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

The penetration and persistence in the serum and lungs of guinea pigs after parenteral administration of erythromycin, gentamicin, chloramphenicol and rifampicin, and their in-vitro activities against Legionella pneumophila were investigated. The most active agent was rifampicin (MIC 0.0625 mg/l, MBC 0.125 mg/l) and effective levels of this drug were present in serum and lungs up to 10 h after injection. Erythromycin accumulated to very high levels in the lungs and had good bacteriostatic activity in vitro. Gentamicin was highly bactericidal in liquid culture but showed poor lung penetration on injection. Chloramphenicol, the least inhibitory of the four antibiotics, had an MIC of 1.0 mg/l. Active chloramphenicol was not detected in guinea pig serum and lungs following ip or im administration. The differences in the penetration and persistence of these drugs in the lungs of guinea pigs may explain the reported poor correlation between in-vitro and in-vivo activity against L. pneumophila. The results are useful for evaluating regimens for therapy of Legionnaires' disease in the aerosol infected guinea pig model.
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PMID:Persistence in serum and lungs of guinea pigs of erythromycin, gentamicin, chloramphenicol and rifampicin and their in-vitro activities against Legionella pneumophila. 663 Jan 6

The tetracyclines are active in vitro against many urinary tract pathogens such as Chlamydia, Mycoplasma pneumoniae, Brucella, rickettsiae, and Nocardia. Chloramphenicol is used primarily for anaerobic infections, Haemophilus influenzae meningitis, and infections due to Salmonella typhi. Erythromycin is active in vitro against M. pneumoniae, Legionella spp., Streptococcus pneumoniae, and group A beta-hemolytic streptococci; it may also be used as prophylactic therapy for subacute bacterial endocarditis and for recurrence of acute rheumatic fever in patients who are allergic to penicillin. Clindamycin should be used primarily for the treatment of anaerobic infections. The tetracyclines may cause gastrointestinal upset; phototoxic dermatitis; hepatitis, especially in pregnant women; discoloration of the teeth and bone dysplasia in the human fetus and in children; and superinfections, especially oral and anogenital candidiasis. The tetracyclines should be used with caution in patients with renal insufficiency. The most important toxic effect of chloramphenicol is bone marrow suppression, which is dose related or idiosyncratic. The incidence of undesirable side effects associated with the use of erythromycin is low; gastrointestinal irritation is the most common, and cholestatic hepatitis may occur with the use of erythromycin estolate. Pseudomembranous colitis is the most important toxic effect associated with the use of clindamycin.
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PMID:Tetracyclines, chloramphenicol, erythromycin, and clindamycin. 682 63

Sixty-five cases of nosocomially acquired Legionnaires' disease are reported and the world literature is reviewed. The etiologic agent, Legionnella pneumophila, has been isolated from several environmental sources at outbreak sites. Legionnaires' disease appears to be acquired by inhalation and is primarily manifested by severe, potentially fatal, pneumonia. Characteristic clinical disease consists of high fever with relative bradycardia, dry cough, chills, diarrhea, and pleuritic pain. Although no single feature is pathognomonic, the clinical presentation is usually sufficiently characteristic to suggest the diagnosis. The diagnosis of Legionnaires' disease during acute illness may be established by culture of Legionella pneumophila, or by demonstration of the bacterium using special stains. However, in most instances, the physician must make a presumptive diagnosis based on the clinical presentation in order to institute appropriate antimicrobial therapy. Retrospective confirmation of the diagnosis may be made by serologic studies in most instances. Erythromycin is, at this time, the drug of choice for the treatment of Legionnaires' disease. A prompt salutory response following institution of erythromycin therapy is typical.
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PMID:Legionnaires' disease: report of sixty-five nosocomially acquired cases of review of the literature. 699 73

Legionella pneumophila is transmitted by aerosolization of water or dust from soil. There are six serotypes and four newly recognized related organisms. Sporadic cased of Legionnaires; disease are more common than epidemic case and are less likely to be suspected . Most reporters cases are characterized by severe pneumonia. Bacteriologic culture is the preferred method of diagnosis, but most cases are identified by the indirect fluorescent antibody method. Erythromycin is the drug of choice.
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PMID:Legionnaires' disease: an update. 702 Mar 90

Diagnosis of acute, primary extensive pneumopathies provoking severe hypoxemia is particularly difficult, became of the non-specific radiological findings, resulting from the oedema and associated alveolar collapse, and the fact that the clinical picture and biological test results are not very characteristic of a particular etiology. Similar findings may be obtained, therefore, in bacterial pneumopathies so-called typical pulmonary affections, certain forms of acute, tuberculosis, and other types of infection of three patients admitted for acute respiratory insufficiency, two died after treatment with a betalactamine, alone or associated with an aminoside, subsequent serology providing evidence of psittacosis. Diagnosis was immediately established in the third patient, the wife of one of the other cases, and she recovered after erythromycin treatment. The lungs of the two patients that died showed suggestive bronchiolitis and peribronchiolar alveolitis, together with obliterative alveolar granulations and fibrosis, probably secondary to the psittacosis, and responsible for the fatal outcome. Psittacosis as a cause of an extensive pneumopathy of probable infectious origin may easily pass unrecognized, typical etiologies being infections due to pneumococcus, Legionella pneumophila. Mycoplasma pneumoniae, and viruses. Erythromycin, active against these microorganisms, would therefore appear to be the antibiotic therapy that should be prescribed initially, those with wider spectrums being reserved for cases with atypical radiological findings, or when precise bacteriological data is available.
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PMID:[Psittacosis as a cause of acute respiratory distress syndrome (author's transl)]. 710 4

