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

Mycoplasmal pneumonia, tularemic pneumonia, Q fever pneumonia, psittacosis, and Legionnaires' disease are the most frequently encountered treatable atypical pneumonias. Mycoplasmal pneumonia, the most common, is often accompanied by nonexudative pharyngitis, conjunctivitis, or otitis. The nonproductive cough is characteristic. Tularemic pneumonia is characterized by substernal chest pain, bloody pleural effusion, and bilateral hilar adenopathy. Although the clinical presentation is mild, roentgenographic findings are impressive. Q fever pneumonia resembles psittacosis but is less serious; it may be accompanied by subacute bacterial endocarditis, hepatitis, or both. Psittacosis is characterized by prominent headache, bloody sputum, and relative bradycardia. Tetracycline is the drug of choice for either. In Legionnaires' disease, pneumonia is accompanied by prominent extrapulmonary symptoms. The most important diagnostic clues include diarrhea and mental confusion. Relative bradycardia and laboratory abnormalities are also helpful. Erythromycin is the drug of choice unless doubt exists as to the diagnosis.
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PMID:The atypical pneumonias: a diagnostic and therapeutic approach. 47 55

In a double blind trial erythromycin was compared with a combination of ampicillin and amoxycillin for treating adults admitted to hospital with primary pneumonia. The clinical course of 42 patients treated with ampicillin and amoxycillin was similar to that of the 49 in the erythromycin group. Fall in temperature, symptomatic recovery and radiographic improvement were similar (two-thirds made an uncomplicated recovery). Infusion-related phlebitis was more common with erythromycin. Otherwise adverse reactions were unusual. The outcome was related principally to the cause of the pneumonia with bacteraemic/antigenaemic pneumococcal pneumonia, Legionnaires' disease, other bacterial pneumonias and psittacosis having a poor prognosis. Both forms of antibiotic therapy gave similar results but we suggest that a combination of erythromycin with ampicillin may be logical initial treatment for severe pneumonia of unknown cause.
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PMID:Erythromycin compared with a combination of ampicillin and amoxycillin as initial therapy for adults with pneumonia including Legionnaires' disease. 635 70

A previously well 56 year-old woman presented with an adult respiratory distress syndrome which worsened under penicillin treatment, responding only to erythromycin and rifampicin, as well as CPAP ventilation. Diagnostic serology was positive to Chlamydia psittaci. Psittacosis is not a frequent cause of primary extensive pneumonia in intensive care units; other diseases should be looked for in the presence of these non-specific clinical and biological pictures (Legionella pneumophila, Mycoplasma pneumoniae, Streptococcus pneumoniae). Pneumocystis should also be looked for in a typical pneumonia; erythromycin is the antibiotic of first choice in the treatment of primary extensive pneumonia.
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PMID:[Severe Chlamydia psittaci pneumopathy in an adult]. 639 29

Out of 2,105 patients with atypical pneumonia and febrile infections 15 cases of legionellosis were diagnosed by the indirect immunofluorescent antibody test (IFA) in Austria from the middle of 1977 to the end of 1979. Among the patients with the diagnosis of atypical pneumonia Legionnaires' disease was found in 0.65%. Among those patients whose sera were examined because of suspected legionella infection the frequency was 1.96% (p less than 0.1). Therefore it may assumed that some symptoms of legionella infections may lead to the clinical diagnosis of the disease. Neither the geographical distribution of the cases nor environmental examinations nor the prevalence of antibodies gave any indication of an epidemic or hyperendemic occurrence of Legionnaires' disease in Austria. Low antibody titres to serogroup 1 of Legionella pneumophila (1:32-1:64) were found in 6.4%, higher titres (greater than or equal to 1:128) in 1.2% of all patients examined. Crossreactions of sera mainly occurred between antigens of serogroup 1 and serogroup 2. Antibodies to serogroups 3 and 4 were found seldom. According to our results crossreactivity between L. pneumophila on the one side and Mycoplasma pneumoniae or Chlamydia psittaci on the other side is of no importance and does not interfere with serological diagnosis. In serological routine examinations frequency of recent infections with L. pneumophila in patients with pneumonia was about as high as with Chlamydia psittaci or Picornavirus. To our opinion the expenditure for serological diagnosis is justified in all patients with severe pneumonia of unclear etiology as there exists the possibility of a purposive chemotherapy in legionellosis as it does in mycoplasma pneumonia or ornithosis. Moreover for quick diagnosis it should always be attempted to demonstrate the causative agent by direct immunofluorescence or by isolation.
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PMID:[Epidemiology and diagnosis of Legionella infections in Austria (author's transl)]. 679 7

Sera from six outbreaks of legionellosis and four outbreaks of pneumonia of other etiologies were tested with the indirect immunofluorescence assay (IFA) as currently performed. The current IFA is at least as sensitive as the original test in detecting cases of Legionnaires disease (78 to 91%). By using Center for Disease Control criteria for a positive (fourfold increase in titer during convalescence to greater than or equal to 128) or presumptive (single titer greater than or equal to 256) serological test, the specificity exceeded 99%. No cross-reactions against Legionella pneumophila antigens were observed among sera from epidemic cases of Q fever, tularemia, and psittacosis; the only positive L. pneumophila IFA titer among the epidemic Mycoplasma pneumonia sera was reduced to a negative titer with an immunosorbent extracted from Escherichia coli strain O13:K92:H4. The slight increase in specificity (to 100%), however, was offset by a slight decrease in sensitivity. The sensitivity of the IFA was maximal when a conjugate that detected immunoglobulins G, M, and A was used. IFA titers were not significantly altered by replacing the monovalent serogroup 1 antigen with a polyvalent antigen (serogroups 1 through 4) nor by the presence of rheumatoid factor or heat-labile serum factors.
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PMID:Validation of Legionella pneumophila indirect immunofluorescence assay with epidemic sera. 700 17

