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

An increase in endemic rate of nosocomial Legionella pneumophila pneumonia prompted an investigation that revealed 16.2% (12/74) of patient care hot-water sites surveyed were culture-positive for L. pneumophila. No positive cultures were recovered from cooling towers, air intakes, or construction areas. Heat flushing of hospital hot-water outlets to temperatures greater than 60 degrees C for 30 min achieved a 66% reduction in positive Legionella cultures. After 4 1/2 months, different serotypes recurred in previously eradicated areas and there were new positive cultures. Continuous supplemental chlorination of the hot-water system (2 parts per million [ppm]) significantly reduced the number of culture-positive samples from 37.4% (43/115) to 7.0% (8/115) after 6 weeks (P less than .005). Of 30 sites surveyed 6 months after hot-water chlorination, 67% (20) were still culture-negative. Of those positive, 70% had less than or equal to 150 L. pneumophila/ml and 90% were from bathtubs. Adverse effects of chlorination on users and plumbing have not been seen. There have been no definite cases of nosocomial L. pneumophila in areas served by supplemental chlorine during the first 17 months of the chlorination project. Technology allowing tighter regulation of chlorine and use of silicates to control corrosion have made continuous hot-water chlorination a safe and effective option in Legionella control.
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PMID:Reduction in Legionella pneumophila through heat flushing followed by continuous supplemental chlorination of hospital hot water. 198 27

Immunologic attempts to detect mycoplasma antigens in fluids of infected patients have been rare and largely unsuccessful. Nucleic acid hybridization procedures appear promising on the basis of successes in detecting mycoplasmal contamination of tissue culture cells; results of attempts to apply these techniques to human infections have not been reported. Antigens can be detected in the urine of about 80% of patients with serogroup 1 Legionella pneumophila pneumonia and of some patients with serogroup 4 Legionella pneumophila and Legionella dumoffii pneumonia. The specificity of these assays is greater than 99%. In a test population in which the prevalence of Legionella pneumophila was 4%, the posterior probabilities of positive and negative results of tests for antigen were 86.5% and 99.3%, respectively. Antigen is detectable within the first 3 days of illness approximately as often as at later periods, and antigen may remain detectable for a few days to 1 yr after successful therapy. Antigen is detectable in serum, but the concentrations are considerably lower than in urine. Combining urinary antigen detection with direct fluorescent antibody examination of secretions increases the rapid diagnostic yield by 10%-20%. Monoclonal antibody studies demonstrate that subgroup specificities are present among the serogroup 1 urinary antigens. Radiometric and enzyme immunoassays detect antigen in equal proportions of patients. Latex agglutination results are positive in about 80% of those cases positive by the other methods.
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PMID:Antigen detection for the rapid diagnosis of mycoplasma and Legionella pneumonia. 242 69

An outbreak of Legionella pneumophila pneumonia occurred in 6 of 49 new renal transplant recipients over the course of 13 months. We compared infected patients (cases) and uninfected patients (controls) with respect to potential risk factors. Corticosteroid use, need for hemodialysis and number of days of hemodialysis were significantly greater among the cases. Logistic regression analysis identified corticosteroid dosage and number of days of hemodialysis as independent risk factors. Lymphopenia and monocytopenia were correlated with the amount of corticosteroid administered and occurred to a greater degree in the cases. All clinical isolates were of L. pneumophila serogroup 1, subtype Philadelphia 1, which was also cultured from a recovery room sink outside the operating room where the transplants were done. Other areas of the hospital were colonized with other, heterogeneous strains of L. pneumophila. The organism was not eliminated from the hospital water supply despite shock chlorination and superheating of water tanks. The epidemic ended when new transplant recipients routinely received prophylactic trimethoprim-sulfamethoxazole (160-800 mg given orally once daily) while in hospital after transplantation. Corticosteroid-induced monocytopenia and lymphopenia and the complement activation and monocyte depletion effects of hemodialysis may combine to increase susceptibility to Legionnaires' disease.
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PMID:Epidemic of nosocomial Legionnaires' disease in renal transplant recipients: a case-control and environmental study. 265 Aug 36

The commonest infectious agents identified in community acquired pneumonia (CAP) amongst 50 patients admitted to a Dublin hospital were Streptococcus pneumoniae and Haemophilis influenzae. Legionella pneumophila pneumonia occurred in only one patient who acquired infection abroad. A serological screen of blood bank donors and renal transplant recipients failed to detect antibody to Legionella pneumophila supporting the clinical findings of a low prevalence of infection in this community. It is concluded that initial antibiotic therapy for patients with CAP need not routinely include cover for Legionella.
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PMID:Legionella: an infrequent cause of adult community acquired pneumonia in Dublin. 279 4

Lung abscess is an infrequently reported complication of Legionella pneumophila pneumonia associated with a high mortality rate. The risk factors, natural course, optimal method of diagnosis, and optimal therapy of this complication are not well defined. One case of Legionella pneumophila lung abscess occurring in a patient with systemic lupus erythematosus is described, and the reports of 26 other cases are reviewed. This complication is usually hospital-acquired and occurs predominantly in transplant recipients and systemic lupus erythematosus patients treated with corticosteroids with or without a cytotoxic drug. The time interval between the onset of immunosuppressive therapy and infection is usually of several weeks. Progression from pneumonia to abscess formation may be rapid, more commonly within an upper lobe. Transthoracic aspiration within the abscess cavity may be diagnostic, thus obviating the need for open lung biopsy. The prompt institution of erythromycin 4 gm daily intravenously followed by oral therapy for at least 4 weeks is associated with a high survival rate. Adequate drainage from the abscess cavity must be maintained. Radiologic healing may be slow. Long-term survival without relapse does occur. That the clinical spectrum of Legionella pneumophila infection includes lung abscess has not been sufficiently emphasized. This agent should be considered early in the differential diagnosis of lung abscess.
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PMID:Legionella pneumophila lung abscess in a patient with systemic lupus erythematosus. 359 19

