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

Invasive pulmonary aspergillosis (IPA), although unusual, has been recognized in the immunocompetent host. Several cases of IPA with rapidly progressive respiratory failure have been reported in patients receiving short-term corticosteroid therapy for chronic obstructive pulmonary disease. Atypical pneumonia caused by dual infection with Legionella pneumophila and Mycoplasma pneumoniae has also been reported. We report an unusual case of simultaneous L pneumophila pneumonia and IPA in an asthma patient with suspected allergic bronchopulmonary aspergillosis newly treated with corticosteroids.
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PMID:Simultaneous legionellosis and invasive aspergillosis in an immunocompetent patient newly treated with corticosteroids. 825 95

Community-acquired pneumonia (CAP) is an infectious illness that frequently motivates hospital admission when comorbid conditions are present. However, the epidemiology of CAP in relation to the underlying disease of the patients is not well known. We performed a prospective multicenter study with the aim of assessing the clinical characteristics, etiology, and outcome of chronic obstructive pulmonary disease (COPD) patients with CAP. Between October 1992 and December 1994 we studied 124 COPD patients (mean FEV1 40 +/- 11% of predicted, mean FVC/FEV1 49 +/- 10) admitted because of CAP to one of the participating centers. An attempt to obtain an etiologic diagnosis was performed by means of blood cultures (n = 123), sputum cultures (n = 97), pleural fluid cultures (n = 17), protected specimen brush samples (n = 41), percutaneous transthoracic needle aspiration (n = 41), and serology (n = 106). Etiologic diagnosis was achieved in 80 (64%) of cases, however, diagnosis based upon valid techniques was only possible in 73 (59%) cases. The main causal microorganisms were the following: Streptococcus pneumoniae in 32 (43%), Chlamydia pneumoniae in 9 (12%), Hemophilus influenzae in 7 (9%), Legionella pneumophila in 7 (9%), Streptococcus viridans in 3 (4%), Coxiella burnetii in 3 (4%), Mycoplasma pneumoniae in 2 (3%), Nocordia asteroides 2, Aspergillus ssp. 1, and others 10. In three of these cases the etiology was polymicrobial. Bacteremia was present in 19 (15%) cases; S. pneumoniae was the most frequent isolate (13 cases). Antibiotic treatment was modified in 22 cases due to etiologic findings, and in 9 due to therapeutic failure. Ten patients died (8%), and 22 needed mechanical ventilation, the mortality rate in the latter population being 23%. Total or partial resistance of S. pneumoniae to penicillin was observed in 10 of 32 (31%) isolations, and to erythromycin in 2 (6%). The results of this study are important for the standardization of empiric antibiotic strategies in COPD patients with pneumonia.
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PMID:Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. 891 64

Between July 1992 and June 1993, 61 patients with severe community-acquired pneumonia were admitted to our semi-intensive care unit. For all patients chest X-ray, blood gas analysis while breathing room air, Gram stain and culture of bronchoaspirate, determination of acute and convalescent anti-body titers for Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae, blood culture when body temperature was greater than 38 degrees C, and pharyngeal swab for C. pneumoniae detection by means of an indirect immunofluorescence test were obtained. Among the patients enrolled, 15 suffered from chronic obstructive pulmonary disease, 18 had serious chronic diseases, 9 were immunodeficient and 15 had cardiovascular diseases, and only 4 had no underlying disease. Etiologic diagnosis was reached in 30 cases (49%). As expected, due to the high rate of seriously ill patients, gram-negative pathogens were identified most commonly (15%), followed by Streptococcus pneumoniae (10%) and, surprisingly, by C. pneumoniae (10%). These data, showing the possible emergence of Pseudomonas aeruginosa and C. pneumoniae, warrant further studies in order to verify whether the epidemiological pattern of severe community-acquired pneumonia is actually changing.
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PMID:Severe community-acquired pneumonia: a possible role for Chlamydia pneumoniae. 896 67

