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

Since July 1976 when an outbreak of severe, acute respiratory disease of unknown origin occurred among attendees at the 58th Annual Convention of the American Legion in Philadelphia, great progress has been made, including identification of the causative organism, Legionella pneumophila. Clinical features include not only respiratory involvement but often abdominal complaints, encephalopathy, renal disease, and rhabdomyolysis. Erythromycin appears to be an effective antimicrobial agent. Epidemiologic studies have defined epidemics as well as sporadic cases. Legionella pneumophila has appeared as an opportunistic pathogen. Organisms have been isolated from air-handling equipment and evaporative condensers in four instances. At present diagnosis usually is based on the demonstration of a fourfold rise in antibody titer between serum specimens obtained 3 to 6 weeks apart. Recent data suggest that organisms may be shown in tracheal secretions using a direct flluorescent antibody procedure and that antigen may be shown in urine using the microenzyme-linked immunosorbent assay (ELISA) technique.
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PMID:Legionnaires' disease: one person's perspective. 37 55

Since the initial description of Legionnaires' disease 2 years ago, a clearer picture of its clinical manifestations has emerged as a result of investigations of further epidemics and studies of laboratory-confirmed sporadic cases. Although individual clinical features are not sufficiently distinctive to distinguish Legionnaires' disease from other types of acute pneumonia, a composite can provide a sufficiently characteristic clinical profile to indicate the likelihood of this diagnosis. Such a profile includes high fever (above 39.4 degrees C); recurrent chills; relative bradycardia; early gastrointestinal symptoms (particularly diarrhea); prominent myalgias; microscopic hematuria; liver function abnormalities; toxic encephalopathy; nonproductive cough; absence of bacterial pathogens on Gram stain and culture of transtracheal aspirate; progression from patchy bronchopneumonia to lobar and multilobar consolidation; and frequently prompt and sometimes dramatic response to treatment with erythromycin.
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PMID:Clinical aspects of Legionnaires' disease. 43 24

Retrospectively, we clinically compared community-acquired cases of Legionnaires' disease, pneumococcal, and mycoplasmal pneumonias. Relative to pneumococcal and mycoplasmal pneumonias, patients with Legionnaires' disease were significantly more likely to present with unexplained encephalopathy, hematuria, and elevation of serum glutamic-oxalacetic transaminase than were those with pneumococcal and mycoplasmal pneumonias. We found upper respiratory symptoms infrequently in patients with Legionnaires' disease, and progression of pulmonary infiltrates occurred commonly. Differentiation of Legionnaires' disease pneumonia without encephalopathy from pneumococcal and mycoplasmal pneumonias may be difficult because of demographic, clinical, laboratory, and radiographic similarities.
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PMID:Comparative features of pneumococcal, mycoplasmal, and Legionnaires' disease pneumonias. 43 31

In 1986, an unusual syndrome of acute febrile cerebrovasculitis in the Piedmont Region of Virginia was reported. All patients had encephalopathy and prior exposure to both a sylvan environment and flea-infested animals. The initial serological studies suggested a rickettsial origin, corroborating clinical, epidemiological, and histopathological findings. Sera from four of five patients were subsequently studied by immunoblotting. Unabsorbed and absorbed sera were tested with electrophoresed and electroblotted Rickettsia typhi, Legionella bozemanii, and Proteus vulgaris OX19 antigens. The unabsorbed sera reacted with all three antigens. The P. vulgaris- and L. bozemanii-absorbed sera reacted with R. typhi only and without significantly less intensity. In contrast, the reactivity of R. typhi-absorbed sera was significantly lower with all three antigens. These results indicate that these patients had specific antibodies to a typhus group antigen. Although our findings suggest that a rickettsia of the typhus group may have caused this syndrome, no definitive diagnosis could be achieved because a rickettsial organism was not isolated.
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PMID:Immunoblot studies to analyze antibody to the Rickettsia typhi group antigen in sera from patients with acute febrile cerebrovasculitis. 172 73

