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

Fourteen open lung biopsies were done in 13 patients out of a total of 63 heart transplant recipients. All of the patients were receiving cyclosporine and azathioprine (Imuran) and had received prophylactic antithymocyte globulin or murine antihuman mature T cell (OKT3). Eight of the patients were receiving steroids, and five of the patients had been weaned off steroids. A fever of greater than 38.5 degrees C was present in all 13 patients. Hypoxia, defined as PO2 less than 60 on room air, was present in 11 of the 13 patients. One patient had to be intubated before surgery for respiratory failure. The chest x-ray film most often revealed bilateral interstitial infiltrates. The operative approach was by a small anterior thoracotomy in 12 patients and a posterolateral thoracotomy in two patients. A definitive diagnosis was made in 11 of the 14 open lung biopsies: three patients had Legionella, one had cytomegalovirus (CMV), one had a Pseudomonas infection, three had Pneumocystis, one patient had CMV and Pneumocystis, one patient had a pulmonary infarct, and one patient had a pulmonary infarct and CMV. Specific therapy was instituted in all these patients. In the three patients in whom no specific diagnosis was made, therapy was also changed and the use of antibiotics discontinued. There was no mortality in this group. Morbidity was minimal. No patient had excessive bleeding, and none of the patients required the transfusion of blood or blood products. Three patients required mechanical ventilatory support for longer than 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early, aggressive open lung biopsy in heart transplant recipients. 330 35

We reviewed records of patients with hematologic malignancy requiring mechanical ventilation (MV) from 1976 to 1985 (excluding postoperative MV less than 48 hours). There were 119 episodes in 116 patients. In-hospital mortality was 82 percent. Of 21 (18 percent) episodes survived, median duration of survival was 12 months. Survivors did not differ from nonsurvivors in age, leukocyte count, or duration of MV. Survival for chronic lymphocytic leukemia was 42 percent, for other leukemias 16 percent, Hodgkin's disease 29 percent, and non-Hodgkin's lymphomas, 6 percent. Bronchoscopy was performed in 28 patients, resulting in a diagnosis of infection, hemorrhage, or malignancy in 19 cases. Open lung biopsy (OLB) was obtained in 23 patients, yielding a diagnosis of interstitial inflammation or fibrosis (13 cases), drug effect (three), malignancy (two), hemorrhage (one), Pneumocystis (seven), aspergillosis (two), and Legionella (one). Only two patients survived following OLB. Despite intensive management and adequate diagnosis, respiratory failure in patients with hematologic malignancy carries a high mortality. Although these data may help identify groups with a limited prognosis for long-term recovery, patient care must be individualized.
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PMID:Outcome of respiratory failure in hematologic malignancy. 338 63

During a recent nosocomial outbreak, 20 critically ill patients with acute Legionnaires' disease were admitted to the intensive care unit of Hopital Bichat, Paris. Pulmonary specimens were obtained at surgery or immediately after death in 12 patients and were examined by light, immunofluorescent, and electron microscopy. Five of these 12 patients showed evidence of pulmonary fibrosis. In all of these five patients, infection with Legionella pneumophila was evidenced by bacteriologic methods, and other diseases known to cause fibrosis were excluded. The condition of four patients deteriorated rapidly with respiratory failure, and they died with pulmonary fibrosis. Only one patient finally recovered but was left with pulmonary sequelae. Two distinctive morphologic patterns were observed, one in which interstitial fibrosis was predominant and one in which intra-alveolar organization and fibrosis were also present. The alveolar epithelial lining and the basement membranes were disrupted in all patients, as evidenced by ultrastructural observations and by immunofluorescent studies showing gaps in the distribution of type 4 collagen and laminin. Types 1 and 3 collagen accumulated in areas corresponding to thickened interstitium and intra-alveolar fibrosis. Thus, some patients who survive the acute pneumonia of Legionnaires' disease may develop pulmonary fibrosis, and this process may lead to functional impairment or death despite prompt and appropriate treatment.
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PMID:Pulmonary fibrosis following pneumonia due to acute Legionnaires' disease. Clinical, ultrastructural, and immunofluorescent study. 353 46

To assess the role of open lung biopsy in patients with the acquired immunodeficiency syndrome (AIDS), we retrospectively reviewed the cases of 42 patients with AIDS who underwent this procedure for the diagnosis of pulmonary infiltrates. Four patients had no preceding bronchoscopy because the severity of the respiratory failure or abnormalities of coagulation precluded the safe performance of this procedure. Twenty-nine cases had a preceding nondiagnostic bronchoscopic procedure, and nine others underwent open lung biopsy because of progressive deterioration despite treatment for diseases diagnosed bronchoscopically. We found that open lung biopsy was likely to be useful diagnostically when bronchoscopy could not be safely performed or when a preceding bronchoscopic procedure was not diagnostic. Open lung biopsies done on patients whose condition continued to deteriorate despite treatment for disorders established bronchoscopically were not likely to yield information therapeutically useful. In only one of nine such cases was a new treatable diagnosis obtained (Legionella). The others showed either severe pulmonary fibrosis or persistence of the initial disease process diagnosed at the time of bronchoscopy.
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PMID:The role of open lung biopsy in patients with the acquired immunodeficiency syndrome. 356 70

