RESUMO
BACKGROUND: Legionella has a higher prevalence in India than in the world. Legionaries' disease most commonly involves the lungs but because of increased awareness, extrapulmonary manifestations are also being diagnosed more frequently. CASE DESCRIPTION: We present a case of a young female with acute onset of fever and chest pain. On initial investigation, an electrocardiogram (ECG) reported widespread pulse rate (PR) depression suggestive of pericarditis which was confirmed by ECG. High-resolution computed tomography (HRCT) thorax suggested mild bilateral pleural effusion with normal lung parenchyma. elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) added to the diagnosis of serositis. Serological study for atypical organisms was remarkable for positive immunoglobulin M (IgM) for Legionella. She was treated with a high dose of steroids and azithromycin successfully. CONCLUSION: Isolated extrapulmonary presentation of legionaries disease is often overlooked and is common. So it should be always included in the diagnostic armamentarium as treatment is highly efficacious if started early.
Assuntos
Azitromicina , Serosite , Feminino , Humanos , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Eletrocardiografia , Legionella/isolamento & purificação , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Doença dos Legionários/diagnóstico , Doença dos Legionários/tratamento farmacológico , Serosite/diagnóstico , Serosite/etiologia , Tomografia Computadorizada por Raios XRESUMO
La enfermedad de los legionarios es un importante problema de salud pública particularmente por su frecuente presentación en forma de brotes, tanto comunitarios como nosocomiales, y por su letalidad, especialmente en personas de edad avanzada o con otras enfermedades. La notificación oportuna de casos y/o brotes de enfermedad y la investigación epidemiológica permiten la identificación de la/s fuentes de exposición y la adopción de medidas de prevención y control adecuadas. Las infecciones por Legionella son más frecuentes entre adultos mayores de 50 años, hombres, fumadores y huéspedes inmunocomprometidos o con ciertas enfermedades crónicas subyacentes. La infección en niñas/os es rara, con ≤ 1% de los casos de neumonía causada por Legionella, y puede ser asintomática o leve y no detectada. La Legionella puede multiplicarse si el agua no es tratada de manera adecuada o si los sistemas de agua no son mantenidos adecuadamente.
Assuntos
Legionelose/prevenção & controle , Legionelose/tratamento farmacológico , Surtos de Doenças , Monitoramento EpidemiológicoRESUMO
BACKGROUND: The goal of the study was to analyze the clinical characteristics of Legionella cases caused by Legionella micdadei and explore the diagnosis and treatment. METHODS: The pathogen was identified by routine isolation and culture, biochemical identification, serum agglutination test, mass spectrometry identification, and routine PCR. Combined with the related literature review, the clinical diagnosis and treatment of Legionella micdadei were analyzed. RESULTS: The patient suffered from pulmonary infection caused by Legionella micdadei. After treatment with moxi-floxacin for 2 weeks, the body temperature dropped and the shadow of the lung was completely absorbed after 2 months. Combined with literature analysis, 8 cases of Legionella micetidis, including 7 males and 1 female, aged from 27 to 57 years old, 6 cases with basic diseases, which were treated with azithromycin, erythromycin or levofloxacin, and all of them achieved good therapeutic effect. CONCLUSIONS: The detection of Legionella should be strengthened in patients with pneumonia whose symptoms have no obvious improvement after antibiotic treatment. Azithromycin, erythromycin or levofloxacin are effective in the treatment of Legionella spp.
Assuntos
Legionella , Legionelose , Pneumonia , Adulto , Azitromicina/farmacologia , Azitromicina/uso terapêutico , Eritromicina/farmacologia , Feminino , Humanos , Legionellaceae , Legionelose/complicações , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Levofloxacino/farmacologia , Levofloxacino/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnósticoRESUMO
OBJECTIVES: Due to recent safety concerns regarding fluoroquinolones and the potential medical and economic benefits, we investigated the efficacy of a single intravenous dose of 1.5 g azithromycin for the treatment of pulmonary legionellosis. METHODS: Using a nationwide legionellosis registry for pre-selection, 74 patients admitted from 2000-2018 to a tertiary care hospital owing to pneumonia caused by Legionella pneumophila were retrospectively included in this study. RESULTS: Conventional treatment regimens consisting of fluoroquinolones (n = 20), macrolides (n = 30) or combinations of both (n = 24) and a single intravenous dose of azithromycin (n = 12) have been demonstrated to be equally effective. Single-dose azithromycin treatment was well tolerated and resulted in a shorter hospital stay (P = 0.0464) and shorter antibiotic treatment duration (P = 0.0004) allowing earlier discharge. CONCLUSION: A single intravenous dose of azithromycin might be a valuable treatment alternative for patients with legionellosis.