The acquired immunodeficiency syndrome (AIDS) is a devastating new disease caused by the human immunodeficiency virus (HIV). This retrovirus causes profound immunoincompetence in its infected hosts, who are thereafter susceptible to develop myriad severe and relapsing protozoal, fungal, bacterial, viral, and arthropodal opportunistic infections, as well as unusual malignancies. The more than 50,000 patients who have developed AIDS in the United States have produced a sudden unexpected deluge of diagnostic dilemmas that are stressing laboratories of pathology everywhere. This paper describes the gross and microscopic pathology of the numerous complications in patients infected by HIV: (a) the prodromal AIDS-related complex with persistent generalized lymphadenopathy, (b) lymphoid infiltration of salivary gland and lung, including the complex of lymphoid interstitial pneumonitis-pulmonary lymphoid hyperplasia, (c) extranodal non-Hodgkin's lymphomas, (d) multifocal mucocutaneous and visceral Kaposi's sarcoma, (e) small cell undifferentiated (oat cell) carcinomas, (f) protozoal infections caused by Pneumocystis carinii, Toxoplasma gondii, Acanthamoeba, Cryptosporidium species (sp.), and Isospora belli, (g) the causes of chronic enteritis, (h) mycotic infections caused by Candida sp., Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, and Sporothrix schenckii, (i) bacterial infections caused by Mycobacterium avium-intracellulare, M. tuberculosis, M. kansasii, Nocardia sp., Listeria monocytogenes, Legionella sp., Treponema pallidum, and others, (j) viral infections caused by cytomegalovirus, herpes simplex and zoster, polyomavirus (progressive multifocal leukoencephalopathy), hepatitis B, molluscum contagiosum, and papillomavirus, (k) oral hairy leukoplakia, (l) subacute encephalopathy, and (m) Norwegian scabies.
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PMID:The pathology of AIDS. 283 78

The neurologic manifestations of Legionnaires' disease were reviewed in this paper. Nine (42.9%) of 21 patients seen at this institution had neurologic abnormalities during acute infection, comparable to 52% of patients found in the literature. Abnormal mentation was most common, occurring in all our patients and in 29.6% of patients in the literature. Encephalopathy disproportionate to metabolic disturbances varied from mild confusion to coma, was not associated with increased mortality, and tended to resolve with acute illness although some patients reported persistent memory defects. Rarely did these changes in mentation precede the development of pulmonary infiltrates. Headache occurred in two (22.2%) of our patients and in 28.7% of those in the literature. Headache, noted in many febrile illnesses, is common but nonspecific in Legionnaires' disease. Other neurologic abnormalities including cerebellar dysfunction and focal deficits were relatively infrequent and tended to persist beyond resolution of clinical infection. In some cases these neurologic derangements may have occurred coincidentally with Legionnaires' disease. Diagnostic evaluations and autopsies were frequently normal, nonspecific, or revealing of pathology unrelated to infection. Only two patients had evidence of direct invasion of the central nervous system by Legionella, and the cause of encephalopathy and neurologic abnormalities in most cases remains unclear. Patients with neurologic abnormalities and Legionnaires' disease deserve full evaluation to exclude other entities. Only encephalopathy appears to be a characteristic manifestation of Legionnaires' disease.
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PMID:Neurologic manifestations of Legionnaires' disease. 608 42

