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

The pulmonary histopathologic features in a sporadic case of Legionnaires' disease are shown. The changes include acute bronchitis with focal ulceration and diffuse acute interstitial pneumonitis. These changes are not those seen with typical bacterial pneumonia but are similar to changes seen when viruses, rickettsiae, chlamydiae, or Mycoplasma pneumoniae organisms are the infecting agents.
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PMID:Legionnaires' disease. Clinical and pulmonary histopathologic features of a sporadic case. 67 58

The reliability of bronchoscopy with transbronchial biopsies for the diagnosis of acute graft rejection has recently been questioned. We present our experience with 59 transbronchial and bronchial biopsies and two open-lung biopsies from 12 patients that underwent lung transplantation. The diagnosis of acute rejection was established in 14 biopsies based on the absence of infection and presence of one or more of the following features: perivascular lymphoid infiltrates, usually associated with endothelial swelling; bronchial "acute on chronic" inflammation; and/or angiitis. Problems and potential pitfalls in the diagnosis of acute graft rejection in lung transplant patients are discussed. The biopsies were also sensitive for the diagnosis of cytomegalovirus pneumonitis and fungal infections but were not helpful for the diagnosis of bacterial pneumonias. Indeed, one patient died with Legionella sp. pneumonia diagnosed only on open-lung biopsy after two negative transbronchial biopsies. The significance of other histologic changes, such as nonspecific interstitial pneumonitis, diffuse alveolar damage, acute alveolitis, goblet cell hyperplasia of the bronchial mucosa, and pulmonary infarction, is discussed.
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PMID:Lung transplantation: the pathologic diagnosis of pulmonary complications. 164 51

In a prospective study the efficacy of fiberoptic bronchoscopy was evaluated in the diagnosis of infections with opportunistic pathogens, Kaposi's sarcoma and nonspecific interstitial pneumonitis in 171 episodes of pneumonitis in 151 HIV-infected patients. Samples were collected by suction through the inner aspiration channel of the bronchoscope (n = 164), telescoping plugged catheter (n = 117) and transbronchial lung biopsy (n = 82). A high incidence of infections with pyogenic bacteria (12%), Legionella spp. (5 %) and Mycobacterium tuberculosis were diagnosed (9%). Bronchoalveolar lavage demonstrated a high diagnostic rate in bacterial pneumonia (significance level greater than 10(5) cfu/ml) and a low degree (10%) of contamination (less than 1% squamous epithelial cells). Bronchoalveolar lavage was more effective than the telescoping plugged catheter in yielding a significant number of colonies in patients with bacterial pneumonia previously treated with antibiotics. Nondiagnosed pneumonitis was more frequent in intravenous drug abusers than in homosexual men (p less than 0.001).
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PMID:Fiberoptic bronchoscopic diagnosis of pulmonary disease in 151 HIV-infected patients with pneumonitis. 165 32

Pulmonary infection is a frequent and serious complication following kidney transplantation. Increased susceptibility to infection is due to a decrease in the patient's immunological response caused by immunosuppression through drug administration, and by other influences. The majority of bacterial sources are gram-negative, often hospital strains. The most important gram-positive bacterium is Staphylococcus aureus. Lung tb occurs with a 10-25 times higher frequency than in the rest of the population. Nocardial and Legionella pneumonias are no exception. Candida and Aspergillus are the most common fungus infections. They affect patients weakened by previous bacterial or virus infections. Cytomegalovirus is the most serious among the latter. The disease is usually accompanied by fever, leukopenia, thrombocytopenia and hepatitis. Pneumocystic pneumonia is characterized by a rapid progression of hypoxemia without any marked skiagraphical changes. Disseminated toxoplasmosis affects also the central nervous system simultaneously with the lungs, and the clinical picture shows a combination of interstitial pneumonia and a focal neurological finding with consciousness impairment.
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PMID:[Lung infection after kidney transplantation. I. Etiology, pathogenesis and clinical picture]. 236 54

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

Several studies have concluded that bronchoalveolar lavage (BAL) is a useful technique for diagnosing pulmonary disease in immunocompromised patients, but implementation of a protocol for obtaining, processing, and analyzing BAL specimens in a clinical microbiology laboratory has not been reported. We determined the utility of a laboratory protocol by analyzing 100 BAL specimens from 94 immunocompromised patients. Each BAL specimen was cultured quantitatively for bacteria. A concentrate of each specimen was cultured for fungi, viruses, mycobacteria, and Legionella sp. Slides of the BAL concentrate were prepared by cytocentrifugation and stained by a number of histochemical and fluorescence techniques. Overall diagnostic yields of 81% for infections, 90% for hemorrhage, and 13% for neoplasms were obtained with the patients studied. BAL analysis was incapable of diagnosing drug- or radiation-induced pneumonitis or idiopathic interstitial pneumonitis. After evaluation of the protocol was completed, it was successfully implemented in two university-based clinical microbiology laboratories as a routine diagnostic service.
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PMID:Analysis of bronchoalveolar lavage specimens from immunocompromised patients with a protocol applicable in the microbiology laboratory. 283 15