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Fluoroquinolonas/uso terapêutico , Legionelose/tratamento farmacológico , Centros de Atenção Terciária/estatística & dados numéricos , Administração Intravenosa , Adulto , Idoso , Áustria , Feminino , Humanos , Legionella pneumophila/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
As a type of Legionella bacteria, Legionella longbeachae bacteria can lead to very rare legionella disease case in China with clinical characteristics, such as no typical early clinical symptoms, strong toxicity, high mortality, and not easy to detect by conventional etiology. A case of severe pneumonia caused by Legionella longbeachae infection was confirmed by bronchoalveolar lavage fluid pathogen metagenomics, and the patient's condition was improved after targeted anti-infection treatment. At present, our understanding in Legionella longbeachae severe pneumonia is limited. The diagnosis and treatment process of the patient with severe pneumonia of Legionella longbeachaeis retrospectively analyzed and the relevant literature was reviewed to provide the experience for its future diagnosis and treatment.
Assuntos
Legionella longbeachae , Legionella , Legionelose , Pneumonia , Humanos , Legionella/genética , Legionella longbeachae/genética , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Pneumonia/diagnóstico , Estudos RetrospectivosRESUMO
Herein, we report the case of a 74-year-old man diagnosed with Legionella pneumonia detected by Loop-Mediated Isothermal Amplification (LAMP) method, which was suspected to have been transmitted from the potting soil. Legionella longbeachae was identified in the sputum culture. The patient was intubated and maintained on mechanical ventilation. Antimicrobial therapy with azithromycin was also administered. His symptoms were resolved and he was discharged after 26 days of hospitalization. Legionella longbeachae pneumonia rarely occurs in Japan, and published literature of Legionella longbeachae pneumonia cases in Japan was reviewed. Patients with severe pneumonia exposed to potting soils, but with negative urinary antigen test results, should be examined by LAMP method.
Assuntos
Legionella longbeachae , Legionella , Legionelose , Pneumonia , Idoso , Humanos , Japão , Legionella/genética , Legionella longbeachae/genética , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Masculino , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológicoRESUMO
Legionellosis caused by Legionella longbeachae is diagnosed mainly by PCR. We report a case of L. longbeachae infection in mainland China, which was diagnosed by metagenomic next-generation sequencing, in a man who developed an epileptic seizure after using moxifloxacin. Metagenomic next-generation sequencing may be a useful tool to detect Legionella spp.
Assuntos
Epilepsia/induzido quimicamente , Legionelose , Moxifloxacina/efeitos adversos , Pneumonia Bacteriana/tratamento farmacológico , Convulsões/induzido quimicamente , China , Humanos , Legionella longbeachae , Legionelose/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Moxifloxacina/uso terapêuticoRESUMO
To date, only twenty cases of cutaneous legionellosis have been reported. Cutaneous legionellosis has heterogeneous manifestations including abscesses, nodules, and cellulitis. The detection of most cutaneous Legionella species requires specific diagnostic cultures and assays. Herein, we report a case of cutaneous legionella in a hematopoietic cell transplantation recipient with culture-negative nodules unresponsive to empiric antibiotics. We also discuss the varied morphology of cutaneous legionellosis and important diagnostic considerations.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hospedeiro Imunocomprometido , Legionella , Legionelose/patologia , Dermatopatias Bacterianas/patologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Legionella/isolamento & purificação , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológicoRESUMO
Legionella species are consistently identified as some of the most common causative agents of severe community-acquired pneumonia (CAP) or nosocomial pneumonia. Although the number of reported Legionella infection cases is gradually increasing in Japan, most cases are diagnosed by a urinary antigen test, which identifies only L. pneumophila serogroup 1. Therefore, assessment of pneumonia-causing Legionella species and serogroups would be important. The Japan Society for Chemotherapy Legionella committee has collected the isolates and clinical information on cases of sporadic community-acquired Legionella pneumonia throughout Japan. Between December 2006 and March 2019, totally 140 sporadic cases were identified, in which L. pneumophila was the most frequently isolated species (90.7%) followed by L. bozemanae (3.6%), L. dumofii (3.6%), L. micdadei (1.4%), and L. longbeachae (0.7%). Among 127 isolates of L. pneumophila, 111 isolates were of serogroup 1, two of serogroup 2, four of serogroup 3, one of serogroup 4, one of serogroup 5, seven of serogroup 6, and one was of serogroup 10. We also assessed in vitro activity of antibiotics against these isolates and showed that quinolones and macrolides have potent anti-Legionella activity. Our study showed that pneumonia-causing Legionella species and serogroup distribution was comparable to that reported in former surveillances. L. pneumophila was the most common etiologic agent in patients with community-acquired Legionella pneumonia, and L. pneumophila serogroup 1 was the predominant serogroup.
