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Legionnaire’s Disease and Severe Pneumonia Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Based on a clinical syndromic diagnosis, as described earlier, early empiric therapy for Legionnaire’s disease should be started if diagnostic probability is high and should be initiated pending test results (Table 14.10). The diagnosis of Legionnaire’s disease may be confirmed by Legionella sp. titers or Legionella urinary antigen (LUA). The limitation of LUA testing is that results may be negative early and the test only detects L. pneumophilia (serotype 01) and not other serotypes or species [30–32].
Section 10
Published in Padmanabhan Ramnarayan, MCQs in Paediatrics for the MRCPCH, Part 1, 2017
Legionella pneumonia is a serious form of infection in the immuno-compromised patient. It classically presents with a diffuse pneumonia, hyponatraemia, diarrhoea, uraemia and a high phosphate level. Treatment is with erythromycin. Q fever is caused by Coxiella burnetti and presents in a normal host with an atypical pneumonia and is not associated with a rash. The main complication is an endocarditis in children with a previous heart disease. Treatment is with tetracycline or chloramphenicol.
Case 54: Recurrent Lower Respiratory Infections Following a Renal Transplant
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
A septic screen, including blood and sputum cultures and respiratory viral swabs should be taken. Urine should be sent for routine culture and to be tested for legionella antigen. The patient will need a chest x-ray to identify consolidation or evidence of tuberculosis or malignancy.
Clinical features of Legionnaires’ disease at three Belgian university hospitals, a retrospective study
Published in Acta Clinica Belgica, 2022
Marco moretti, Sabine D. Allard, Nicolas Dauby, Deborah De Geyter, Bhavna Mahadeb, Véronique Y. Miendje, Eric V. Balti, Philippe Clevenbergh
Sixty-two patients with a positive LUA or RT-PCR for LD on respiratory samples were considered. Eight cases were excluded as they did not match the criteria of LD diagnosis. Indeed, they were previously diagnosed with Pontiac fever. Four other patients were not included in the current study as their medical records were incomplete and the date of symptoms’ onset was not mentioned. Fifty LD patients were hence enrolled. The median age was 64 (IQR: 52–74) years and 72% (36) were male. Urinary antigen detection test was requested in all patients and was positive in 94% (47) of cases. Forty-two LD cases (84%) were diagnosed only with LUA. Eight cases (16%) were diagnosed with PCR performed on respiratory specimens. Among them, five patients were affected by Lp1 and three by Legionella pneumophila serogroup 3, this last three patients had a false-negative LUA. All patients except one received a validated antibiotic regimen for Legionella. The patient, who did not receive any effective antibiotics, died at diagnosis. Moxifloxacin was chosen in 21 (42%) cases and high-dose levofloxacin was used in 18 (36%). Other regimens were ciprofloxacin in six patients (12%) and clarithromycin in four patients (8%). The median length of treatment was 12 days (IQR: 10–20).
Drug screening of rhodanine derivatives for antibacterial activity
Published in Expert Opinion on Drug Discovery, 2020
Suresh Maddila, Sridevi Gorle, Sreekantha B Jonnalagadda
Bacterial infections are a serious health risk and these include clinically acquired ones. The alarming increase in these types of infections has imposed a severe challenge on healthcare organizations to develop new and more effective drugs for their treatment [1–3]. Multidrug-resistant (MDR) gram-positive and gram-negative bacteria cause many of these infections [4]. Generally, the pathogens in medicinal settings are gram-positive bacteria, which include Staphylococcus epidermidis/S. epidermidis, Streptococcus pneumoniae/S. pneumoniae, Staphylococcus aureus/S. aureus, Enterococcus faecalis/E. faecalis, and Enterococcus faecium/E. faecium. The gram-negative bacteria are Escherichia coli/E. coli, Pseudomonas aeruginosa/P. aeruginosa, Chlamydophila pneumonia/C. pneumonia, Mycoplasma pneumonia/M. pneumonia, and Legionella pneumophila/L. pneumophila among others, which are proficient in triggering severe deadly toxicities [5–8].
Detection of amoeba-associated Legionella pneumophila in hospital water networks of Johannesburg
Published in Southern African Journal of Infectious Diseases, 2018
P Muchesa, M Leifels, L Jurzik, TG Barnard, C Bartie
Legionella species are gram-negative, non-spore-forming, rod-shaped or filamentous fastidious aerobic bacteria. They have been isolated from man-made aquatic environments such as cooling towers, hot tubs, air-conditioning systems and potable water systems where they can proliferate at temperatures between 20° and 50°C.1,2. Among the 58 described Legionella spp., Legionella pneumophila serogroup 1 is the most common serotype responsible for at least 84% of infections in humans. Inhalation of aerosols containing Legionella spp. may result in two kinds of infections, the mild, non-fatal, influenza-like illness Pontiac fever and the severe form of pneumonia and potentially fatal Legionnaires’ disease (LD) in both community and health-care settings. Aspiration of contaminated water or direct contact with surgical wounds are the other less common modes of transmission.3 Worldwide, there are few LD cases where the environmental source of Legionella infection is determined successfully. Studies have shown that contaminated potable water supplies within hospitals could be responsible for hospital-acquired LD cases.4,5