Diagnosis of acute, primary extensive pneumopathies provoking severe hypoxemia is particularly difficult, became of the non-specific radiological findings, resulting from the oedema and associated alveolar collapse, and the fact that the clinical picture and biological test results are not very characteristic of a particular etiology. Similar findings may be obtained, therefore, in bacterial pneumopathies so-called typical pulmonary affections, certain forms of acute, tuberculosis, and other types of infection of three patients admitted for acute respiratory insufficiency, two died after treatment with a betalactamine, alone or associated with an aminoside, subsequent serology providing evidence of psittacosis. Diagnosis was immediately established in the third patient, the wife of one of the other cases, and she recovered after erythromycin treatment. The lungs of the two patients that died showed suggestive bronchiolitis and peribronchiolar alveolitis, together with obliterative alveolar granulations and fibrosis, probably secondary to the psittacosis, and responsible for the fatal outcome. Psittacosis as a cause of an extensive pneumopathy of probable infectious origin may easily pass unrecognized, typical etiologies being infections due to pneumococcus, Legionella pneumophila. Mycoplasma pneumoniae, and viruses. Erythromycin, active against these microorganisms, would therefore appear to be the antibiotic therapy that should be prescribed initially, those with wider spectrums being reserved for cases with atypical radiological findings, or when precise bacteriological data is available.
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PMID:[Psittacosis as a cause of acute respiratory distress syndrome (author's transl)]. 710 4

The incidence of bacterial, viral, mycoplasma, and rickettsial infections has been assessed prospectively in 210 adult patients with pneumonia who presented to a district hospital over a six-year period. One hundred and thirteen infective agents were detected in 103 patients. The agent most frequently detected was Mycoplasma pneumoniae which accounted for 30 infections. A bacterial pathogen was found in 43 patients. Streptococcus pneumoniae was the most common of these (24 patients); Staphylococcus aureus (eight), Haemophilus influenzae (four), Klebsiella spp (three), and Legionella pneumophila (three) were all less common. Chlamydial or rickettsial infections (Psittacosis or Q fever) were detected in nine patients. Viral infections were found in 31 patients (22 influenza A, four influenza B, two parainfluenza, and three respiratory syncytial virus). There were 10 patients in whom more than one pathogen was identified. In 107 patients no pathogens could be identified. Seventy-five per cent of these patients had either received antibiotics before entering hospital, or were unable to produce any sputum for culture. The incidence of bacterial pneumonia has probably therefore been underestimated. Nevertheless this survey does emphasise the importance of M pneumoniae as a pathogen in patients with pneumonia presenting to hospital.
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PMID:Causes of pneumonia presenting to a district general hospital. 731 31

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

Over a two year period, we prospectively studied 110 adult patients with Community Acquired Pneumonia (CAP) who presented to the Black Lion Hospital, Addis Ababa, Ethiopia. Pneumococcal infection was diagnosed in 41% by the detection of pneumococcal antigen in sputum and other biologic fluids; in 72% by Gram stain of Lung Aspirate (LA) and in 67.5% by Gram stain of sputum. Blood and Lung Aspirate culture grew Streptococcus Pneumoniae in 4 cases (6%), Staphylococcus Aureus in 4 (6%), Enterobacteriacae in 3(5%), Pseudomonas, Klebsiella Pneumoniae and Strep. Viridans in one case each. Other non-bacterial causes included Mycoplasma Pneumoniae in 4 (4%) Influenza A in 4 (4%), Influenza B in 3 (3%) and Psittacosis/LGV in a 4 (4%). There was no case of Legionnaires disease. 39% had taken treatment before coming to hospital. The mortality was 11%. The study showed that antibiotic treatment during the preceding 36 hours did not affect the outcome of the Gram stain.
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PMID:The etiology of community acquired pneumonia in adults in Addis Ababa. 784 Nov 1

Atypical pneumonia has been recognized for at least four decades as a clinical syndrome characterized by a less severe clinical course than typical bacterial pneumonia. It is caused by a variety of different organisms including Mycoplasma pneumoniae, chlamydiae, rickettsiae, viruses and Legionella pneumophila. Of the chlamydiae, TWAR-strain (Chlamydia pneumonia) is now considered the most important pathogen. Its prevalence in community-acquired pneumonia varies considerably depending on the cyclical nature of the disease, but also on the diagnostic methods applied. The first line therapy in community-acquired pneumonia is usually empirical administration of a penicillin or cephalosporin to cover the bacterial pathogens which usually cause 'typical' pneumonia, most importantly Streptococcus pneumoniae. If, however, atypical pneumonia is diagnosed by bacteriological or serological testing, or is suspected clinically or on the basis of treatment failure, the treatment of choice would be erythromycin 2-4 g or tetracyclines (doxycycline 200 mg) daily for M. pneumoniae pneumonia and C. pneumoniae (TWAR-strain) infection. For coxiella pneumonia tetracycline is preferred. Psittacosis (ornithosis) has a high mortality and must be treated with tetracyclines immediately. Legionella pneumonia is preferably treated with erythromycin 2-4 g for at least three weeks; as an alternative, tetracyclines or quinolones may be given. Quinolones are less effective in mycoplasma and chlamydial infection. The new macrolide antibiotics are promising agents in pneumonia due to M. pneumoniae, L. pneumophila and C. pneumoniae. Compared to erythromycin they have improved pharmacological properties. They have long half-lives allowing once-daily dosing and achieve high tissue and intracellular concentrations.
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PMID:The problems of treating atypical pneumonia. 847 2


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