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

Despite the fact that the epidemiology of community-acquired pneumonia and nosocomial Legionella infection is well known, there are no specific reports dealing with severe cases of Legionella pneumophila pneumonia admitted to intensive care units. We undertook a prospective study upon 84 patients with a reliable diagnosis of L. pneumophila pneumonia that required ICU admission. The study assessed the prognostic factors, clinical, radiological and outcome variables of both nosocomial (n = 33) and community-acquired (n = 51) cases of L. pneumophila pneumonia. The following variables were more common in nosocomial acquired as compared to community-acquired Legionella pneumonia: Chronic obstructive pulmonary disease (COPD) (64 versus 41%), cardiac disease (39 versus 10%), chronic renal failure (21 versus 4%), alcoholism (54 versus 18%), septic shock (33 versus 16%), and unilateral chest X-ray involvement (61 versus 39%). The crude mortality rate in this study was 30% (25 of 84) with no differences when comparing mortality between nosocomial (9, 27%) to community-acquired (16, 31%) types. The univariate analysis showed that cardiac disease, diabetes mellitus, creatinine > or = 1.8 mg/dl, septic shock, chest X-ray extension, mechanical ventilation, hyponatremia < or = 136 mEq/L, PACO2/FIO2 < 130, and blood urea levels > or = 30 mg/dl were factors related to poor outcome. On the other hand, the following two variables were related to better outcome: adequate treatment for Legionella and pneumonia improvement. The logistic regression analysis demonstrated that APACHE II score > 15 at admission (RR: 11.5; 95% CI 1.75 to 76.1; p = 0.025), and serum Na levels < or = 136 (RR: 21.3; 95% CI 1.11 to 408; p = 0.023), were the only independent factors related to death. On the other hand, improving pneumonia is associated with better outcome in Legionnaires' disease than for patients not having improving pneumonia (RR: 0.019; 95% CI: 0.036 to 0.106; p < 0.0001). A better understanding of the prognostic factors in cases of severe Legionella pneumonia will optimize our therapeutic approach in this disease and help to decrease both its mortality and morbidity rates.
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PMID:Prognostic factors of severe Legionella pneumonia requiring admission to ICU. 998 59

Patients with chronic renal failure are at increased risk for infections because of impaired cellular immunity. This study was designed to determine the prevalence of antibodies to Legionella pneumophila serogroups 1 to 6 and to evaluate the possible risk factors for Legionnaires' disease in hemodialysis patients. Serum samples to be screened for antibodies against L pneumophila and risk factor data were collected from 252 hemodialysis patients. The overall prevalence of L pneumophila antibodies in hemodialysis patients was found to be 5.16% There was no statistically significant difference between L pneumophila seropositivity and potential risk factors. Further studies are needed to determine possible risk factors for Legionnaires' disease in hemodialysis patients.
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PMID:Seroprevalence of antibodies to legionella pneumophila in hemodialysis patients. 1501 96

Legionella species have been widely recognized as among the important causative organisms of community-acquired pneumonia in Japan. A delay in the start of adequate treatment has a negative influence on the outcome of the disease. Telithromycin, the first oral ketolide antibacterial, was developed for the treatment of community-acquired pneumonia, including Legionella pneumonia. However, few reports have indicated the efficacy of telithromycin in community-acquired pneumonia caused by Legionella species. We report three cases of Legionella pneumonia, that were improved by early telithromycin therapy. The first patient (67-year-old man) had bronchiectasis as an underlying disease, and the second patient (73-year-old man) had diabetes mellitus and chronic renal failure. The third patient (62-year-old man) developed pneumonia after a spa tour. The diagnosis of Legionella pneumonia was made on the basis of the presence of a single IgG titer of 1/256 in case 1 and positive antigenuria in cases 2 and 3. The patients were classified into a mild group (case 1) and a moderate group (cases 2 and 3) based on the severity of the community-acquired pneumonia according to the 2005 Japanese Respiratory Society Guidelines. The results support the efficacy of telithromycin in mild to moderate Legionella pneumonia.
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PMID:[Successful telithromycin therapy of Legionella pneumonia --report of three cases]. 1692 86

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

We reviewed findings of clinical, epidemiologic, and environmental investigations for 288 confirmed case-patients with Legionnaires' disease reported in Hong Kong, China, during January 2005-December 2015. We found that chronic renal failure/impairment (adjusted odds ratio [aOR] 4.09), chronic pulmonary diseases (aOR 3.22), malignancy (aOR 3.04), and heart diseases (aOR 2.15) were independently associated with a higher risk for severe Legionnaires' disease. However, patients with hyperlipidemia had a lower risk for severe outcome (aOR 0.17). Legionella positivity rate was 22% for 1,904 water samples collected. We found a higher positivity rate in summer months (28%-30%), which corroborated with months of highest rainfalls. Our novel finding that Legionnaires' disease patients with hyperlipidemia had a lower risk for severe outcome deserves further study to confirm the observation and ascertain the underlying reason.
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PMID:Epidemiology of Legionnaires' Disease, Hong Kong, China, 2005-2015. 3268 25