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)

A 46-year-old man showed a clinical response when treated with parenteral erythromycin for what was initially thought to be legionnaires' disease, but an organism isolated from his pleural fluid on CYE agar was subsequently identified as Francisella tularensis. Tularemia should be suspected in all cases of atypical pneumonia in the appropriate setting. Erythromycin may be effective empiric therapy in such cases. Because of the possibility of inadvertent isolation of Francisella tularensis on CYE agar, all cultures for suspected Legionella should be handled with extreme caution, preferably in a biological hood.
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PMID:Tularemia pneumonia mimicking legionnaires' disease: isolation of organism on CYE agar and successful treatment with erythromycin. 661 98

Out of 2,105 patients with atypical pneumonia and febrile infections 15 cases of legionellosis were diagnosed by the indirect immunofluorescent antibody test (IFA) in Austria from the middle of 1977 to the end of 1979. Among the patients with the diagnosis of atypical pneumonia Legionnaires' disease was found in 0.65%. Among those patients whose sera were examined because of suspected legionella infection the frequency was 1.96% (p less than 0.1). Therefore it may assumed that some symptoms of legionella infections may lead to the clinical diagnosis of the disease. Neither the geographical distribution of the cases nor environmental examinations nor the prevalence of antibodies gave any indication of an epidemic or hyperendemic occurrence of Legionnaires' disease in Austria. Low antibody titres to serogroup 1 of Legionella pneumophila (1:32-1:64) were found in 6.4%, higher titres (greater than or equal to 1:128) in 1.2% of all patients examined. Crossreactions of sera mainly occurred between antigens of serogroup 1 and serogroup 2. Antibodies to serogroups 3 and 4 were found seldom. According to our results crossreactivity between L. pneumophila on the one side and Mycoplasma pneumoniae or Chlamydia psittaci on the other side is of no importance and does not interfere with serological diagnosis. In serological routine examinations frequency of recent infections with L. pneumophila in patients with pneumonia was about as high as with Chlamydia psittaci or Picornavirus. To our opinion the expenditure for serological diagnosis is justified in all patients with severe pneumonia of unclear etiology as there exists the possibility of a purposive chemotherapy in legionellosis as it does in mycoplasma pneumonia or ornithosis. Moreover for quick diagnosis it should always be attempted to demonstrate the causative agent by direct immunofluorescence or by isolation.
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PMID:[Epidemiology and diagnosis of Legionella infections in Austria (author's transl)]. 679 7

In a clinical demonstration, case reports on 3 patients are presented: 1. In a 27-year-old male who developed severe multicentric atypical pneumonia, CNS, liver and renal involvement and signs of rhabdomyolyses suggested infection with Legionella pneumophila. Diagnosis was confirmed by the presence of Dieterle-stain positive organisms and positive culture of lung biopsy tissue. Antibiotic treatment, especially erythromycin, and prolonged mechanical respiration produced complete recovery. 2. The presence of chylomycrons Rin ascitic and pleural fluid in a patient with epimembranous glomerulonephritis and nephrotic syndrome was the first sign of malignant non-Hodgkin lymphoma. Chemotherapy with cyclophosphamid, oncovin and prednisone induced remission of tumor and nephrotic syndrome, which promptly recurred parallel to later reactivation of the malignancy. Paraneoplastically induced nephrotic syndrome, especially due to lymphoma, may precede the malignancy by months. 3. In a 52-year-old male with terminal renal failure due to primary oxalosis a cadaver renal transplant functioned for only 14 months because of oxalate deposits in the transplant. Hemodialysis before and after transplantation modified the clinical course. In place of uremia, the clinical picture was dominated by oxalate-induced gangrenous arteriopathy, arthritis, and heart disease.
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PMID:[Clinical demonstrations. Legionnaires' disease. Tumor-associated nephrotic syndrome. Primary oxalosis]. 703 33

Legionella infections can take the clinical course of a relatively harmless respiratory infection. However, serious, atypical pneumonia is a more frequent manifestation of infection with these pathogens. As yet, six different Legionella species can be identified; Legionella pneumophila appears to be the most common. Legionnaires' pneumonia is being found with increasing regularity during summer and autumn in elderly male patients with previous illnesses. The clinical picture is characterised by viral "prodrome", high fever, a dry cough, breast pain, confusion, diarrhoea, haematuria, moderate leukocytosis with lymphopenia, low concentrations of sodium in the serum and negative results from microbiological analysis of the sputum and pleural exudate. Diagnosis is confirmed culturally, microscopically and serologically; the indirect immunofluorescence test is of particular value for this purpose. Erythromycin alone or in combination with rifampicin is the treatment of choice.
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PMID:[Clinical picture of Legionnaires' disease (author's transl)]. 710 21