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

Ever since the 1976 Philadelphia epidemic and the isolation of the causative organism by MacDade in 1977, numerous clinical, epidemiological and bacteriological papers have stressed the significance of the "new" causative organisms responsible for serious cases of pneumonia. On the basis of knowledge available at present, the Legionellaceae family accounts for these bacteria. There are five different species in the genus Legionella: L. pneumophila, L. micdadei, L. bozemannii, L. dumoffii and L. gormanii. L. pneumophila occurs most frequently and has six serogroups (Serogroups 1-6), the first of which is the most important. Legionelloses, the diseases caused by these organisms, occur epidemically, endemically or sporadically. In clinical terms, these are acute cases of pneumonia which occur especially frequently in older persons and immunocompromised hosts. The course is severe in such patients. There is increased lethality. Erythromycin, rifampicin and cefoxitin are the most effective antibiotics. After the culture has been made in the suitable milieu and the material obtained by pulmonary aspiration has been inoculated into guinea pigs, the bacteriological diagnosis is made by direct immunofluorescence. The serological diagnosis is based on evidence of serological changes demonstrated by the indirect immunofluorescence test.
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PMID:[Diseases of the lungs caused by legionella species (author's transl)]. 710 22

In the case reported pulmonary Legionella infection was diagnosed by sputum cultures even though immunofluorescence tests were negative. The patient had positive Coomb's test due to circulating auto-antibodies which disappeared after he recovered. The course of the disease was prolonged by perforation of the coecum requiring excision of the colon and terminal ileostomy. Erythromycin had to be given intravenously. Pathological examination of the digestive tract lesions showed inflammatory colitis with presence of Legionella pneumophilia which seemed to have been responsible for the complication. This is the first time a digestive lesion caused by this organism is described, adding yet another extrapulmonary visceral involvement to those already reported and suggesting that Legionella may spread throughout the body.
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PMID:[Legionnaires' disease with digestive tract lesions. One case]. 714 57

Although erythromycin was introduced into clinical medicine more than 28 years ago, the indications for its use continue to expand. This antibiotic has emerged as appropriate therapy for Legionnaires' disease, chronic bacterial prostatitis caused by Escherichia coli, Klebsiella pneumoniae, and Proteus species, enteritis and colitis produced by Campylobacter fetus, and soft tissue and pleuropulmonary anaerobic infections in which Bacteroides fragilis plays no role. In combination with an aminoglycoside, erythromycin has proven to be effective for perioperative antibiotic prophylaxis in patients undergoing elective colon surgery. Additional therapeutic indications continue to be explored. The renewed interest in erythromycin has resulted in a closer examination of its potential for toxicity. New untoward events attributed to erythromycin administration have been described. This antibiotic has produced both reversible hearing loss and pseudomembranous colitis. Erythromycin also possesses the ability to inhibit the degradation of theophylline.
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PMID:Erythromycin. New indications and toxicities. 719 77

In 1978 and 1979, eight sporadic cases of Legionella pneumonia were observed in the Berne and Ticino areas of Switzerland. In all cases the diagnosis was established serologically using indirect immunofluorescence. Seroconversion was observed in five patients. In three cases initially high antibody titers decreased progressively. The clinical picture was characterized by acute onset with high fever, frequent chills, and dry cough. Occasional concomitant symptoms included muscular pains, headache, thoracic pain, dyspnea, hemoptysis, and gastrointestinal and central nervous symptoms. Laboratory findings showed markedly increased BSR as well as slightly increased WBC with a pronounced shift to the left. In all cases, X-ray examinations demonstrated extended, mainly unilateral and often remarkedly peripheral infiltrations of the lung. On the basis of the clinical course, two groups could be distinguished: (a) non-complicated cases of pneumonia with rapid improvement within 2-3 weeks; and (b) cases with a protracted sometimes severe course with persistence of the infiltrations up to 4 months and more. All patients with a protracted course suffered from concomitant symptoms. Whereas none of the patients died of legionellosis, two patients died six months later from their underlying disease. Most patients were treated with several antibiotics. In three patients definite improvement occurred only after therapy had been changed to doxycycline. Erythromycin, currently recommended as the drug of choice, was used in none of these cases.
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PMID:[Clinical data on Legionnaires' disease. Report on 8 sporadic cases of Legionella pneumonia]. 720 64


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