The guinea pig is the most widely used animal model in the study of Legionellosis. The hamster should also be considered, since it acquires virtually no spontaneous epidemic lung infection, possesses similar cellular immune components observed in other mammals, has a normal body temperature identical to that of man, and is readily available for laboratory investigation. We studied the pathologic findings of four 12 week old inbred London School of Hygiene (LSH) hamsters inoculated intraperitoneally with 0.2 ml of 10(9) organisms per ml suspension of a viable Philadelphia 1 strain of Legionella pneumophila. Four LSH hamsters (control group) received 0.2 ml of sterile phosphate buffered saline, intraperitoneally. All animals of the test group became clinically ill and two of the four spontaneously expired on days 1 and 2 after inoculation. The remainder were sacrificed on day 3. In three out of four animals of the test group, a suppurative peritonitis and an interstitial pneumonitis were observed. It was characterized by infiltrates of neutrophils and macrophages. The test group also exhibited acute splenitis, including microabscesses, and two of four test animals showed hepatic congestion, vacuolization of hepatocytes, and microabscesses. None of the controls appeared sick or died after three days, and neither gross nor microscopic lesions were found at autopsy. Culture results documented L pneumophila in lung and spleen of all test animals and the absence of organisms in the control group. Hence, the LSH hamster is rapidly infected with the Philadelphia 1 strain of L pneumophila given intraperitoneally, and pathological changes can be readily observed. The findings of our study add hamsters to the list of animals susceptible to intraperitoneal infection by L pneumophila.
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PMID:Susceptibility of LSH hamsters to intraperitoneal inoculation with Legionella pneumophila. 394 31

A 4 1/2 month-old infant presented with severe alveolo-interstitial pneumonitis needing intubation and mechanical ventilation. Legionella pneumophila infection was established by a significant increase in antibody titers. The clinical picture was consistent with that of legionnaires' disease. No immune defect could be proven.
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PMID:[Legionella pneumophila pneumopathy in a 4 1/2-month-old infant]. 665 55

Over a 2 1/2 year period, 61 clinical specimens from 41 patients with pneumonia of uncertain etiology were evaluated for the presence of Legionella pneumophila (serogroups 1 to 4) by immunofluorescent antibody techniques. In 13 of 19 patients with Legionnaires' disease, the diagnosis was established by fluorescent antibody (FA) staining of lung biopsies, pleural fluids, or respiratory tract secretions. In the 19 patients with Legionnaires' disease, the diagnosis was confirmed by isolation of L pneumophila by in vitro culture techniques in five or by measurement of serum antibody titers in 17. Although the FA staining technique was of limited sensitivity (68 percent), it was highly specific: no patients with non-Legionnaires' pneumonia had a false-positive fluorescent stain. In addition, the FA staining of lung tissue was positive only when performed during the first nine days of antimicrobial therapy and when an acute bronchopneumonia was noted histologically. In cases of a nonspecific interstitial pneumonitis, FA stain was always negative, and the diagnosis could be confirmed only by serum antibody measurements. Tests for serogroups 1 to 4 with a polyvalent conjugate showed that L. pneumophila serogroup 1 was the predominant strain detected in pneumonia of uncertain etiology in the Detroit area.
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PMID:Direct immunofluorescence in the diagnosis of Legionnaires' disease. 701 23

The current authors present the case of a 68-yr-old female patient who developed severe respiratory failure after medication with ciprofloxacin for acute urinary tract infection. A chronic subdural haematoma was surgical evacuated. Postoperatively, an acute urinary tract infection was treated with ciprofloxacin. Six days later, C-reactive protein was rising and the patient was suffering from intermittent high fever, dyspnoea and severe hypoxaemia. The high-resolution-computed tomography (HRCT) showed an interstitial lung disease in the anterior upper lobe on the left side as well as in the lingula. Assuming a bacterial infection amoxyl/clavulanic acid was started which did not improve the clinical symptoms. Bronchoalveolar lavage revealed a marked lymphocytosis (87%). Analysis for typical bacterial infections, Tuberculosis, Mycoplasma, Chlamydia and Legionella spp. were all negative. Another HRCT scan was made because of worsening of symptoms and this showed rapidly progressive infiltrates in most lobes. An open lingular biopsy showed an interstitial lymphoplasmocytotic infiltrate with some eosinophilic granulocytes and a few scattered giant cell granulomas, consistent with hypersensitivity pneumonitis. The patient's symptoms rapidly improved with systemic corticosteroid therapy and another HRCT scan revealed complete remission of pulmonary infiltrates. Ciprofloxacin can induce interstitial pneumonitis with acute respiratory failure. This is an important fact considering that ciprofloxacin is a widely used antibiotic agent in treatment of urinary tract infection.
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PMID:Ciprofloxacin-induced acute interstitial pneumonitis. 1473 49


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