A Novel Case of Legionnaire's Disease after Staying at Home Rentals.

Case of a 44-year-old woman with past medical history of dermatomyositis who had been on Methrotexate therapy who became infected with Legionella pneumophila after staying at a home rental, known commercially as an Airbnb. The patient presented to the ER with complaints of general malaise and subsequently developed sepsis with respiratory failure requiring intubation. CT scan confirmed the diagnosis of pneumonia and through extensive research L. pneumophila was identified using a pneumonia panel that works by identifying nucleic acids of fastidious organisms that are difficult and take long to grow by culture. As the patient's pneumonia progressed to ARDS and her clinical impression worsened, pronation technique was begun in addition to her course of antibiotics that were already being administered. The patient began showing significant improvement in her clinical picture and was extubated with progressive recovery.

Legionnaires' disease: a rare entity in Puerto Rico?

Legionnaires' disease is a severe, often fatal pneumonia, caused by Legionella pneumophila. Its incidence is reported about 6. In Puerto Rico, there is no data available of the prevalence of Legionnaires' disease. A case of Legionnaires' is presented as well as data to support that the prevalence in our Island is higher than the reported elsewhere.

Legionnaires' disease: a rare entity in Puerto Rico?

Legionnaires' disease is a severe, often fatal pneumonia, caused by Legionella pneumophila. Its incidence is reported about 6%. In Puerto Rico, there is no data available of the prevalence of Legionnaires' disease. A case of Legionnaires' is presented as well as data to support that the prevalence in our Island is higher than the reported elsewhere.

[Atypical pneumonia caused by Legionella pneumophila. Report of a second case in Mexico]. / La neumonía atípica por Legionella pneumophila. Informe del segundo caso en México.

An outbreak of pneumonia that caused 34 deaths among 221 legionnaires was reported in 1977 at the American Legion Convention in Philadelphia. The causative agent was eventually recognized and named Legionella pneumophila. Legionellosis is a worldwide disease, but in Mexico there is only one report of Legionnaires' disease, possibly because it is not thought of as a cause of community-acquired pneumonia. We report a previously healthy patient who required admittance to our ICU with community-acquired Legionnaires' disease.

Legionelose associada a pneumopatias em São Paulo. Estudo da comprovação etiológica por isolamento e sorologia (1) / Legionellosis associated with pneumopathies in São Paulo. Study of the etiologic confirmation by isolation and serology

The role of Legionella sp as an important pathogen, although reported in many countries, had not been well documented in Brazil. The main objective of the present study is to detect this organism or it's immunological response in patients with pulmonary infections in the city of São Paulo. For this purpose, specific laboratory methodology was introduced to cultivate the agent and demonstrate specific antibodies by serology. Patients from two University centers in São Paulo were studied: 100 from the Hospital Universitario, University of São Paulo with general pulmonary infections and 100 from Hospital das Clínicas, Faculdade de Medicina, University of São Paulo. The latter were selected to exclude pulmonary infections of other bacterial aetiology, and 30 of these were selected from the Renal Transplant Unit. Clinical specimens for cultures included sputum tracheal secretion, pleural, fluid, bronchial washing or lung tissue biopsy. Isolation of Legionella sp was attempted in BCYE medium with and without antibiotics, presumptive diagnosis by biochemical methods and identification through direct immunofluorescence staining and slide agglutination test. Direct evidence of the organism in tissue was attempted by direct immunofluorescence staining. Specific antibodies for Legionella pneumophila serogroup 1 were tested by the indirect immunofluorescence assay. Serology was also carried out in specimens from human contacts with Legionnaires' Disease. Legionella pneumophila serogroup 1 was isolated from two patients, demonstrating the presence of the pathogen in this country. Serology was able to establish present or past infection with the agent in 16 of the 100 patients from Hospital das Clínicas and in only one from Hospital Universitário. In patients considered as high risk groups from Hospital das Clínicas with renal transplantation, serology for present or past Legionellosis was positive in 33 and in 8.5 for community acquired infections. Serology in specimens from Medical personnel in contact with patients of Legionnaires' disease was positive for past infection in one single subject, confirming information already published that direct transmission from person to person is unusual. The introduction of specific methods for laboratorial evidence of Legionella sp infections at the Hospital das Clínicas-Faculdade de Medicina USP community has permitted diagnosis in able time to allow use of specific anti-microbial therapy, with good results.