To add information about sporadic Legionnaires' disease, 87 cases of L. pneumophila pneumonia were reviewed. Twenty cases were nosocomial infections and 67 cases were community-acquired. Most cases (64%) occurred between July and October. The mean age of patients was 51.4 years and males outnumbered females 2.5:1.0. Thirty-one percent of patients were receiving corticosteroid, immunosuppressive, or antineoplastic chemotherapy when illness began. Immunosuppression at onset of illness was more common in nosocomial infections (90%) than in community-acquired infections (14%). Seventy percent of patients had underlying diseases. Malignancies, renal failure, and transplantation were the most common conditions underlying nosocomial infections. Chronic lung disease and malignancies were the most common diseases underlying community-acquired infections. The case-fatality rate in nosocomial infection (70%) was greater than that in community-acquired disease (22%). Clinical, laboratory, and radiologic features of the cases were examined. Illness ranged from mild to severe. Extrapulmonary findings of encephalopathy and renal failure were more common in fatal than in non-fatal cases. Indirect immunofluorescent and microagglutination antibody responses plateaued by the fourth week of illness. Twenty-nine patients died. The case-fatality rate of patients receiving erythromycin (6%) was less than that of patients receiving penicillin (36%), ampicillin (28%), cephalosporin (32%), or aminoglycosides (41%). Despite erythromycin therapy, the case fatality rate for nosocomial L. pneumophilia pneumonia was unacceptably high (25%).
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PMID:Sporadic Legionnaires' disease: clinical observations on 87 nosocomial and community-acquired cases. 646 87

Eight adult patients from Port Elizabeth with significantly raised indirect fluorescent antibody titres of greater than or equal to 256 against the Legionnaires' disease bacterium are described. One of these patients had in addition elevated antibody levels against Mycoplasma pneumoniae. The clinical manifestations of the patients ranged from an 'influenza-like' illness in 1 patient to pneumonia of varying severity in 6. One patient had a severe illness with fever, couth and encephalopathy, together with the uncharacteristic features of lymphadenopathy and a petechial rash. This patient did not have pneumonia. Attention is drawn to unusual clinical aspects in some of the patients and the need for improved definitive diagnostic procedures is emphasized.
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PMID:Legionnaires' disease in Port Elizabeth. 699 44

Six sporadic cases of Legionnaires' disease seen over 13 months in the region of Lake Zurich (Switzerland) are reported. The disease was severe in all cases; 2 patients died while on artificial respiration; 5 patients were heavy smokers; 3 had probably acquired the infection in France. These 6 patients showed the following typical symptoms and signs: fever above 39 degrees C (6 patients), nonproductive cough (4), gastrointestinal symptoms (4), encephalopathy (4), renal insufficiency (5), hepatic involvement (4), bilateral pneumonia (4), and pO2 below 60 mm Hg (4). The disease was diagnosed serologically in all cases and by staining and culturing Legionella pneumophila from lung tissue in one case. The authors propose to treat unusual cases of pneumonia with erythromycin from the outset.
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PMID:[Legionnaires' disease in the Lake Zurich area. Report on 6 sporadic cases]. 720 63

We reviewed retrospectively the clinical records of 30 cases of sporadic Legionella pneumophila infection that occurred in Iowa between FY 1972 and 1978. Cases occurred throughout the year, most between May and December. Twenty-one male patients and 9 female patients ranging in age from 5-80 years were infected. Half the patients smoked or had an underlying illness; five were receiving corticosteroids or immunosuppressive therapy. Occupations and exposures related to hospitals, construction and travel were common; four patients had been exposed to birds. In addition to L. pneumophila infection, six patients had evidence of infection with a viral, mycoplasmal, bacterial, mycobacterial or fungal pathogen; three had had preceding dental infections. Twenty-seven cases were pneumonias visible on radiographs. Fever, cough, chills, myalgia and rales occurred inover half the cases. Headache, gastrointestinal symptoms and encephalopathy also were seen. Upper respiratory symptoms were uncommon. Urinalysis and blood studies often suggested renal and hepatic involvement, but other routine laboratory diagnostic tests were not helpful. All but two patients were hospitalized; seven required intensive care. The median duration of hospitalization was 12 days. Two patients who did not receive erythromycin or tetracycline therapy died.
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PMID:Legionnaires' disease among pneumonias in Iowa (FY 1972-1978) II. Epidemiologic and clinical features of 30 sporadic cases of L. pneumophila infection. 746 37


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