Assuntos
Legionella/classificação , Legionella/isolamento & purificação , Legionelose/microbiologia , Pneumonia Bacteriana/microbiologia , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Japão , Legionella pneumophila/classificação , Legionella pneumophila/isolamento & purificação , Legionelose/tratamento farmacológico , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Sorogrupo , SorotipagemRESUMO
Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.
Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Adulto , Assistência Ambulatorial , Antígenos de Bactérias/urina , Hemocultura , Infecções por Chlamydophila/diagnóstico , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/metabolismo , Técnicas de Cultura , Quimioterapia Combinada , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Infecções por Haemophilus/metabolismo , Hospitalização , Humanos , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Legionelose/metabolismo , Macrolídeos/uso terapêutico , Infecções por Moraxellaceae/diagnóstico , Infecções por Moraxellaceae/tratamento farmacológico , Infecções por Moraxellaceae/metabolismo , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/metabolismo , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/metabolismo , Pneumonia Estafilocócica/diagnóstico , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/metabolismo , Radiografia Torácica , Índice de Gravidade de Doença , Escarro , Estados Unidos , beta-Lactamas/uso terapêuticoRESUMO
Diagnosed and reported Legionella pneumonias are slightly increasing during recent years. This might at least partially be due to more frequently used diagnostic tests.In severe pneumonia, nucleic acid amplification based methods should supplement the L. pneumophila serogroup-1 urinary antigen test because of their improved spectrum and sensitivity.Recent in vitro data suggest enhanced efficacy of levofloxacin when compared to macrolides. This complements recent clinical cohort data. Thus levofloxacin (750-1000âmg/d) is regarded the treatment of choice for confirmed legionellosis. Second line options are azithromycin or moxifloxacin. Treatment duration of 7 days should be sufficient in most cases.Development of resistance is rare and no routine resistance testing is necessary.
Assuntos
Antibacterianos , Legionella/efeitos dos fármacos , Legionelose , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Humanos , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Legionelose/microbiologia , Levofloxacino/farmacologia , Levofloxacino/uso terapêuticoAssuntos
Hospedeiro Imunocomprometido , Legionelose/diagnóstico , Pulmão/patologia , Nódulos Pulmonares Múltiplos/diagnóstico , Neoplasias da Bexiga Urinária/complicações , Diagnóstico Diferencial , Humanos , Legionella/isolamento & purificação , Legionelose/tratamento farmacológico , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Resultado do Tratamento , Tuberculose/diagnóstico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/microbiologiaRESUMO
We here report on two immunocompetent patients admitted to our hospital within 3 weeks' time, both suffering from pneumonia caused by Legionella longbeachae (L. longbeachae). The pathogen was identified in broncho-alveolar lavage (BAL) liquid by Polymerase Chain Reaction (PCR), whereas sputum cultures remained negative. This organism is worldwide still relatively unknown and consequently underdiagnosed. However, with an increasing number of confirmed infections in Europe and more specifically in the Netherlands, early awareness and diagnostic measurements are indicated. As routine laboratory techniques like the urine antigen test do not detect L. longbeachae, we advocate early use of specific tests for non-pneumophila Legionella species such as PCR. Furthermore, we advocate the start of empirical antibiotic therapy (i.e. ciprofloxacin) and continuation in suspected cases.
