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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

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

The bacteriological study of sputa, nasopharyngeal smears and bronchial washings taken from pneumonia patients has shown that the leading etiological agent was Streptococcus pneumoniae isolated in the diagnostic titre (10(7) bacteria per ml) in 78.1% of the cases. Staphylococcus aureus, Haemophilus influenzae, enterobacteria and yeast-like fungi have been found to play an insignificant role in the etiology of acute pneumonia (2.5 +/- +/- 0.9%). The results of the serological diagnosis by means of the complement fixation test have revealed that, alongside S. pneumoniae, the following infective agents are of etiological importance in cases of acute pneumonia: respiratory viruses (more than 50%), Mycoplasma pneumonia (10%), Chlamydia psittaci (6.4%) and Legionella pneumophila (3.8%). The study has first revealed that, under the conditions of Alma-Ata, serotypes 19, 23, 8 and 4 prevail among circulating pneumococci. This study has also shown that the use of M. pneumoniae antibody erythrocyte diagnosticum enhances the detection rate of mycoplasma infections in pneumonia patients.
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PMID:[Etiological structure of pneumonias in children and adults]. 296 Jan 6

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

During autumn 1992, we observed two unrelated family outbreaks of Chlamydia pneumoniae infection. Family A consisted of grandmother (aged 77 yrs), father (aged 41 yrs), mother (aged 38 yrs), daughter (aged 10 yrs), and two sons (aged 6 yrs and 3 months, respectively). The grandmother and daughter suffered from pneumonia, father from pharyngitis and bronchitis and the older son from mild bronchitis. No symptoms were recorded in the mother and younger son. Symptomatic subjects showed a fourfold increase in immunoglobulin G (IgG) titre for Chlamydia pneumoniae, determined by a microimmunofluorescence test with specific antigen (TW-183). Other serological studies against Mycoplasma pneumonia, Legionella pneumophila, influenza virus type A and B, adenovirus and respiratory syncytial virus (RSV) were negative. Sputum culture gave a positive result for Haemophilus influenzae, colony forming units (cfu) = 10(4).ml-1 in the grandmother. No serum positivity was recorded in the mother and younger son, who remained asymptomatic. All symptomatic patients were successfully treated with macrolides. Family B consisted of mother (aged 63 yrs) and daughter (aged 36 yrs). Both suffered from Chlamydia pneumoniae pneumonia. Diagnosis was made by means of serological microimmunofluorescence test, and direct identification using an indirect immunofluorescence test on pharyngeal swab. Sputum culture and other serological tests remained negative. Both patients were successfully treated with macrolides. These observations emphasize the relevance of Chlamydia pneumoniae in family cluster respiratory infections.
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PMID:Two family outbreaks of Chlamydia pneumoniae infection. 814 7

In a 5-year period, 254 patients with community-acquired pneumonia were attended to. Transtracheal aspiration (TTA) could be performed on 119 patients, blood cultures were performed on 201 patients, and 74 patients underwent serologic examinations. By use of these procedures, an etiologic diagnosis was established in 93 cases. Streptococcus pneumoniae was the most common pathogen as it was found in 35 cases. Eleven of these 35 patients (31.4 percent) had pneumococcemia, and the mortality in this group was 27.3 percent. None of the patients with pneumococcal pneumonia and negative blood culture died. Haemophilus influenzae was the only isolated pathogen from transtracheal aspirated sputum in 16 cases and accounted for 17.5 percent of pneumonias in previous healthy individuals under 50 years of age. Mycoplasma pneumonia infections, Legionella pneumophila infections, and Chlamydia infections were found in ten, eight, and three cases, respectively. The overall agreement between microscopy and culture of respiratory secretions obtained by TTA was 58.8 percent, and microscopy can be a guide when choosing the initial antibiotic treatment. No statistically significant difference in the rate of isolating bacteria among patients treated with antibiotics prior to TTA and patients not previously treated with antibiotics was seen. When contraindications were respected, we found TTA to be a safe procedure.
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PMID:Etiology of community-acquired pneumonia. Evaluation by transtracheal aspiration, blood culture, or serology. 822 95