Despite the fact that the epidemiology of community-acquired pneumonia and nosocomial Legionella infection is well known, there are no specific reports dealing with severe cases of Legionella pneumophila pneumonia admitted to intensive care units. We undertook a prospective study upon 84 patients with a reliable diagnosis of L. pneumophila pneumonia that required ICU admission. The study assessed the prognostic factors, clinical, radiological and outcome variables of both nosocomial (n = 33) and community-acquired (n = 51) cases of L. pneumophila pneumonia. The following variables were more common in nosocomial acquired as compared to community-acquired Legionella pneumonia: Chronic obstructive pulmonary disease (COPD) (64 versus 41%), cardiac disease (39 versus 10%), chronic renal failure (21 versus 4%), alcoholism (54 versus 18%), septic shock (33 versus 16%), and unilateral chest X-ray involvement (61 versus 39%). The crude mortality rate in this study was 30% (25 of 84) with no differences when comparing mortality between nosocomial (9, 27%) to community-acquired (16, 31%) types. The univariate analysis showed that cardiac disease, diabetes mellitus, creatinine > or = 1.8 mg/dl, septic shock, chest X-ray extension, mechanical ventilation, hyponatremia < or = 136 mEq/L, PACO2/FIO2 < 130, and blood urea levels > or = 30 mg/dl were factors related to poor outcome. On the other hand, the following two variables were related to better outcome: adequate treatment for Legionella and pneumonia improvement. The logistic regression analysis demonstrated that APACHE II score > 15 at admission (RR: 11.5; 95% CI 1.75 to 76.1; p = 0.025), and serum Na levels < or = 136 (RR: 21.3; 95% CI 1.11 to 408; p = 0.023), were the only independent factors related to death. On the other hand, improving pneumonia is associated with better outcome in Legionnaires' disease than for patients not having improving pneumonia (RR: 0.019; 95% CI: 0.036 to 0.106; p < 0.0001). A better understanding of the prognostic factors in cases of severe Legionella pneumonia will optimize our therapeutic approach in this disease and help to decrease both its mortality and morbidity rates.
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PMID:Prognostic factors of severe Legionella pneumonia requiring admission to ICU. 998 59

A 52-year-old male had fever, pleuritic chest pain, cough with purulent sputum and hemoptysis for 4 days. The patient had underlying alcoholic cardiomyopathy, cirrhosis of the liver, chronic obstructive lung disease and underwent corticosteroids therapy. Chest radiograph showed round opacities bilaterally. Legionella pneumophila serogroup 5 was identified by direct fluorescent antibody staining and culture from the sputum. Despite intravenous erythromycin and rifampin therapy, he died on the 7th hospital day. The autopsy showed bilateral pulmonary consolidation with abscess formation. Legionnaires' disease should be included in the differential diagnosis if an immunosuppressed patient presents with multilobar opacities on chest radiograph. Specific tests for Legionnaires' disease should be performed.
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PMID:Multilobar consolidation with abscess formation caused by Legionella pneumophila: an unusual chest radiographic presentation. 1049 59

Severe CAP is a life-threatening condition defined by the presence of respiratory failure or symptoms of severe sepsis or septic shock. It accounts for approximately 10% of hospitalized patients with CAP. The majority of patients with severe pneumonia have underlying comorbid illnesses, with COPD, alcoholism, chronic heart disease, and diabetes mellitus being the most frequent. S. pneumoniae, Legionella spp, GNEB (especially K. pneumoniae), H. influenzae, S. aureus/spp, Mycoplasma pneumoniae, respiratory viruses (especially influenza viruses), and P. aeruginosa represent the most important causative organisms of severe CAP. Rapid initiation of appropriate antimicrobial treatment is crucial for a favorable outcome. Initial antimicrobial treatment should be based on an epidemiological (empiric) approach. Microbial investigation may be helpful in the individual case but is probably more useful to define local antimicrobial policies based on local epidemiologic and susceptibility patterns. Mortality rates range from 21% to 54%. The most important prognostic factors include general health state of the patient, appropriateness of initial antimicrobial treatment, and the existence of bacteremia, as well as factors reflecting severe respiratory failure, severe sepsis, septic hypotension or shock, and the extent of infiltrates in chest radiograph. Initial antimicrobial treatment should consist of a second (or third) generation cephalosporin and erythromycin. Modifications of this basic regimen should be considered in the presence of distinct comorbid conditions and risk factors for distinct pathogens. Promising new approaches of nonantimicrobial treatment, including noninvasive ventilation, treatment of hypoxemia, and immunomodulation, are under investigation.
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PMID:Severe community-acquired pneumonia. 1051 5