Assuntos
Antibacterianos/uso terapêutico , Legionella longbeachae/isolamento & purificação , Legionelose/diagnóstico por imagem , Legionelose/microbiologia , Reação em Cadeia da Polimerase/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Gasometria , DNA Bacteriano/análise , Progressão da Doença , Humanos , Imunocompetência/imunologia , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Legionelose/tratamento farmacológico , Masculino , Países Baixos/epidemiologia , Medição de Risco , Índice de Gravidade de DoençaAssuntos
Antibacterianos/farmacologia , Antivirais/farmacologia , Fragmentos de Peptídeos/química , Peptidomiméticos/farmacologia , Proteínas Proto-Oncogênicas/química , Animais , Antibacterianos/química , Antivirais/química , Humanos , Legionelose/tratamento farmacológico , Peptidomiméticos/química , Viroses/tratamento farmacológicoRESUMO
Legionellosis refers to the two clinical syndromes caused by Legionella : Pontiac fever, a benign febrile illness and Legionnaires'disease (or pneumonia). Clinically and radiologically, Legionnaires'disease presents itself as a « typical ¼ pneumonia caused by Streptococcus pneumonia. Diagnosis is usually made by using urinary antigen testing. Culture and PCR are also helpful. Legionella is resistant to betalactam antibiotics, and is treated by quinolones or macrolides.
La légionellose regroupe deux entités cliniques : la fièvre de Pontiac, une maladie fébrile bénigne, et la pneumonie à Legionella ou maladie du légionnaire. Sur les plans clinique et radiologique, la pneumonie à Legionella se présente le plus souvent comme une pneumonie « typique ¼ à pneumocoque. Son diagnostic repose généralement sur la mise en évidence d'un antigène de la bactérie dans les urines ; la culture et la PCR sont également des examens utiles. La légionelle est un germe résistant aux bêtalactamines et nécessite un traitement par quinolones ou macrolides.
Assuntos
Legionelose , Doença dos Legionários , Antibacterianos/uso terapêutico , Humanos , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Doença dos Legionários/diagnóstico , Doença dos Legionários/tratamento farmacológicoAssuntos
Parto Obstétrico/métodos , Legionelose/diagnóstico , Pneumonia Bacteriana/diagnóstico , Antibacterianos/administração & dosagem , Canadá , Exantema/etiologia , Feminino , Febre/etiologia , Humanos , Recém-Nascido , Legionella/efeitos dos fármacos , Legionella/isolamento & purificação , Legionelose/tratamento farmacológico , Parto , Pneumonia Bacteriana/terapia , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Tomografia Computadorizada por Raios X , Microbiologia da ÁguaRESUMO
Urinary antigen test is frequently used as a routine laboratory test for early diagnosis of Legionella infection, which is especially suitable for ordinary Legionella pneumophila serogroup 1, but not for other types of Legionella. We report a case of severe pneumonia caused by Legionella longbeachae, where a method of loop-mediated isothermal amplification (LAMP) assay contributed an important role for the early detection. This case involved an 83-year-old man who developed fever, dyspnea, and productive cough. Since the medication of prescribed ceftriaxone had not been effective, he visited the emergency room of our hospital, where an X-ray revealed a severe pneumonia harboring a consolidation with air bronchogram in his right lower lung. His sputum and urine were subjected to the routine bacterial culture or the urinary antigen test for Legionella, which initially brought negative results. However, a positive result of LAMP assay enabled early diagnosis of Legionella pneumonia. Later, the bacterial cultures of sputum made some progress and 16S rRNA sequencing provided a proof of L. longbeachae. This LAMP assay may bring a benefit for the patients with Legionella pneumonia by enabling early detection of not only specific L. pneumophila serogroup 1, but also of the other Legionella species.
Assuntos
Legionella longbeachae/isolamento & purificação , Legionelose/diagnóstico por imagem , Técnicas Microbiológicas , Pneumonia/diagnóstico por imagem , Pneumonia/microbiologia , Idoso de 80 Anos ou mais , Humanos , Legionella longbeachae/genética , Legionelose/tratamento farmacológico , Masculino , Pneumonia/tratamento farmacológico , RNA Ribossômico 23S/isolamento & purificação , Tomografia Computadorizada por Raios XRESUMO
Invasive aspergillosis of the lungs and the central nervous system and Legionella pneumophilia serotype 1 infection of the lungs were diagnosed in a 22-month old child during inpatient induction treatment for T-lymphoblastic leukemia. Environmental investigations i.e. samples from the hospital water system did not reveal any Legionella. The patient may have been exposed to waterborne pathogens despite terminal water filtration due to a technical device to release residual tap water from the hose after showering. A sodium chloride nose spray was found to be contaminated with the A. fumigatus isolate of the patient.