subtype Pontiac was isolated from a bronchial lavage sample of one patient and from the water supply of the rehabilitation center. Monoclonal antibody subtyping and restriction endonuclease analysis were performed on both environmental and patient isolates. Potable water was identified as the source of the outbreak based on identical patterns on restriction endonuclease analysis. Despite thermic and chemical disinfection with chlorination (up to 15 ppm) in the rehabilitation clinic, an eleventh case of Legionnaire's disease was detected 11 months later.
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PMID:Nosocomial outbreak of legionellosis in a rehabilitation center. Demonstration of potable water as a source. 822 27

Legionella pneumophila is the second most common cause of severe community-acquired pneumonia requiring treatment with intermittent positive pressure ventilation. The prognosis of this condition and its complications have not been well documented. Erythromycin is the first-line antibiotic of choice based on clinical experience. Rifampicin has been recommended as an additional agent, though clinical experience has not been reported. We have retrospectively examined 30 cases of severe community-acquired legionella pneumonia. The mean age of the patients was 53 years, 24 were male and eight died (27%, mean age 57 years). During admission 26 patients received erythromycin (eight died) and 15 received rifampicin in addition (five died); four received neither drug and survived. Mean duration of intermittent positive pressure ventilation was 15.9 days for survivors and 14.1 days for fatal cases. Acute renal failure requiring dialysis developed in 13 (43%), of whom five died (38%). Positive inotropic drugs were used in 10 patients and of these six died. Jaundice occurred in 11 patients and was significantly more common (p = 0.028) in patients who received rifampicin (60%) than in those who did not (17%). Excess bilirubin was largely conjugated when measured and there was no consistent hepatitic or obstructive change in the liver enzymes. Severe community-acquired legionella pneumonia has a relatively good outcome with a mortality of 27%, though prolonged intermittent positive pressure ventilation may be required. Acute renal failure is common but reversible in survivors, and jaundice is more common in those who receive rifampicin.
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PMID:Severe community-acquired legionella pneumonia: treatment, complications and outcome. 832 50

We describe a patient with bilobar pneumonia and acute renal failure, whose unusual skeletal muscle uptake on technetium methylenediphosphonate bone scan led to the diagnosis of rhabdomyolysis. The clinical and serologic findings were most consistent with Legionnaires' disease. Radioisotope scanning may occasionally be useful in the diagnosis and management of muscle disease, particularly myositis and rhabdomyolysis.
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PMID:Diphosphonate bone scan in an unusual case of rhabdomyolysis: a report and literature review. 847 81

We report the case of a 73-year-old man, who developed acute renal failure in association with a Legionella pneumophila serotype 1 pneumonia. Renal biopsy revealed a tubulointerstitial nephritis. Treatment with erythromycin, rifampicin and haemodialysis resulted in a clinical resolution of the pulmonary and renal syndromes.
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PMID:Legionnaires' disease and acute renal insufficiency: report of a case and review of the literature. 857 32

The clinical course of legionella pneumonia in immunosuppressed patients is uncertain. This study was undertaken to determine the clinical evolution of legionellosis on the basis of the immune state and to establish the variables associated with death directly related to legionellosis. The study included 78 patients: 28 with chronic disease who had received immunosuppressive treatment (group 1), 24 with chronic disease without immunosuppressive treatment (group 2), and 26 controls. Inclusion criteria were the occurrence of nosocomially acquired pneumonia, Legionella pneumophila infection, and erythromycin therapy that was initiated within 72 hours following diagnosis. Respiratory and extrarespiratory complications were observed more frequently in groups 1 and 2. Bilateral radiological involvement was most frequent in group 1, and recurrence of legionella pneumonia was observed exclusively in group 1. None of these variables achieved statistical significance. The global mortality of the series was 11.5% (17.9%, 12.5%, and 3.8% in groups 1, 2, and 3, respectively). Variables statistically related to mortality were acute renal failure, shock, and need for mechanical ventilation. Although many of the variables analyzed lacked statistical significance, a trend was seen between complications and basal immunosuppression, as previously suggested.
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PMID:Role of immunosuppression in the evolution of Legionnaires' disease. 945 4


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