Pneumonias caused by atypical organisms usually have extra-pulmonary features. Chlamydial pneumonia often starts with hoarseness and fever, and respiratory tract symptoms may not appear for days. Mycoplasmal pneumonia may manifest with ear pain and a nonproductive cough. Legionnaires' disease presents with high fevers and central nervous system and gastrointestinal abnormalities. Diagnosis of chlamydial infection is accomplished with serologic testing. Patients are unresponsive to erythromycin treatment and should be started on empirical doxycycline (Doryx, Vibramycin) therapy. The presence of cold agglutinins in the appropriate clinical setting permits a presumptive diagnosis of mycoplasmal infection. Clinical diagnosis of Legionella pneumonia may be made in patients with pneumonia who also have relative bradycardia with elevated serum transaminases or hypophosphatemia with gastrointestinal or central nervous system symptoms. Erythromycin is the mainstay of treatment of legionnaires' disease, but treatment failures have been reported. Doxycycline is less expensive, has a better safety profile, and is better tolerated than erythromycin.
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PMID:Atypical pneumonias. Clinical and extrapulmonary features of Chlamydia, Mycoplasma, and Legionella infections. 849 98

Procedures for the microbiological diagnosis of acute community-acquired pneumonia are based on the expected pathogens. Although a great variety of microorganisms are able to cause community-acquired pneumonia only a few pathogens play an important role in daily practice. The most important investigations are blood cultures and sputum cultures to detect bacteria like pneumococci, Haemophilus influenzae and Staphylococcus aureus as well as antibody tests for Mycoplasma pneumonia and Chlamydia pneumonia. According to anamnesis and clinic presentation tests such as for Legionella or viruses have to be added. Sometimes also rare pathogens have to be considered such as Coxiella burnetii, Leptospira, Hantaviruses, cryptococci or Chlamydia psittaci. The standard procedure for diagnosis of tuberculosis is the microscopical examination and the standardized culture in liquid and on solid media. Amplification methods such as PCR are also useful for a rapid diagnosis. However, the application of amplification procedures alone without culture is not recommended.
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PMID:[Community-acquired pneumonia--current status of pathogen diagnosis]. 920 30

Concern about emerging and reemerging respiratory pathogens prompted the development of a respiratory disease reference laboratory at the Naval Health Research Center. Professionals working in this laboratory have instituted population-based surveillance for pathogens that affect military trainees and responded to threats of increased respiratory disease among high-risk military groups. Capabilities of this laboratory that are unique within the Department of Defense include adenovirus testing by viral shell culture and microneutralization serotyping, influenza culture and hemagglutination inhibition serotyping, and other special testing for Streptococcus pneumoniae, Streptococcus pyogenes, Mycoplasma pneumonia, and Chlamydia pneumoniae. Projected capabilities of this laboratory include more advanced testing for these pathogens and testing for other emerging pathogens, including Bordetella pertussis, Legionella pneumoniae, and Haemophilus influenzae type B. Such capabilities make the laboratory a valuable resource for military public health.
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PMID:The Naval Health Research Center Respiratory Disease Laboratory. 1092 Jun 35

To clarify the etiology of community-acquired pneumonia (CAP) in Japan, the causative pathogens were prospectively investigated in adult patients admitted to Kurashiki Central Hospital. The microbiological diagnosis was based on the results of quantitative sputum culture, blood culture, and other invasive procedures, including transthoracic needle aspiration or bronchoscopic examination. Five hundred fifty-two episodes of CAP in 540 patients were admitted between July 1994 and June 1999. Causative pathogens were identified in 353 episodes (63.9%). Several characteristics about the etiology of CAP in Japan were recognized: 1) Streptococcus pneumoniae is the most common pathogen followed by Haemophilus influenzae; 2) Mycoplasma pneumonia is dominant among young patients; 3) Chlomydia pneumoniae is one of the significant pathogens in Japan as well as in western countries; 4) Streptococcus milleri group and anaerobes are important pathogens in patients with suppurative pulmonary diseases; 5) The incidence of Legionella pneumonia is far lower than in western countries; 6) The prevalence of tuberculosis in CAP is still high in Japan; etc. Recognition of these results will lead us to treat patients with prompt antimicrobial therapy.
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PMID:[Etiology of community-acquired pneumonia among adult patients in Japan]. 1257 85


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