1/69. Bilateral pleuritis caused by Legionella micdadei. A 58-year-old woman was hospitalized because of progressive respiratory distress. She had a history of myasthenia gravis and invasive thymoma. After thymectomy, she had been administered oral prednisolone and intrathoracic anti-cancer drugs postoperatively. Her chest radiograph revealed bilateral pleural effusions. Legionella micdadei (L. micdadei) was isolated from the pleural effusions, and she was diagnosed as pleuritis caused by L. micdadei. She died despite intensive therapy with mechanical ventilation, drainage tube in the chest and intravenous erythromycin. Although only two cases of legionellosis caused by L. micdadei have been reported in japan, clinicians should be aware of L. micdadei as one of the candidates for infection in immunosuppressed hosts. ( info) |
2/69. Relapsing life threatening community acquired pneumonia due to rare Legionella species responsive to ceftriaxone and aztreonam. A 24 year old Saudi housewife was admitted thrice with life threatening community acquired pneumonia. Even though she responded to an initial cocktail of cefriaxone, erythromcin, rifampicin and flucloxacillin during the second admission, she relapsed within four days of discharge when she was on erythromycin only. During the third admission she was put on ceftriaxone and aztreonam and recovered fully without any relapse. serology results received later showed Legionella IgM titres of more than 1:256 for Legionella micdadei and Legionella bozemanii, and IgG titres of Legionella hackeliae. This case demonstrates relapsing pneumonia due to Legionella micdadei and bozemanii infection, and previous exposure to Legionella hackeliae. Both species, that is, Legionella micdadei and bozemanii, are resistant to erythromycin, but responded very well to a combination of ceftriaxone and aztreonam have not been used previously for the treatment of Legionnaires diseases. ( info) |
3/69. Isolation of Legionella anisa using an amoebic coculture procedure. Conventional diagnostic tests for legionellosis were negative for a 61-year-old immunocompromised man with pneumonia. However, coculture of a sputum sample with acanthamoeba polyphaga amoebae led to the recovery of Legionella anisa. This procedure may be a sensitive and convenient diagnostic method, especially for non-legionella pneumophila species infections that can be diagnosed only by culture. ( info) |
4/69. Legionella micdadei lung abscess in a patient with hiv-associated nephropathy. A patient with end-stage renal disease due to human immunodeficiency-associated nephropathy developed fever, cough and chest pain over a week's duration. He was diagnosed with lung abscess and started on antibiotic coverage. He underwent bronchoscopy because of progression of his illness and persistent fever and bronchoalveolar lavage culture isolated Legionella micdadei. In spite of appropriate antibiotic therapy, the patient remained febrile for 10 days, necessitating chest tube drainage. After a 6-week course of antibiotics and drainage, the patient made an uneventful recovery. Infections due to L. micdadei may be hard to diagnose because of difficulties in isolating this bacteria. ( info) |
5/69. Recurrent soft tissue abscesses caused by Legionella cincinnatiensis. Recurrent soft tissue abscesses of the jaw, wrist, and arm developed in a 73-year-old housewife with nephrotic syndrome and immunoglobulin a(kappa) gammopathy of unknown etiology. Conventional cultures remained negative, despite visible gram-negative rods on microscopy. Broad-spectrum PCR revealed Legionella cincinnatiensis, which was confirmed by isolation of the organism on special Legionella medium. Infections due to Legionella species outside the lungs are rare. L. cincinnatiensis has been implicated in only four cases of clinical infection; these involved the lungs in three patients and the central nervous system in one patient. We conclude that broad-spectrum PCR can be a valuable tool for the evaluation of culture-negative infections with a high probability of bacterial origin and that Legionella might be an underdiagnosed cause of pyogenic soft tissue infection. ( info) |
6/69. Legionella-like and other amoebal pathogens as agents of community-acquired pneumonia. We tested serum specimens from three groups of patients with pneumonia by indirect immunofluorescence against Legionella-like amoebal pathogens (LLAPs) 1-7, 9, 10, 12, 13; Parachlamydia acanthamoeba strains BN 9 and Hall's coccus; and afipia felis. We found that LLAPs play a role (albeit an infrequent one) in community-acquired pneumonia, usually as a co-pathogen but sometimes as the sole identified pathogen. ( info) |
7/69. Systematic reviews of infectious diseases. The World Wide Web provides ready access to a wealth of information on infectious diseases topics. Systematic reviews and practice guidelines help to focus that evidence with in-depth literature analysis of a specific question. These reviews are typically rigidly structured, often periodically updated, and include critical evaluation of available data. In this article, Web sites of organizations that publish systematic reviews and practice guidelines for infectious diseases are identified and reviewed with regard to ease of use, comprehensiveness, quality of information, and cost. Examples of information available in databases of practice guidelines and systematic reviews are provided. A hypothetical case is used to illustrate the use of electronic resources in evidence-based infectious diseases practice. ( info) |
| During a nine-day period, five patients in a 14-bed intensive care unit (ICU) were shown to have seroconverted with a four-fold or greater rise in serum antibody titre to legionella longbeachae serogroup 1. A further two patients were observed to have high titres consistent with previous exposure but earlier serum samples were not available for comparison. No patients had antibody responses to legionella pneumophila serogroups 1 and 2. L. longbeachae was not cultured from respiratory secretions from patients or from the environment within the unit. Legionella anisa was recovered from one cooling tower on the ninth floor of the tower block. The ICU is located on the first floor of the same tower and receives external air from two vents, one on the eastern and the other on the western aspect. All patients with serological evidence of L. longbeachae infection were concomitantly infected with multiresistant staphylococcus aureus, and were located in bays on the eastern side of the unit. A large pigeon nest was discovered within 1-2 m of the eastern vent. Following removal of the birds' nest, no further cases were seen on routine screening of all patients within the unit over the next eight weeks. Alternatively, seroconversion may have been related to demolition of the adjacent nine-storey nurses home. This was begun one month before the first case was diagnosed and was completed four months later. The periodic northerly winds could have carried legionellae from the demolition site directly over the block housing the ICU and may have concentrated them near the eastern air vent. All patients had pneumonia, which was probably multifactorial in origin. There is some uncertainty whether the serological responses seen were an epiphenomenon or were truly indicative of infection with L. longbeachae. ( info) |
9/69. Extrapulmonary Legionella micdadei infection in a previously healthy child. A previously healthy 9-year-old girl presented with a 1-week history of left neck mass and low grade fever. Surgical drainage specimens from the mass were bacterial culture-negative. Legionella micdadei infection was diagnosed by a two step PCR-nucleic acid sequencing method and supported by organism-specific serology. A backyard hot tub was suspected as the source of infection. ( info) |
10/69. Fatal case of community-acquired pneumonia caused by legionella longbeachae in a patient with systemic lupus erythematosus. Reported here is a rare case of atypical pneumonia due to a non- pneumophila Legionella sp. that occurred in a young patient with systemic lupus erythematosus. In spite of aggressive treatment, the patient died 24 h following admission to the intensive care unit. legionella longbeachae was cultured from respiratory tract specimens and identified to the genus level by PCR and to the species level by an immunofluorescence test. Since most current laboratory tests for Legionella spp., including urinary antigen and serology, cannot detect infections caused by non- pneumophila Legionella spp., culture on legionella-selective media should be strongly considered when diagnosing immunosuppressed patients with pneumonia. ( info) |