[Legionellosis associated with pneumopathies in São Paulo. Study of the etiologic confirmation by isolation and serology]. / Legionelose associada a pneumopatias em São Paulo. Estudo da comprovação etiológica por isolamento e sorologia (1).

The role of Legionella sp as an important pathogen, although reported in many countries, had not been well documented in Brazil. The main objective of the present study is to detect this organism or it's immunological response in patients with pulmonary infections in the city of São Paulo. For this purpose, specific laboratory methodology was introduced to cultivate the agent and demonstrate specific antibodies by serology. Patients from two University centers in São Paulo were studied: 100 from the Hospital Universitario, University of São Paulo with general pulmonary infections and 100 from Hospital das Clínicas, Faculdade de Medicina, University of São Paulo. The latter were selected to exclude pulmonary infections of other bacterial aetiology, and 30 of these were selected from the Renal Transplant Unit. Clinical specimens for cultures included sputum tracheal secretion, pleural, fluid, bronchial washing or lung tissue biopsy. Isolation of Legionella sp was attempted in BCYE medium with and without antibiotics, presumptive diagnosis by biochemical methods and identification through direct immunofluorescence staining and slide agglutination test. Direct evidence of the organism in tissue was attempted by direct immunofluorescence staining. Specific antibodies for Legionella pneumophila serogroup 1 were tested by the indirect immunofluorescence assay. Serology was also carried out in specimens from human contacts with Legionnaires' Disease. Legionella pneumophila serogroup 1 was isolated from two patients, demonstrating the presence of the pathogen in this country. Serology was able to establish present or past infection with the agent in 16 of the 100 patients from Hospital das Clínicas and in only one from Hospital Universitário. In patients considered as high risk groups from Hospital das Clínicas with renal transplantation, serology for present or past Legionellosis was positive in 33% and in 8.5% for community acquired infections. Serology in specimens from Medical personnel in contact with patients of Legionnaires' disease was positive for past infection in one single subject, confirming information already published that direct transmission from person to person is unusual. The introduction of specific methods for laboratorial evidence of Legionella sp infections at the Hospital das Clínicas-Faculdade de Medicina USP community has permitted diagnosis in able time to allow use of specific anti-microbial therapy, with good results.

Insuficiência respiratória aguda secundária a pneumonia por Legionella: relato de um caso / Acute pulmonary insufficiency secondary to Legionella pneumonia: a case report

Os autores descrevem o caso de um jovem policial da Polícia Militar, com 24 anos de idade e previamente gozando de um excelente estado de saúde, que se apresentou com um quadro clínico de broncopneumonia adquirida na comunidade, seguindo-se de uma evoluçäo rápida para a insuficiência respiratória aguda, com necessidade precoce de prótese respiratória e admissäo em Centro de Tratamento Intensivo. Com base no quadro clínico grave de insuficiência respiratória aguda, secundária à infecçäo pulmonar adquirida na comunidade e na história epidemiológica, foi feita a hipótese diagnóstica de pneumonia por Legionella, e iniciado o tratamento específico com sulfametoxazol e trimetoprin, com 800 e 160 mg por dia, respectivamente. Com a confirmaçäo de legionelose pulmonar, pela avaliaçäo de anticorpo por imunofluorescência indireta (IFA), alcançando um título de 1:4000, foi associada ao esquema antibioterápico inicial a eritromicina na dose de 4 g por dia. Assim, o paciente gradativamente desmamou do respirador, recebeu alta da terapia intensiva para a enfermaria, e no 15§ dia de tratamento com a eritromicina teve alta hopitalar, indo para a residência, se sentindo bem e em franca melhora clínica, a ser acompanhada no ambulatório de clínica médica.

Nosocomial legionnaires disease in a children's hospital.

Between August 1982 and December 1985, seven patients at a children's hospital developed hospital-acquired pneumonia caused by Legionella pneumophila. Demographic data included the following: mean age 12.3 years (range 9 months to 20.5 years); male/female ratio 5:2; all patients were white. Some previously identified risk factors present in our patients included high-dose corticosteroid therapy (five patients), other immunosuppressive therapy (four), and chronic lung (five) or kidney (three) disease. Symptoms and signs included rapid onset, fever, cough, pleuritic chest pain, dyspnea, abdominal pain, diarrhea, and headache. Rhinitis, myalgia, and neurologic abnormalities were not noted. Chest roentgenograms revealed single-lobe consolidation in three patients, diffuse bilateral alveolar infiltrates in three, and pleural effusion in three. All patients were treated with erythromycin; three patients also received rifampin. Tracheal intubation and mechanical ventilation were required by four patients. Six patients improved after therapy. One child died of persistent lung disease 1 month after the onset of legionnaires disease. L. pneumophila was isolated from potable water in the hospital. Aerosol equipment cleansed with tap water and the showers were implicated as means of exposure by patients to contaminated potable water. No new nosocomial cases were seen after immunocompromised children were prohibited from taking showers, and sterile water was used to cleanse equipment for administering aerosol medications.