Legionella pneumophila was isolated in 1947 but its etiological role was only recognized after the Philadelphia outbreak in 1976. Since then, infections with Legionella pneumophila in patients with so-called atypical pneumonia have been found in different parts of the world in sporadic cases and outbreaks affecting up to several hundred patients. The etiological agent is a bacterium which can be found in dust, mud and water. Transmission to the human most likely occurs through water-cooled air condition units or showers. Air conditioning in hotels, hospitals and offices may transmit the organism and lead to infection which, moreover, is more frequent during the warm season. The diagnosis is based on clinical data and the demonstration of specific antibodies. Isolation of the agent is technically difficult and up to now only approximately 3% of the cases have been confirmed by isolation of the agent. Evidence of Legionella pneumophila infection in Switzerland was obtained by testing stored blood samples from transplanted patients in 1970. Sporadic cases were observed in the period 1977 to 1980. Acute infection was considered in 141 patients on the basis of serological results. Approximately 3% of all pneumonias in 1979 were caused by Legionella pneumophila. Isolation of the etiological agent has been achieved in 3 patients only.
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PMID:[Microbiological aspects of Legionnaires' disease]. 720 65

Hitherto, nosocomial epidemic outbreaks of legionnaire's disease have not been reported in Denmark. Only sporadic cases have been described. A survey of 75 Danish hospitals concerning the dimensions and operation of the hot-water systems revealed that only 13% had a hot water tank temperature above the recommended 60 degrees C. Temperatures of coldest tap water and of returning water were above 50 degrees C in only 31% and 24% respectively. Twelve representative hospitals with 35 independent water systems were investigated for the presence of Legionella pneumophila (Lp). Lp was demonstrated in all the hospitals and in 34 (97%) of the systems. The prevailing serogroups were (in order of frequency) 3, 1, 2, 5 and 6. We conclude that the operation of the hot tap water systems should be optimized. This report indicates that nosocomial epidemics are conceivable and attention should be paid to the disease as a diagnostic possibility in patients with primary atypical pneumonia.
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PMID:[Legionella pneumophila in the hot water system of Danish hospitals and institutions. A questionnaire study and a random sample test]. 763 14

The traditional classification of community-acquired pneumonia into typical and atypical pneumonia to facilitate successful empirical treatment is no longer optimal. An accurate prediction of cause and adequate empirical therapy cannot be provided with this approach in severely ill patients. There is an increasing spectrum of recognized treatable pathogens presenting as community-acquired pneumonia including Legionella species, Chlamydia pneumoniae, and Pneumocystis carinii in addition to the traditional community pathogens. The variability of presentation in severely ill or compromised hosts makes clinical prediction of cause inadequate. A more rational approach may involve the classification of patients by the severity of illness and underlying disease with little or no microbiological workup in mild illness unless the results will contribute to the epidemiological surveillance of resistance because these investigations have not been shown to affect outcome in this setting. Etiologic diagnosis should be more aggressively sought and the microbiology laboratory can be best used by providing the efficient and rapid diagnosis of this expanded range of pathogens in more severely ill patients. The mounting antimicrobial resistance of common pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus will require not only a critical review of empirical therapy, but an increased emphasis on epidemiological monitoring of resistance by laboratories and effective communication with clinicians.
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PMID:Community-acquired pneumonia: the future of the microbiology laboratory: focused diagnosis or syndromic management? 783 39

The activity of six intracellular antibiotics, doxycycline, erythromycin, clarithromycin, azithromycin, rifampicin and ciprofloxacin, was tested against 60 strains of Legionella pneumophila (21 of human and 39 of environmental origin). MIC50, MIC90, and MBC values were determined by a microdilution method. Inhibitory and bactericidal activity against human and environmental isolates were similar except for rifampicin, which was 100-fold less active for human strains than for environmental strains, particularly in terms of bactericidal activity. Nevertheless, in general, rifampicin was found to be the most active drug. Among the macrolides tested, clarithromycin showed the greatest activity in MIC assays and erythromycin was the least bactericidal. Azithromycin showed higher MICs and MBCs than the two macrolides, and doxycycline was the least active. The most important factors influencing in-vivo activity of antibiotics are discussed. Even if the in-vitro results cannot be fully extrapolated to activity in vivo, these results indicate the susceptibility of L. pneumophila strains in Italy as a basis for treatment of atypical pneumonia that may be due to Legionella spp.
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PMID:In-vitro activity of six intracellular antibiotics against Legionella pneumophila strains of human and environmental origin. 805 94

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

A molecular assay based on a rapid DNA extraction protocol and the EnviroAmp Legionella Kits was used to detect Legionella species in bronchoalveolar fluid specimens. All Legionella strains isolated from tap water in hospitals could be detected distinctly. Both sensitivity and specificity were tested. In a prospective study, bronchoalveolar lavage fluids obtained from patients with atypical pneumonia were investigated. Three positive samples were detected with the molecular techniques and were subsequently confirmed by culture. Application of the system described may lead to safe and early diagnosis of Legionnaires' disease in patients with atypical pneumonia.
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PMID:Rapid detection of Legionella species in bronchoalveolar lavage fluids with the EnviroAmp Legionella PCR amplification and detection kit. 830 30


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