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)

We made an open, noncomparative evaluation of ofloxacin, 400 mg orally bid for 10 days, in 98 subjects with community-acquired pneumonia or pathogen-confirmed bronchitis. Thirty-nine (40%) of the subjects were treated in the hospital and 59 (60%) were treated as outpatients. The mean age of those treated was 56.2 years; 73 (74%) of the subjects either were more than 60 years old or had a history of chronic obstructive pulmonary disease, or both. There were 95 organisms initially isolated in sputum, aspirate, or lavage fluid; all were susceptible to ofloxacin, and none acquired resistance during therapy. Haemophilus influenzae was the most common pathogen (19 isolates), followed by Streptococcus pneumoniae (18) and Staphylococcus aureus (10). Clinical responses included cure in 70 patients (71%), improvement in 26 (27%), and failure in two (2%). After 10 days of therapy, pathogens persisted in two cases; in one case, Streptococcus salivarius was isolated, though it remained susceptible to ofloxacin, and in the other, Klebsiella pneumoniae was accompanied by superinfection due to a resistant strain of Serratia marcescens. We included in this study three confirmed cases of atypical pneumonia successfully treated with ofloxacin, two of them due to Mycoplasma pneumonia and one to Legionella pneumophila. Ofloxacin was well tolerated. Our data indicate that ofloxacin is effective and safe as specific and empiric treatment for many lower respiratory tract infections.
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PMID:Oral ofloxacin therapy for lower respiratory tract infection. 173 27

Over a period of 4 consecutive yr, 92 nonimmunosuppressed patients (21 women and 71 men aged 53 +/- 16 yr, means = SD) with critical acute respiratory failure (PaO2/FiO2, 209 +/- 9 mm Hg) caused by severe community-acquired pneumonia were admitted to the respiratory intensive care unit (RICU) of a general hospital. The most frequent underlying clinical condition was chronic obstructive pulmonary disease (44 patients, 48%). A total of 56 patients (61%) required mechanical ventilation for a mean period of 10.7 +/- 12.5 days, 29 of them (52%) needing PEEP (9.9 +/- 3.8 cm H2O). A group of 23 (25%) patients had criteria of adult respiratory distress syndrome (ARDS). A causal microorganism was identified in 48 patients (52%), the two most frequent etiologies being Streptococcus pneumoniae (14, 15%) and Legionella pneumophila (13, 14%). Pseudomonas aeruginosa (5, 5%) was always associated with bronchiectasis. Mortality due to severe community-acquired pneumonia was 22% (20 patients). According to univariate analysis, mortality was associated with anticipated death within 4 to 5 yr, inadequate antibiotic treatment before RICU admission, mechanical ventilation requirements, use of PEEP, FIO2 greater than 0.6, coexistence of ARDS, radiographic spread of the pneumonia during RICU admission, septic shock, bacteremia, and P. aeruginosa as the cause of the pneumonia. Further, recursive partitioning analysis selected two factors significantly related to the prognosis: the radiographic spread of the pneumonia during RICU admission and the presence of septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Severe community-acquired pneumonia. Epidemiology and prognostic factors. 185 53

Despite the apparent common occurrence of pneumonia in patients with chronic obstructive pulmonary disease (COPD), there are little firm data on incidence, etiology, diagnostic procedures, and therapy in these patients. It appears that traditional respiratory pathogens such as the pneumococcus are declining in importance while "new" pathogens such as Pseudomonas sp., Moraxella catarrhalis, and Legionella sp. are becoming more important. The diagnosis of a specific etiologic agent is difficult in COPD and can be aided by obtaining specimens bronchoscopically. Directed therapy is optimal; however, empiric therapy is frequently unavoidable.
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PMID:Pneumonia in chronic obstructive lung disease. 195 95