The protean manifestations of Legionnaires' disease are described in an analysis of 12 sporadic cases. Two forms of the disease have been delineated. One variant (Group A) consisted of six patients who had a mild form of non-progressive pneumonia with minimum extra-pulmonary involvement. Six patients (Group B) were differentiated by rapidly progressive pulmonary infiltrates, severe hypoxia and respiratory failure, plus a higher frequency of band neutrophils and extra-pulmonary manifestations. Particularly notable were evidence of severe myositis (elevated creatinine phosphokinase and lactate dehydrogenase), anaemia, and neurological findings which included alterations in the sensorium, meningitis, and convulsions. Cerebrospinal fluid (CSF) abnormalities were seen frequently in patients with neurological manifestations, and necropsy findings in one patient suggested that the Legionnaires' bacillus was capable of producing a fatal leucoencephalitis. Renal findings included haematuria, proteinuria and oliguric renal failure. Hepatic transaminases (SGPT, SGOT) were elevated in six patients and serum bilirubin was abnormal in five. Alkaline phosphatase values were normal to minimally elevated. The gastrointestinal symptoms commonly considered to be a frequent initial manifestation of Legionnaires' disease were rare in this series. Recommendations for instituting empirical therapy, based upon recognition of a clinical syndrome which should suggest the diagnosis of Legionnaires' disease, are included.
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PMID:The protean manifestations of Legionnaires' disease. 663 Oct 29

Eight patients with Legionnaires' disease were seen at one hospital in the summer of 1979. They presented in the same 12-day period with an illness of rapid onset characterized by fever, chills, malaise, profuse sweating and neurologic symptoms. Neutrophilia, a high erythrocyte sedimentation rate, proteinuria, hypoalbuminemia, hyponatremia, hypochloremia and abnormal liver enzyme levels in the serum were usually noted. The roentgenographic findings in the lungs ranged from segmental interstitial infiltration to panlobar pneumonia. Seven patients responded to erythromycin treatment, though one died suddenly, presumably of unrelated cardiac disease. The other patient died of a combination of renal and respiratory failure, with pulmonary edema.
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PMID:Eight cases of Legionnaires' disease. 700 76

Four severe cases of Legionnaires' disease are described. In addition to multilobar pneumonia with respiratory failure, involvement of the central nervous, cardiovascular, renal, hepatic and coagulation systems had occurred. Adult respiratory distress syndrome complicated respiratory management. Early development of acute renal failure was associated with a poor prognosis. Erythromycin was the most commonly used antibiotic. Review of stored pathological material from patients who died from unidentified pneumonias enabled confirmation of the existence of Legionnaires' disease in Australia in 1974.
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PMID:Legionnaires' disease in South Australia. Four case reports. 739 74

Seven cases of fulminant Legionnaires' disease treated at Kitasato University Hospital between 1985 and 1992 were reviewed. These patients were male with a mean age of 55.9 years (range, 37-67 yrs), and five were heavy alcohol drinkers. All seven patients required mechanical ventilation. Four patients recovered (group 1) and three expired due to respiratory failure (group 2). The mean interval from initial symptoms to the development of respiratory failure was 8.8 days in group 1 and 6.0 days in group 2, except in the one patient with lung cancer (case 6). The progression of pneumonia was more rapid in group 2. The mean intervals from admission to administration of erythromycin were 1.5 days and 3.5 days, respectively, in groups 1 and 2. In group 1, pulmonary infiltrates and respiratory insufficiency worsened for the first few days after erythromycin administration but improved thereafter. The average duration of ventilatory care in group 1 was 13.3 days. The administration of rifampicin combined with erythromycin may be useful for the treatment of fulminant Legionnaires' disease. When fulminant pneumonia is encountered in a middle-aged or elderly male alcoholic, Legionnaires' disease should be suspected and erythromycin administration with rifampicin should be initiated as early as possible.
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PMID:[A clinical study of fulminant Legionnaires' disease]. 816

Ten patients from a rehabilitation center were admitted to hospital with serious respiratory infections within ten weeks. An outbreak of Legionnaire's disease was suspected based on the epidemic and atypical manifestation of pneumonia and could be proven microbiologically. Pulmonary and extrapulmonary complications included respiratory failure, lung abscess, transitory renal impairment in five patients and acute renal failure requiring dialysis in one, tetraparesis caused by peripheral neuropathy and acute psychosis. Three patients died despite immediate institution of therapy with erythromycin. Legionella pneumophila serogroup 1 subtype Pontiac was isolated from a bronchial lavage sample of one patient and from the water supply of the rehabilitation center. Monoclonal antibody subtyping and restriction endonuclease analysis were performed on both environmental and patient isolates. Potable water was identified as the source of the outbreak based on identical patterns on restriction endonuclease analysis. Despite thermic and chemical disinfection with chlorination (up to 15 ppm) in the rehabilitation clinic, an eleventh case of Legionnaire's disease was detected 11 months later.
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PMID:Nosocomial outbreak of legionellosis in a rehabilitation center. Demonstration of potable water as a source. 822 27

Invasive pulmonary aspergillosis (IPA), although unusual, has been recognized in the immunocompetent host. Several cases of IPA with rapidly progressive respiratory failure have been reported in patients receiving short-term corticosteroid therapy for chronic obstructive pulmonary disease. Atypical pneumonia caused by dual infection with Legionella pneumophila and Mycoplasma pneumoniae has also been reported. We report an unusual case of simultaneous L pneumophila pneumonia and IPA in an asthma patient with suspected allergic bronchopulmonary aspergillosis newly treated with corticosteroids.
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PMID:Simultaneous legionellosis and invasive aspergillosis in an immunocompetent patient newly treated with corticosteroids. 825 95


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