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

Legionnaires' disease is an established and frequent cause of pneumonia in adults but is thought to be a rare cause in children. We reviewed the medical literature for cases of Legionnaires' disease in children and analysed the epidemiology, clinical characteristics, and treatment. 76 cases of legionella infection in children were identified. In 56%, diagnosis was made with culture methodology. 46% were community-acquired infections. 51.5% were under 2 years of age. 78% of the patients had an underlying condition such as malignancy. Fever, cough, and tachypnoea were the most common symptoms. The overall mortality rate was 33% and was higher in immunosuppressed children and in children younger than the age of 1 year. Patients who were treated empirically with anti-legionella therapy had a notably lower mortality rate compared with patients on inappropriate therapy (23%vs 70%). In 88% of hospital-acquired cases, an environmental link to potable water colonised with legionella was identified. We found no clinical features unique to Legionnaires' disease in children that would allow differentiation from pneumonia due to other respiratory pathogens. Awareness of legionella as a potential cause of paediatric pneumonia is particularly important because infection can be severe and life threatening and antimicrobial therapy often used for empirical therapy in children is not effective against legionella. In any case of pneumonia unresponsive to antibiotics, Legionnaires' disease should be considered and specific diagnostic tests to verify this diagnosis should be done. As legionella diagnostic tests become more widely applied, we predict that legionellosis may appear as an emerging infectious disease in children.
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PMID:Problem pathogens: paediatric legionellosis--implications for improved diagnosis. 1687 May 31

A 46-year-old man whose parents were from Nagasaki had a 24-hour bath system in his house. He had had a cough for 26 years and dyspnea for 2 years. He consulted our hospital because of the increase of his cough and dyspnea. Chest X ray and CT showed abnormal shadows in both lung fields and Legionella pneumophila type 3 was detected by sputum cultivation. The condition which appeared this time responded to antibiotic medication. However, the abnormal shadows in both lung fields and the abnormalities in respiratory function remained. The remaining abnormal shadows in both lung fields were considered to be the cause of his dyspnea for 2 years and cough for 26 years. Atypical lymphocytes with a floriform nucleus were observed in peripheral blood. Gene analysis detected monoclonal human T lymphotropic virus type I (HTLV-I) provirus DNA. We diagnosed as smoldering type adult-T-cell-leukemia (ATL). Thoracoscopic lung biopsy revealed fibrotic thickening of the interstitial tissue accompanied by structural destruction. The pathological changes in both lung fields were diagnosed as HTLV-I related lung disease and infiltration of ATL. Known pathogens of lung infection accompanying ATL include viruses, acid fast organisms, and fungi. Legionella pneumonia happened to be the opportunity leading to the diagnosis of HTLV-I related lung disease is this case.
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PMID:[A case of human T lymphotropic virus type I-related lung disease in which Legionella pneumonia led to the diagnosis]. 1714 92

In July 2002, a large outbreak of legionellosis occurred in a bathhouse with spa facilities in Miyazaki Prefecture. Among the visitors, 295, including suspected cases had pneumonia and/or symptoms of fever, coughing, etc. Of these, 37% were hospitalized and 7 died. Clinical samples from 95 mainly inpatients were collected and microbiologically tested at our laboratory. Legionella pneumophila serogroup (SG) 1 was isolated from 3 of 24 in sputum culture, and none of the 3 had been treated effectively with antibiotics at sputa collection. L. pneumophila antigen in urine was detected by using enzyme immunoassay and/or immunochromatographic kits in 23 of 75 patients. Serum antibodies to L. pneumophila SG1 and Legionella dumoffii were detected in 5 each of 66 patients--9 cases including a case at mixed infection-by microplate agglutination test and/or indirect immunofluorescence assay. At our laboratory, 32 were diagnosed with legionellosis. In this outbreak, 14 were diagnosed at other laboratories, resulting in 46 confirmed cases. Urine antigen was detected more frequently by Binax NOW immunochromatographic assay than by Biotest EIA-31% versus 16% of cases tested. Both assays detected urine antigen only in samples collected within 4 weeks after onset. Antigen concentration in urine enhanced sensitivity-58% and 51%-and extended the period of antigen detection beyond 5 weeks. Both antibody titers to L. pneumophila SG1 and L. dumoffii in more than 90% of sera collected within 3 weeks after onset were < 1:16. The rate of serum antibody titer to > or = 1:128 within 3 weeks was 1.6%, during 4 to 6 weeks less than 10%, and after 7 weeks or more 8 to 25%. After an administrative report was published, L. pneumophila DNA in sputa was detected in 5 of 17 patients by nested PCR, resulting in extra 3 cases. Altogether, urinary antigen detection and PCR were more effective in laboratory diagnostic tests than culture and serology. Culture combined with molecular epidemiology is critical, however, for confirming the source of infection.
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PMID:[Largest outbreak of legionellosis associated with spa baths: comparison of diagnostic tests]. 1744 76