Guidelines for the prevention of nosocomial pneumonia specify that only sterile fluids should be used for aerosol therapy; however, this recommendation may not be uniformly followed. Thirteen patients with nosocomial pneumonia due to Legionella pneumophila serogroup 3 (Lp3) were identified at a community hospital in the period from 1984 through 1988; 12 patients (92%) had chronic obstructive pulmonary disease; and 9 patients (69%) died. An epidemiologic investigation suggested that the use of nebulizers to deliver medication was associated with acquiring legionnaires' disease. The hospital potable water system was contaminated with Lp3, and a survey indicated that tap water was commonly used to wash medication nebulizers. Lp3 in respirable-size droplets was isolated from aerosols generated by a nebulizer containing Lp3 at one-tenth the concentration found in the hospital potable water. These findings support the recommendation that only sterile fluids be used for filling or cleaning respiratory care equipment and suggest that this guideline is not universally followed.
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PMID:Nosocomial Legionnaires' disease and use of medication nebulizers. 199 43

Three hundred fifty-nine consecutive patients with community-acquired pneumonia admitted to university, community, and VA hospitals underwent a standardized evaluation, including specialized tests for Legionella spp. and Chlamydia pneumoniae (TWAR). The most common underlying illnesses were immunosuppression (36.3%), chronic obstructive pulmonary disease (32.4%), and malignancy (28.4%). The most frequent etiologic agents were Streptococcus pneumoniae (15.3%) and Hemophilus influenzae (10.9%). Surprisingly, Legionella spp. and C. pneumoniae were the third and fourth most frequent etiologies at 6.7% and 6.1%, respectively. Aerobic gram-negative pneumonias were relatively uncommon causes of pneumonia despite the fact that empiric broad-spectrum combination antibiotic therapy is so often directed at this subgroup. In 32.9%, the etiology was undetermined. Antibiotic administration before admission was significantly associated with undetermined etiology (p = 0.0003). There were no distinctive clinical features found to be diagnostic for any etiologic agent, although high fever occurred more frequently in Legionnaires' disease. Clinical manifestations for C. pneumoniae were generally mild, although 38% of patients had mental status changes. Mortality was highest for Staphylococcus aureus (50%) and lowest for C. pneumoniae (4.5%) and Mycoplasma pneumoniae (0%). We document that specialized laboratory testing for C. pneumoniae and Legionella spp. should be more widely used rather than reserved for cases not responding to standard therapy. Furthermore, realization that C. pneumoniae and Legionella spp. are common etiologies for community-acquired pneumonia should affect empiric antibiotic prescription.
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PMID:New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. 220 84

Cigarette smoking exerts deleterious effects not only on the respiratory tract, but also on the lung's parenchyma. The FEV is reduced in heavy chronic smokers. Persistent smoking has an unfavourable influence on mucociliary activity. According to the results of recent research almost 8 million people in the U.S. were suffering from chronic bronchitis in 1981. There is a direct correlation between the number of cigarettes smoked, over what period of time, and the incidence of chronic bronchitis. In studies with patients suffering from exacerbations of chronic bronchitis the most common bacterial pathogens found were Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis. Mycoplasma pneumoniae and certain viruses are counted amongst the non-bacterial pathogens. Antibiotics should be effective against such possible pathogens. The resistance of H. influenzae to ampicillin/amoxicillin is currently observed in at least 12% of cases, whilst H. influenzae is regularly observed to be resistant to erythromycin. Cefaclor, trimethoprim/sulphamethoxazole and amoxicillin/clavulanic acid offer satisfactory forms of treatment. Pneumonia caused by S. pneumoniae, H. influenzae, B. catarrhalis and Legionella pneumophila is often seen in smokers and patients with COLD. Haemocultures should be prepared for all hospitalized patients. Penicillin G and/or V is the agent of choice. Cefaclor or trimethoprim/sulphamethoxazole can be given to counter beta-lactamase producing H. influenzae whilst cefaclor, erythromycin, tetracycline or trimethoprim/sulphamethoxazole are used for the treatment of B. catarrhalis infections. In Legionella infections erythromycin is the preferred treatment. A combination of erythromycin and cefamandole or ceftriaxone is indicated for empirical management. Patients with COLD should be immunised with pneumococcus and influenza vaccines.
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PMID:[Smoking and lower respiratory tract infection]. 361 Mar 32