Pneumonia acquired in Community (CAP) may be a primary disease occurring in healthy individuals or secondary to predisposing factors or comorbidity. Prevalence of CAP is 2.6 to 5% for all ages, in USA 12%, for over 65 years 30%. Streptococcus pneumoniae is the commonest pathogen 30-50%, H. influenzae in COPD, the atypical pneumonia Mycoplasma pn., M. catharralis, Legionella pn., Enterobacteria, anaerobics often in hospital survey. In children is different RSV, Parainfluenzae type 3, Rhinovirus in the first 2 years old. Others are S. pneumoniae, H. influenzae, Chlamydia sp., etc. Appropriate empiric antibiotic therapy choices are based in guidelines. The most common pathogen is S. pneumoniae, isolates raised resistance rates to Penicillin to 20-50%, 40% in our country and also to Macrolides, with potential clinical failure (21-40%). Specially in elderly people and with the comorbidity are recommended the 23 valent polysaccharide vaccine, effective in bacteremic pneumonia 70-80%. Is not effective in children under 2 years, for that is important conjugated vaccine Hib (toxoids T, D, CRM197, OMP Nm) to prevent carriers, otitis media and reduce exacerbation of these respiratory infections.
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PMID:[Current interest of antipneumococcal vaccination]. 1120 55

Acute exacerbation (AE) is a frequent episode during the prolonged chronic course of chronic obstructive pulmonary disease (COPD), which entails significant morbidity and mortality. The purpose of this study was to determine the frequency distribution of infectious etiologies in these episodes. Two hundred forty hospitalizations for AECOPD were included in a prospective, purely serologically based study. Paired sera were obtained for each of the hospitalizations and were tested using immunofluorescence or EIA methods to identify 13 different pathogens. Only significant changes in antibody titers were considered diagnostic. The mean age ( +/- SD) of the patients was 66.8 +/- 9.0 years and 179 (84%) were males. In 175 (72.9%) hospitalizations at least one infectious etiology was identified. In 117 (48.8%) hospitalizations at least one of 7 viral etiologies was identified. In 72 (30.0%) hospitalizations at least one of the following atypical bacteria was identified: Legionella spp. in 40 (16.7%), Mycoplasma pneumoniae in 34 (14.2%), and Coxiella burnetii in a single hospitalization. In 58 (24.2%) hospitalizations at least one classic bacterial etiology was found: Streptococcus pneumoniae in 48 (20.0%), Hemophilus influenzae in 10 (4.2%) and Moraxella catarrhalis in 9 (3.8%). More than one etiology was found in 72 (30.0%) hospitalizations. There were no significant differences in the etiologic distribution when the patients were classified by severity of airway obstruction or the clinical type of the exacerbation. We conclude that in most cases of hospitalization due to AECOPD the infectious etiology is viral or atypical bacteria and is classic bacteria in only a minority of cases. More than one etiologic cause can be identified in a third of the cases. The frequency distribution of the etiologies is not associated with the severity of airway obstruction or the clinical type of the exacerbation. The results of our study suggest that atypical bacteria should be covered in antibiotic regimens recommended for AECOPD. This issue should be addressed in future studies.
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PMID:Infectious etiologies in acute exacerbation of COPD. 1208 27

