Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over a period of 4 consecutive yr, 92 nonimmunosuppressed patients (21 women and 71 men aged 53 +/- 16 yr, means = SD) with critical acute respiratory failure (PaO2/FiO2, 209 +/- 9 mm Hg) caused by severe community-acquired pneumonia were admitted to the respiratory intensive care unit (RICU) of a general hospital. The most frequent underlying clinical condition was chronic obstructive pulmonary disease (44 patients, 48%). A total of 56 patients (61%) required mechanical ventilation for a mean period of 10.7 +/- 12.5 days, 29 of them (52%) needing PEEP (9.9 +/- 3.8 cm H2O). A group of 23 (25%) patients had criteria of adult respiratory distress syndrome (ARDS). A causal microorganism was identified in 48 patients (52%), the two most frequent etiologies being Streptococcus pneumoniae (14, 15%) and Legionella pneumophila (13, 14%). Pseudomonas aeruginosa (5, 5%) was always associated with bronchiectasis. Mortality due to severe community-acquired pneumonia was 22% (20 patients). According to univariate analysis, mortality was associated with anticipated death within 4 to 5 yr, inadequate antibiotic treatment before RICU admission, mechanical ventilation requirements, use of PEEP, FIO2 greater than 0.6, coexistence of ARDS, radiographic spread of the pneumonia during RICU admission, septic shock, bacteremia, and P. aeruginosa as the cause of the pneumonia. Further, recursive partitioning analysis selected two factors significantly related to the prognosis: the radiographic spread of the pneumonia during RICU admission and the presence of septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Severe community-acquired pneumonia. Epidemiology and prognostic factors. 185 53

Isolation of Legionella pneumophila sero-group 1 with serological evidence of present infection is reported from a 40 year-old male with serious respiratory infection which developed into acute respiratory failure. It was characterized by severe hypoxemia resistant to high inspired oxygen concentrations and radiographically by diffuse infiltrates in both lungs suggesting the clinical aspect of ARDS. Following the introduction of clindamycin, amikacin, ceftriaxone, volume-cycled ventilator and positive end expiratory pressure (PEEP) of 14 cm H2O, stabilization of clinical conditions and gradual recovery were achieved. Suspecting of legionellosis, blood and tracheal secretions specimens were collected for specific laboratory research. From tracheal secretion cultivated in BCYE medium, gran-negative bacilli were isolated and identified as Legionella pneumophila serogroup 1 through cultural and biochemical characteristics and direct immunofluorescence and slide agglutination tests. Serology (IFA) with blood samples collecting during the 1st, 3rd, 4th and 6th weeks of illness demonstrated antibody titers to the isolated microorganism of 128, 1024, 4096 and 8192, respectively. Definitive results were obtained during the patient's recovery. The authors emphasize: a) the demonstration of the presence of Legionella sp. as a pathogenic agent in Brazil; b) the importance of supportive care in the clinical outcome; c) the need of remembering this pathogen while making differential diagnosis of pneumonias and of continuing to pursue this etiology with specific laboratory methodology.
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PMID:[Legionella pneumophila associated with acute respiratory insufficiency. 1st isolation in Brazil]. 270 Nov 94

We describe a previously healthy man who presented with features consistent with Wegener's granulomatosis. While undergoing investigation, he developed acute respiratory failure, thought to represent progression of his vasculitis. Open lung and sinus biopsies were performed to obtain the diagnosis. Vasculitis was confirmed on the paranasasl biopsy, and the lung biopsy showed pneumonia due to Legionella pneumophila, an association not previously reported in Wegener's granulomatosis. If immunosuppressive therapy had been started without making the diagnosis of Legionella pneumonia on lung biopsy, the patient might well have succumbed to the infection.
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PMID:Legionella pneumonia complicating Wegener's granulomatosis. 318 Aug 64

A patient with a clinical course consistent with Legionnaires' disease rapidly developed acute respiratory failure. Sputa and bronchoscopic washings revealed many polymorphonuclear leukocytes but no organisms on gram stain and culture. The diagnosis of Legionnaires' disease was strengthened when the transthoracic aspirate revealed weakly staining gram-negative bacilli with no growth noted on culture. Serologic titers confirmed the diagnosis of Legionnaires' disease. This patient's course was complicated by cavitation which responded to medical therapy with erythromycin. This is the second reported case of Legionnaires' lung abscess.
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PMID:Legionnaires' lung abscess. 738 19

A 72-year-old man was admitted to our hospital because of acute respiratory failure. Initially he had been diagnosed as having pneumonia in the lower left lung field and treated with cephem antibiotics by a local physician. Chest X-ray photograph revealed wide-spread infiltrates throughout both lungs, and chest CT scan revealed pleural effusions. The partial pressure of oxygen in arterial blood was 45.8 Torr. In the bronchoalveolar lavage fluid (BALF) specimen, legionella DNA was detected by the polymerase chain reaction (PCR) method. Thus, we were able to diagnose Legionella pneumonia immediately, and to treat the patient successfully.
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PMID:[A patient with Legionella pneumonia diagnosed early by the PCR method]. 808 49