Between November 2003 and January 2004 in the North of France a large outbreak of legionnaire's disease affected 85 patients. The clinical, biological and radiological characteristics of the patients were investigated to determine factors associated with mortality. Two populations were defined and compared: patients who died within 28 days and those who survived. Eighty-five patients were included in this study. The median age was 75 years. The median fever was 39.3 +/- 0.1 degrees. Fifteen patients (17.6%) had at least 3 underlying co-morbidities. Cough, dyspnoea, confusion and diarrhoea were found in respectively 46, 68, 47, and 15% of the patients. The median of urea was 0.7 +/- 0.05 g/L, creatinine 16 +/- 1.5 mg/L, CRP 332 +/- 15 mg/L. On the chest X-ray, lung infiltrates were present in 64% and multilobar in 40%. The overall mortality rate was 21%. In univariate analysis, diabetes mellitus, dyspnoea, urea>0.90 g/l and CRP>350 mg/l were predictive factors of mortality. In multivariate analysis, diabetes mellitus, urea>0.90 g/l, and bilateral infiltrates on chest X ray were retained as independent risk factors for death.
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PMID:[Factors predicting mortality during an outbreak of Legionnaire's disease in the north of France]. 1844 94

Human metapneumovirus (hMPV) is a paramyxovirus that is associated with respiratory tract infection (RTI) mostly in children, but these outbreaks have rarely been reported in adults. We encountered an outbreak of this disease involving 10 adults in a psychiatric ward in eastern Taiwan. The nasopharyngeal swab specimens from 13 patients with symptoms of RTI were obtained and analyzed. The RT-PCR tests were negative to influenza virus A/B, adenovirus, RSV, parainfluenza virus, coronavirus, Nipah virus and Legionella. The antigen tests were negative to Legionella, Chlamydia, and Mycoplasma. Blood culture was negative in all except patient no. 1, who was found positive for coagulase-negative staphylococci. The hMPV was identified in 10 of 13 adults (77%), but negative for the other virus. Cough was present in all (100%), fever in 90%, and X-ray evidence of pneumonia in 7 patients. One patient died of respiratory failure. We report this outbreak in a mental hospital to alert the medical profession that this unusual infection of hMPV can occur as an outbreak in an adult setting and is an occupational hazard for healthcare personnel.
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PMID:An outbreak of human metapneumovirus infection in hospitalized psychiatric adult patients in Taiwan. 1930 1

Moxifloxacin, a recent, new quinolone agent, has superior pharmacokinetics and appears to be safe for patients with renal failure, as it is mainly excreted in the bile. The case of a hemodialysis patient with Legionella pneumonia who was successfully treated with moxifloxacin is reported. A 76-year-old woman, who had been on hemodialysis for chronic renal failure secondary to diabetic nephropathy, visited her hospital with a cough and fever. Pneumonia was diagnosed, and intravenous administration of cefotiam hydrochloride was begun, but her respiratory condition deteriorated. She was transferred to our hospital with dyspnea. A chest radiograph showed consolidation in both lung fields and cardiomegaly. A urinary antigen test for Legionella was positive. Legionella pneumonia with heart failure was diagnosed and she was started on 400 mg a day moxifloxacin. Her clinical condition improved. Moxifloxacin appears to be useful in the treatment of Legionella pneumonia in patients with renal failure.
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PMID:[Successful treatment of Legionella pneumonia with moxifloxacin in a hemodialysis patient]. 1963 6

Chlamydophila (Chlamydia) pneumoniae is a common, non-zoonotic cause of community-acquired pneumonia (CAP) in ambulatory young adults. C. pneumoniae clinically presents as a mycoplasma-like illness frequently accompanied by laryngitis. C. pneumoniae CAP may also cause nursing home outbreaks in the elderly. Similar to Mycoplasma pneumoniae in immunocompetent hosts, C. pneumoniae CAP usually manifests as a mild/moderately severe CAP. In contrast with Legionnaire's disease, central nervous system involvement is usually not a feature of C. pneumoniae CAP. M. pneumoniae may rarely present with meningoencephalitis accompanied by high cold agglutinin titers. We present the case of a young man who presented with M. pneumoniae-like illness and was hospitalized for severe CAP that was accompanied by a pertussis-like cough and severe headache. Although his chest x-ray showed a right upper lobe infiltrate, a lumbar puncture was performed to rule out meningitis, but his cerebrospinal fluid profile was unremarkable. Titers for non-zoonotic atypical pneumonia pathogens were negative except for a highly elevated C. pneumoniae immunoglobulin-M titer (1:320). Testing for legionella and pertussis was negative. Q fever and adenoviral titers were also negative. Cold agglutinin titers were repeatedly negative. The patient was successfully treated with moxifloxacin but developed permanent asthma after C. pneumoniae CAP. This case is unusual in several aspects. First, C. pneumoniae usually presents as a mild to moderate CAP, but in this case it was severe. Second, hoarseness was absent, which would have suggested C. pneumoniae. Third, wheezing was an important clue to the diagnosis of C. pneumoniae, which is not a clinical finding with other causes of CAP. Fourth, permanent asthma may follow C. pneumoniae, as well as M. pneumoniae CAP. Fifth, severe headache mimicking M. pneumoniae meningoencephalitis may rarely accompany C. pneumoniae CAP.
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PMID:C. pneumoniae community-acquired pneumonia (CAP) in mimicking Mycoplasma pneumoniae meningoencephalitis complicated by asthma. 1994 78