Legionnaire's disease is a life-threatening disease, observed in up to 15% of patients with pneumonia. Legionella pneumophila serogroup 1 is the most frequently implicated species among the genus Legionella. Legionella can cause two clinical pictures: Legionnaire's disease, a severe pneumonia, or Pontiac fever, a self-limiting disease. The attributable mortality of Legionnaire's disease is between 5-30%. Patients with typical Legionnaire's disease present with fever > 39 degrees C, cough and flu-like symptoms that do not respond to betalactam antibiotics. Neurological disorders may accompany severe cases. Laboratory findings include non-purulent sputum, increased liver enzymes and hyponatriemia. However, most patients do not fulfill all of these signs, symptoms and laboratory finding. Patients present with Legionella are frequently missed in the microbiology laboratory because clinicians do not ask for the specimen to be tested for Legionella. Established risk factors for Legionnaire's disease are chronic obstructive pulmonary disease (COPD), smoking and immunosuppressive therapy. New diagnostics tools such as the Legionella antigen in the urine, as well as PCR of a sputum sample allow rapid and accurate diagnosis. Such investigations are recommended for patients with severe pneumonia and those requiring hospitalization. State-of-the-art treatment includes a second generation macrolide, or alternatively, newer quinolones which are recommended as first-line drug for transplant patients. Prevention of Legionella requires a multi-faceted approach: The warm water should be kept at 60 degrees C in the boiler; the warm water should reach 50 degrees C at the faucet two minutes of opening the handle and the shower heads should be preferably made of stainless steel. In the hospital, the warm water supply should be free of Legionella at least for severely immunocompromised patients.
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PMID:[Legionelloses]. 1169 89

An incidence of between 2 and 44 per 1000 population has been reported for community-acquired pneumonia. Epidemiologic studies describe a wide range of causative organisms, including Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella spp., Moraxella catarrhalis, Chlamydia pneumoniae and viruses such as influenza A and B. However, the frequency with which they are reported varies widely. On analysis of these studies, the variation can be explained by a number of factors. The results depend on the definition of pneumonia and the criteria for assigning a causative role to any particular organism. Older studies have not included diagnostic methods for newly described organisms such as C. pneumoniae and Legionella spp. The improved diagnostic methods for these organisms and for Mycoplasma pneumoniae are reflected in more recent studies. Further variation depends on the population studied. As many patients with mild pneumonia are successfully treated in the community, those studies that are hospital-based include patients with more severe pneumonia often in the elderly or in patients with underlying diseases such as chronic obstructive pulmonary disease. The prior use of antibiotics not only contributes to the high percentage of cases for which no etiologic agent is found, but also ensures that treatment failures are selected for hospitalization. This further changes the result, depending on the antibiotic agents used most commonly in the community. The inclusion of nursing home patients or groups where alcoholism is more common will also favor particular organisms. Finally, the timing of the study may be such that an epidemic is included. This has relevance mostly for Mycoplasma pneumoniae, C. pneumoniae, Legionella spp. and influenza. In the assessment of the patient with community-acquired pneumonia, any one of the above organisms can be considered to be responsible. As initial treatment is empirical, other information can be used to ensure that an antibiotic with an adequate spectrum is chosen. Factors of importance are age, underlying illness, severity of disease and any locally recognized epidemics or endemic organisms. Differences in clinical presentation are not sufficiently distinct to allow for accurate prediction of the causative agent. Similarly, chest radiograph changes are not sufficiently specific to discriminate reliably between diverse organisms such as S. pneumoniae, Mycoplasma pneumoniae and Legionella spp. Current recommendations for choice of an empirical antibiotic agent are therefore based, not on the assumption of a single etiologic agent indicated by clinical presentation or radiographic appearances, but on age of the patient, severity of illness, the presence of underlying conditions and the range of possible organisms in that patient group.
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PMID:Community-acquired pneumonia: epidemiologic and clinical considerations. 1186 96


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