A 48-year-old male developed acute respiratory failure owing to Legionnaires' disease (LD). Antibiotic treatment including erythromycin and rifampicin was not effective, thus transbronchial lung biopsy was performed. The histological examination of the lung showed intra-alveolar fibrosis. Corticosteroid therapy was begun and he responded well with definite clinical improvement. Bronchoalveolar lavage (BAL) was performed three times in the following year. The first BAL showed an increase of lymphocytes which then decreased significantly in the following studies. This case report thus demonstrates the importance of lung biopsy of protracted LD and the usefulness of BAL in the assessment of corticosteroid therapy.
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PMID:Serial bronchoalveolar lavage studies in a patient with intra-alveolar fibrosis following Legionnaires' disease. 831 67

Multifocal alveolar hypoxaemic pneumonia caused by sporadic nosocomial infection led to acute respiratory failure and development of cavitations. Legionella pneumophilia type I was isolated. The patient was not in a state of immunosuppression other than that due to Cushing's disease recently treated surgically followed by corticosteroids. Specific clinical and radiological signs of Legionellosis (particularly the development of cavitation) and their mode of infection (community acquired or noscomial, sporadic or epidemic, immunocompetence or immunodepression) are discussed.
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PMID:[Hypoxemic nosocomial pneumonia developing in excavation in a patient with Cushing disease]. 874 27

We performed an observational analysis of prospectively collected data on 1,474 adult patients who were hospitalized for community-acquired pneumonia; 1,169 patients were under 80 years of age and 305 (21%) patients were over 80 years ("very elderly"). Mean patient ages were 60 years in the former group and 85 years in the latter group. Severely immunosuppressed patients and nursing-home residents were not included. Comorbidities significantly associated with older age were chronic obstructive pulmonary disease, chronic heart disease, and dementia. The most common causative organism was Streptococcus pneumoniae (23% in both groups). Aspiration pneumonia was more frequent in the very elderly (5% in younger patients versus 10% in the very elderly); Legionella pneumophila (8% in younger patients versus 1% in the very elderly) and atypical agents (7% in younger patients versus 1% in the very elderly) were rarely recorded in the very elderly. While very elderly patients complained less frequently of pleuritic chest pain, headache, and myalgias, they were more likely to have absence of fever and altered mental status on admission. No significant differences were observed between groups as regards incidence of classic bacterial pneumonia syndrome (60% versus 59%) in 343 patients with pneumococcal pneumonia. The development of inhospital complications (26% in younger versus 32% in very elderly patients) as well as early mortality (2% in younger versus 7% in very elderly patients) and overall mortality (6% in younger versus 15% very elderly patients) were significantly higher in very elderly patients. Acute respiratory failure and shock/multiorgan failure were the most frequent causes of death, especially of early mortality. Factors independently associated with 30-day mortality in the very elderly were altered mental status on admission (odds ratio, 3.69), shock (odds ratio, 10.69), respiratory failure (odds ratio, 3.50), renal insufficiency (odds ratio, 5.83), and Gram-negative pneumonia (odds ratio, 20.27).
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PMID:Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. 1279 2

Severe community-acquired pneumonia (CAP) is a life-threatening condition that requires intensive care unit (ICU) admission. Clinical presentation is characterized by the presence of respiratory failure, severe sepsis, or septic shock. Severe CAP accounts for approximately 5-35% of hospital-treated cases of pneumonia with the majority of patients having underlying comorbidities. The most common pathogens associated with this disease are Streptococcus pneumoniae, Legionella spp., Haemophilus influenzae, and Gram-negative enteric rods. Microbial investigation is probably helpful in the individual case but is likely to be more useful for defining local antimicrobial policies. The early and rapid initiation of empiric antimicrobial treatment is critical for a favorable outcome. It should include intravenous beta-lactam along with either a macrolide or a fluoroquinolone. Modifications of this basic regimen should be considered in the presence of distinct comorbid conditions and risk factors for specific pathogens. Other promising nonantimicrobial new therapies are currently being investigated. The assessment of severity of CAP helps physicians to identify patients who could be managed safely in an ambulatory setting. It may also play a crucial role in decisions about length of hospital stay and time of switching to oral antimicrobial therapy in different groups at risk. The most important adverse prognostic factors include advancing age, male sex, poor health of patient, acute respiratory failure, severe sepsis, septic shock, progressive radiographic course, bacteremia, signs of disease progression within the first 48-72 hours, and the presence of several different pathogens such as S. pneumoniae, Staphylococcus aureus, Gram-negative enteric bacilli, or Pseudomonas aeruginosa. However, some important topics of severity assessment remain controversial, including the definition of severe CAP. Prediction rules for complications or death from CAP, although far from perfect, should identify the majority of patients with severe CAP and be used to support decision-making by the physician. They may also contribute to the evaluation of processes and outcomes of care for patients with CAP.
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PMID:Optimizing treatment outcomes in severe community-acquired pneumonia. 1472 21

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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