Community-acquired Legionnaires' disease.

Legionellae are ubiquitous aquatic organisms. They are unique among the agents commonly responsible for bacterial pneumonia in humans in that they are not part of the normal human flora but are acquired from environmental sources. Prospective studies have shown that legionellae consistently rank among the top three bacteria as etiologic agents of community-acquired pneumonia. The clinical presentation of Legionnaires' disease is not distinguishable from that of other bacterial pneumonias. Culture of respiratory secretions using selective media, combined with one or more rapid diagnostic methods (direct fluorescent antibody staining, radiolabelled DNA probe, or urinary antigen detection) provides a specific diagnosis in the vast majority of cases. Sporadic cases have been linked to legionella colonization of water systems in homes and the work setting. Antibiotics commonly used in the therapy of community-acquired pneumonias, such as beta-lactam agents, are ineffective. Specific therapy with erythromycin reduces mortality to less than 10%.

Legionella: tercera parte / Legionella: third part

Este trabajo compendia la información de la familia Legionellaceae desde su descubrimiento y clasificación, hasta los últimos datos obtenidos de investigaciones que sobre el microrganismo se han desarrollado. Legionella forma parte de ecosistemas acuáticos, requiere de L-cisteína y hierro para su desarrollo in vitro. Produce enfermedad por invasión de tejido local; elaboración de toxinas; liberación de endotoxinas asociadas a la pared celular; mecanismos inmunológicos; o, combinación de estos factores. Fundamentalmente produce dos entidades clínicas; "fiebre Pontiac" y "enfermedad de los legionarios". La neumonía por Legionella se presenta sobre todo en personas con mecanismos de defensa alterados e con enfermedades predisponentes como el alcoholismo, por lo que en los hospitales debe tenerse cuidado especial a pacientes de alto riesgo en unidades de trasplante o con terapéutica inmunosupresora. Se considera a la legionelosis como enfermedad ocupacional o de viajeros y el tratamiento de elección es con eritromicina

Empleo de la inmunofluorescencia indirecta en el diagnóstico serológico de la legionellosis / Use of indirect immunofluorescence in the serologic diagnosis of legionellosis

Se ensayó la técnica de inmunofluorescencia indirecta para el serodiagnóstico de legionellosis con 73 monosueros, de los cuales 48 corresponden a pacientes con neumopatía de causa no precisada, atendidos en el Hospital Benéfico Jurídico y 25 personas aparentemente sanas, asistentes al Banco de Sangre de la provincia Ciudad de La Habana, de los que se detecta el 31,25% y 32% de reactores respectivamente. No se encuentra diferencia significativa al 5% en los resultados obtenidos en ambos grupos, y se emplea el método estadístico de Chi-cuadrado. Se detectan en todos los serogrupos utilizados anticuerpos y un paciente con título >- 1: 256, resultado que permite considerarlo como un caso presuntivo de legionellosis

Doença dos legionários: relato do primeiro caso no Brasil / Legionnaires' disease: first case reported in Brazil

É relatado um caso grave da doença dos legionários identificados na Bahia (Brasil) e confirmado, posteriormente, nos Estados Unidos da América (EUA), pela técnica sorológica de imunofluorescência indireta, com títulos menores que 1:128 (fase aguda) e 1:256 (fase de convalescença)(+). É descrito o caso de um homem branco, com 44 anos de idade, acometido por extensa pneumonia bilateral rapidamente evolutiva, a despeito do emprego de penicilina e amicacina, evidenciando confusäo mental, toxemia, insuficiência respiratória grave e alteraçöes das provas laboratoriais hepáticas e renais. Com a introduçäo de eritromicina houve completa reversäo do quadro clínico e laboratorial, restando mínimas seqüelas pulmonares. A presença de cavidades no seio de áreas de consolidaçäo pulmonar vistas neste caso tem sido relatada como ocorrência infreqüente. Enfatiza-se a necessidade de familiarizaçäo com seu quadro clínico, uma vez que somente a terapêutica adequada precocemente instituida poderá reduzir significativamente sua mortalidade