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

Permissible conclusions both from recent available literature and our own field-study results concerning the problematic nature of microbial contamination of dental hygiene articles and the resulting possible health hazard for the consumer can be summarized as follows: Manufacturing practices as are given in the basic instructions for production sites of the cosmetic industry, render a possible degree of microbial contamination. This largely rules out the danger of infection of the consumer upon acquisition of the dental hygiene product. Secondary contamination of these products, as inevitably is the case during use of dental hygiene articles, leads to microbial colonization especially of toothbrush bristles. The extent of this colonization depends at least partially upon the utilization age of the toothbrush. Also for this reason a toothbrush should be replaced by a new one after period of three months, six months at the latest and in all cases of inflammatory changes of the mouth and throat region. The contamination of both the glass or plastic container used for rinsing the teeth after brushing or for gargling can be held within certain limits by dry storage. Only in exceptional cases do mouthwashes show a small degree of contamination. Provided they contain antimicrobial substances, no therapeutically serviceable possibilities worth mentioning follow for the reduction of oropharyngeal flora. Microbial colonization of toothpastes as a result of secondary contamination following use is observed only in exceptional cases due to their preservative content. Significant germination of stagnated residual water in waterpicks often occurs, achieving germ counts up to more than 10(7) cfu per ml. Moreover, waterpicks can represent a biotope for Pseudomonas aeruginosa, and should be used neither by patients with open wounds or mucous membrane lesions in the oropharyngeal area, nor by patients with reduced immune resistance. Manufacturers of waterpicks are urged to impede or prevent the stagnation of residual water more effectively by introducing constructive improvements. Denture and retainer cleansing agents presently on the market display a sufficient antimicrobial effect within the frame of their application, however do not meet the standards set for disinfectants. Dental hygiene products are without relevance for the epidemiology of Legionnaires' disease.
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PMID:[The significance of the contamination of dental care articles. The results of a field study]. 250 Aug 2

Serious respiratory tract infections are rare in the healthy individual and most of the nuisance morbidity that occurs results from nasopharyngeal viral infections that many people get once or twice a year. The economic impact from these upper respiratory tract infections is appreciable, however, in terms of absenteeism from school or work, but unfortunately there is little that can be done to ward them off in a practical way. Pneumonia is an infrequent lifetime experience for most non-smoking adults and when it occurs, unusual circumstances may pertain--a particularly virulent microorganism is in circulation, or perhaps one has been exposed to a newly recognized germ, such as has occurred with Legionella species in the past 8 years or so. What protects us the great majority of the time is a very effective network of respiratory tract host defenses. These include many mechanical and anatomical barrier mechanisms concentrated in nose and throat; mucociliary clearance, coughing and mucosal immunoglobulins in the conducting airways and in the air-exchange region of the alveolar structures, phagocytes, opsonins, complement, surfactant and many other factors combine to clear infectious agents. The ability to mount an inflammatory response in the alveoli may represent the maximal and ultimate expression of local host defense. In some way these host defenses are combating constantly the influx of micro-organisms, usually inhaled or aspirated into the airways, that try to gain a foothold on the mucosal surface and colonize it. But many general changes in overall health such as debility, poor nutrition, metabolic derangements, bone marrow suppression and perhaps aging promote abnormal microbial colonization and undermine the body's defenses that try to cope with the situation. It is a dynamic struggle. The departure from normal respiratory health may not be obvious immediately to the patient or to the physician and repeated episodes of infection or persisting symptoms of cough, expectoration and sinus or ear infections may develop before serious assessment of the situation is taken and appropriate diagnosis gotten underway. Obvious explanations for respiratory infections may be apparent and, nowadays, side effects from antineoplastic chemotherapy or immunosuppressive therapy for a variety of diseases that create an immunocompromised host are common. In a few subjects, especially young adults who present with a cumulative history of frequent but mild infections in childhood and youth, a subtle deficiency in host defenses may exist and have been partially masked because of attentive pediatric medical care and prompt use of broad spectrum antibiotics.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Respiratory infections may reflect deficiencies in host defense mechanisms. 384 94

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with major morbidity and attributable mortality. Strategies to prevent VAP are likely to be successful only if based upon a sound understanding of pathogenesis and epidemiology. The major route for acquiring endemic VAP is oropharyngeal colonization by the endogenous flora or by pathogens acquired exogenously from the intensive care unit environment, especially the hands or apparel of health-care workers, contaminated respiratory equipment, hospital water, or air. The stomach represents a potential site of secondary colonization and reservoir of nosocomial Gram-negative bacilli. Endotracheal-tube biofilm formation may play a contributory role in sustaining tracheal colonization and also have an important role in late-onset VAP caused by resistant organisms. Aspiration of microbe-laden oropharyngeal, gastric, or tracheal secretions around the cuffed endotracheal tube into the normally sterile lower respiratory tract results in most cases of endemic VAP. In contrast, epidemic VAP is most often caused by contamination of respiratory therapy equipment, bronchoscopes, medical aerosols, water (eg, Legionella) or air (eg, Aspergillus or the severe acute respiratory syndrome virus). Strategies to eradicate oropharyngeal and/or intestinal microbial colonization, such as with chlorhexidine oral care, prophylactic aerosolization of antimicrobials, selective aerodigestive mucosal antimicrobial decontamination, or the use of sucralfate rather than H(2) antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semirecumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of VAP. Measures to prevent epidemic VAP include rigorous disinfection of respiratory equipment and bronchoscopes, and infection-control measures to prevent contamination of medical aerosols. Hospital water should be Legionella-free, and high-risk patients, especially those with prolonged granulocytopenia or organ transplants, should be cared for in hospital units with high-efficiency-particulate-arrestor (HEPA) filtered air. Routine surveillance of VAP, to track endemic VAPs and facilitate early detection of outbreaks, is mandatory.
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PMID:The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. 1642 68