Legionnaires'disease in the renal transplant unit of Hospital das Clinicas FMUSP: during a five year period (1988-1993)

Embora varios trabalhos tem mostrado a presenca de Legionella pneumophila associado a pneumopatias infecciosas em transplantados renais, tal associacao nao fora antes realizado de maneira sistematica no Brasil. Os autores julgaram oportuno a determinacao da incidencia por comprovacao sorologica da Legionella pneumophila sorogrupo 1 em transplantados renais num periodo de 5 anos. Para tanto amostras de soros de 70 pacientes com pneumopatia infecciosa internados na UTR do HC-FMUSP, colhidos na fase aguda e convalescente da infeccao, foram submetidas a reacao de imunofluorescencia indireta para pesquisa de anticorpos anti-Legionella pneumophila sorogrupo 1....

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.

Legionella pneumophila associada a insuficiência respiratória aguda: primeiro isolamento no Brasil / Legionella pneumophila associated with acute respiratory insufficiency: first isolation in Brazil

Relatam os autores isolamento de Legionella pneumophila sorogrupo 1, acompanhado de evidências sorológicas de infecçäo atual, em homem de 40 anos com infecçäo respiratória grave que evoluiu para insuficiência respiratória aguda. Esta foi caracterizada por hipoxemia severa refratária a altas concentraçöes de oxigênio e radiograficamente por infiltrados difusos em ambos pulmöes. Com introduçäo de clindamicina, amicacina, ceftriaxone e ventilaçäo s volume com Pressäo Expiratória Positiva Final (PEEP) de 14 cm de H2O, houve estabilizaçäo do quadro e gradual recuperaçäo. Suspeitando-se de legionelose, foi colhido sangue e secreçäo traqueal exames específicos. A secreçäo traqueal foi semeada em meio BCYE com isolamento de bacilo gram-negativo, identificado como Legionella pneumophila sorogrupo 1 por características culturais, bioquímicas e reaçöes de imunofluorescência direta e de aglutinaçäo em lâmina. O estudo sorológico revelou títulos de anticorpos 128, 1024, 4096 e 8192 para amostras coletadas na 1ª, 3ª,4ª e 6ª semanas após o início do quadro. Os resultados definitivos foram obtidos com o paciente em recuperaçäo. É realçada a comprovaçäo da presença de Legionella sp. como agente patológico em nosso meio; a importância das medidas de suporte na evoluçäo do paciente; a necessidade de se pensar neste agente no diagnóstico diferencial de peneumonias e de se pesquisar mais esta etiologia com metodologia laboratorial específica