Community-acquired pneumonia resulting in hospitalization may have a mortality rate of 10 to 25 percent. The exact incidence of community-acquired pneumonia is unknown because it is not a reportable disease. The etiologic spectrum appears to be changing. Streptococcus pneumoniae causes most of the cases; the rank ordering of other pathogens is uncertain. With the exception of Legionella, colonization of the upper respiratory tract usually precedes clinical pneumonia. Subtle aspiration of the posterior pharyngeal flora accounts for the majority of pneumonias. The need for prompt antibiotic therapy mandates an efficient approach to diagnosis, although it is often difficult to establish a precise etiology. Empiric therapy is often initiated prior to an etiologic diagnosis, and should be as specific as possible. Initial choice of therapy is dictated by the clinical presentation (e.g., "bacterial-like" or "viral-like"), inquiries into the possibility of aspiration or gram-negative pneumonia, and the results of gram-stain examination. When the clinical presentation and Gram-stain results are consistent with pneumococcal pneumonia, penicillin is the drug of choice. A more obtuse presentation in an otherwise healthy patient may call for erythromycin to cover Legionella and Mycoplasma. "Marginally compromised" hosts, such as alcoholics, patients with chronic obstructive pulmonary disease, and elderly nursing home patients, may require empiric broad-spectrum cephalosporin therapy for the first few days. Prevention of pneumonia using available vaccines must be emphasized.
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PMID:Treatment of community-acquired pneumonias. 402 83

In a prospective study (from April, 1980 to April, 1981) of 110 patients with moderately severe to severe pneumonia 11 were found to have 12 manifestations of Legionnaires' disease. Diagnosis was proven by indirect immunofluorescence tests, either a quadruple titre rise to 1 : 128 or a single titre of at least 1 : 256. The clinical picture in all 11 patients was the typical one of severe pneumonia, usually involving the lower lobes, high fever between 39 and 40.4 degrees C, as well as WBC counts between 6.8 and 28.9 X 10(9)/l. In nine cases artificial ventilation was required, in four there was acute renal failure requiring dialysis, in four other definite renal insufficiency. All patients had underlying disease, in some severe, such as chronic obstructive lung disease, diabetes mellitus, heart failure, liver cirrhosis, renal transplantation or extensive operations. Eight patients died, four of them of Legionnaires; disease. The relatively high infection rate (10%) indicates that in patients with risk factors, as well as those with a pneumonia unresponsive to the standard treatment within five to seven days, Legionnaires' disease should be considered in the differential diagnosis.
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PMID:[Legionnaires' disease: prospective study of its incidence, clinical features and prognosis. (author's transl)]. 706 Apr 96

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

Since March 1991 a prospective 1-year study of patients with community-acquired, radiologically verified, pneumonia (CAP) was performed at the Divisione Pneumologica, Ospedali Riuniti Bergamo, and at the Centro Pneumo-Allergologico, Bergamo, Italy. The study included 119 out-patients and 60 in-patients, with a median age of 37.4 and 49.8 years respectively. There were not statistically significant differences between the patients included with respect to the various months. The most common underlying illnesses were: chronic obstructive pulmonary disease (20.7%), diabetes (7.3%) and malignancy (3.4%). We found a quite different etiology of CAP between out- and in-patients. By far the most common etiologic agent in out-patients was Mycoplasma pneumoniae (32.8%), while in in-patients was Legionella pneumophila (11.7%). 5 patients had a double infection. There were no distinctive clinical and radiological features found to be diagnostic for any etiologic agent. Hospital stay averaged 12.1 days. 35% of the patients included in the study were been treated by beta-lactam, often parenterally, nevertheless 88 pathogens of the 100 identified were resistant to this antimicrobial therapy. We believe that there should always be a macrolide, erythromycin or the latest ones such as azythromycin, in the treatment of CAP, owing to their efficiency, ease of use and lower cost.
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PMID:Community-acquired pneumonia: is there difference in etiology between hospitalized and out-patients? 750 Dec 24


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