Despite the fact that the epidemiology of community-acquired pneumonia and nosocomial Legionella infection is well known, there are no specific reports dealing with severe cases of Legionella pneumophila pneumonia admitted to intensive care units. We undertook a prospective study upon 84 patients with a reliable diagnosis of L. pneumophila pneumonia that required ICU admission. The study assessed the prognostic factors, clinical, radiological and outcome variables of both nosocomial (n = 33) and community-acquired (n = 51) cases of L. pneumophila pneumonia. The following variables were more common in nosocomial acquired as compared to community-acquired Legionella pneumonia: Chronic obstructive pulmonary disease (COPD) (64 versus 41%), cardiac disease (39 versus 10%), chronic renal failure (21 versus 4%), alcoholism (54 versus 18%), septic shock (33 versus 16%), and unilateral chest X-ray involvement (61 versus 39%). The crude mortality rate in this study was 30% (25 of 84) with no differences when comparing mortality between nosocomial (9, 27%) to community-acquired (16, 31%) types. The univariate analysis showed that cardiac disease, diabetes mellitus, creatinine > or = 1.8 mg/dl, septic shock, chest X-ray extension, mechanical ventilation, hyponatremia < or = 136 mEq/L, PACO2/FIO2 < 130, and blood urea levels > or = 30 mg/dl were factors related to poor outcome. On the other hand, the following two variables were related to better outcome: adequate treatment for Legionella and pneumonia improvement. The logistic regression analysis demonstrated that APACHE II score > 15 at admission (RR: 11.5; 95% CI 1.75 to 76.1; p = 0.025), and serum Na levels < or = 136 (RR: 21.3; 95% CI 1.11 to 408; p = 0.023), were the only independent factors related to death. On the other hand, improving pneumonia is associated with better outcome in Legionnaires' disease than for patients not having improving pneumonia (RR: 0.019; 95% CI: 0.036 to 0.106; p < 0.0001). A better understanding of the prognostic factors in cases of severe Legionella pneumonia will optimize our therapeutic approach in this disease and help to decrease both its mortality and morbidity rates.
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PMID:Prognostic factors of severe Legionella pneumonia requiring admission to ICU. 998 59

Digestive disorders in Legionella pneumophila pneumonia such as nausea, vomiting, diarrhoea, are common; they are clinical arguments to suspect this bacteria to be responsible for this pneumonia. In this case-report, a patient with pneumonia due to Legionella pneumophila serogroup I presented in the follow-up with signs of enteritis with ascites. We looked ahead in literature who made us discover the multiple organ involvement that may happen in Legionnaires' disease. Diagnostic procedures consist in simple tests as ultrasonography, abdominal computerised tomography, that show inflammatory disease signs and sometimes ascites. Exceptionally, Legionella pneumophila has been demonstrated with direct immunofluorescent microscopic study, in inflammatory colitis pieces with haemorrhagic necrosis in different stage processes. Pathogenesis could be explained by the systemic spread of the organism and formation at distance of necrotising enteritis focus. It is initiated by necrotising factors of bacterial origin and hypersensitivity reactions (type I and III).
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PMID:[Digestive disorders and Legionnaires' lung disease. Accompanying signs or visceral location?]. 1085 68

We report a case of Legionella pneumophila pneumonia in a 7-day old neonate. Because the hospital water, and particularly the pool water for water birthing, was contaminated by L. pneumophila serogroup 1, the newborn was infected following prolonged delivery in contaminated water, perhaps by aspiration. This is the first case of nosocomial Legionella pneumonia in neonate after water birth.
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PMID:Legionella pneumophila pneumonia in a newborn after water birth: a new mode of transmission. 1156 55

Iron plays a crucial role in the energy metabolism of microorganisms. Humans have developed iron-withholding mechanisms as a form of non-specific immunity. We describe a patient with iron overload and severe Legionella pneumophila pneumonia. This report emphasizes the importance of early consideration of and appropriate therapy against Legionella for patients with iron overload who present with community-acquired pneumonia.
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PMID:Severe Legionella pneumophila pneumonia in a patient with iron overload. 1247 34

The aim of this prospective study was to compare patient characteristics, clinical data, and evolution of Legionella pneumophila pneumonia according to the duration of Legionella urinary antigen excretion. Urine samples from 61 patients with Legionella pneumonia diagnosed by detection of urinary antigen were obtained periodically until urinary antigen could no longer be detected. Cases were divided into two groups based on the duration of urinary antigen excretion: group I (46 patients, <60 days) and group II (15 patients, >or=60 days). Groups were compared for patient characteristics, clinical data, and evolution of pneumonia. Antigen excretion >or=60 days was observed significantly more frequently in immunosuppressed patients ( P=0.001) in whom the time to apyrexia was >72 h ( P=0.002), although only the time to apyrexia remained significant on multivariate analysis ( P=0.006). In conclusion, the duration of Legionella urinary antigen excretion was <60 days in most patients but was longer in immunosuppressed patients with a longer time to defervescence of fever.
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PMID:Factors related to persistence of Legionella urinary antigen excretion in patients with legionnaires' disease. 1252 18


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