Common symptoms of upper respiratory infections, such as sore throat, cough, and inflammation, are often caused by bacteria, sometimes as a complication of virus infection. Extracts of Echinacea purpurea (Asteraceae) have been advocated traditionally for use by individuals suffering from these symptoms, although the underlying basis for the beneficial effects of Echinacea is not known. We hypothesized that Echinacea could inactivate certain respiratory bacteria and could also reverse inflammatory effects caused by these bacteria in epithelial cells. In order to test this we used a commercial standardized extract of Echinacea purpurea (Echinaforce), and a novel cytokine array system designed to measure simultaneously the levels of 20 different cytokines secreted by bronchial epithelial cell cultures in response to infection. Streptococcus pyogenes (Group A Strep), which is often associated with sore throat and more severe pulmonary infections, was readily inactivated by Echinacea, which also completely reversed the cellular pro-inflammatory response. Hemophilus influenzae and Legionella pneumophila were also readily inactivated, and their pro-inflammatory responses reversed. Staphylococcus aureus (methicillin-resistant and sensitive strains) and Mycobacterium smegmatis were less sensitive to the bactericidal effects of Echinacea however, but their pro-inflammatory responses were still completely reversed. In contrast some other pathogens tested, including Candida albicans, were relatively resistant. Thus Echinaforce) exerts a dual action against several important respiratory bacteria, a killing effect and an anti-inflammatory effect. These results support the concept of using a standardized Echinacea preparation to control symptoms associated with bacterial respiratory infections.
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PMID:Bactericidal and anti-inflammatory properties of a standardized Echinacea extract (Echinaforce): dual actions against respiratory bacteria. 2003 23

The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP), as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29), followed by gram positive (10/29). In 71 cases no etiological cause was obtained. Pseudomonas aeruginosa was the commonest pathogen (10/29), followed by Staphylococcus aureus (7/29), Escherichia coli (6/29), Klebsiella spp. (3/29), Streptococcus pyogenes (1/29), Streptococcus pneumoniae (1/29) and Acinetobacter spp. (1/29). Sputum was the most common etiological source of organism isolation (26) followed by blood (6), pleural fluid (3), and pus culture (1). Maximum number of patients presented with cough (99%), fever (95%), tachycardia (92%), pleuritic chest pain (75%), sputum production (65%) and leucocytosis (43%). The commonest predisposing factors were smoking (65%), COPD (57%), structural lung disease (21%), diabetes mellitus (13%), and decreased level of consciousness following seizure (eight per cent) and chronic alcoholism (one per cent). Fourteen patients, of whom, nine were males and five females, died. Staphylococcus aureus was the causative organism in four, Pseudomonas in two, Klebsiella in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and staphylococcus pneumonia and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for legionella, mycoplasma and viruses are performed the diagnostic yield would definitely be better. This emphasizes the need for further studies (including the serological tests for Legionella, mycoplasma and viruses) to identify the microbial etiology of CAP.
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PMID:Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients. 2061 35

Legionnaires' disease is primarily a pneumonic process caused by Legionella pneumophilia, a gram-negative aerobic bacillus but also has multiple system involvement. The most common manifestation is encephalopathy suggesting a generalized brain dysfunction but focal neurological manifestations have been reported. We report a patient with Legionella pneumonia associated with cerebellar dysfunction and unilateral facial nerve weakness. 51-year-old previously healthy male presented with shortness of breath, cough, slurred speech, and unsteadiness on feet associated with malaise, fevers and myalgias. Patient's family reported facial asymmetry for 2 days. Patient had no significant medical history and was not on any medication. He denied smoking, alcohol or illicit drug use. Chest X-ray showed bilateral lower lobe infiltrates. Urinary antigen assay for Legionella pneumophilia serogroup 1 was positive. Patient was started on intravenous moxifloxacin. On day 5 the patient was discharged home and continued oral moxifloxacin for two weeks. After the two weeks, his respiratory symptoms, gait ataxia and dysarthria resolved. We report the first case of Legionnaires' disease with cerebellar dysfunction and seventh nerve palsy. Legionnaires' disease should be considered in patients with any neurological symptoms in the setting of pneumonia. Failure to recognize and treat the infection may lead to poor outcomes.
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PMID:Legionnaires' disease with facial nerve palsy. 2146 Oct 48


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