1/25. Multiple types of legionella pneumophila serogroup 6 in a hospital heated-water system associated with sporadic infections.Five sporadic cases of nosocomial legionnaires' disease were documented from 1989 to 1997 in a hospital in northern italy. Two of them, which occurred in a 75-year-old man suffering from ischemic cardiopathy and in an 8-year-old girl suffering from acute leukemia, had fatal outcomes. legionella pneumophila serogroup 6 was isolated from both patients and from hot-water samples taken at different sites in the hospital. These facts led us to consider the possibility that a single clone of L. pneumophila serogroup 6 had persisted in the hospital environment for 8 years and had caused sporadic infections. Comparison of clinical and environmental strains by monoclonal subtyping, macrorestriction analysis (MRA), and arbitrarily primed PCR (AP-PCR) showed that the strains were clustered into three different epidemiological types, of which only two types caused infection. An excellent correspondence between the MRA and AP-PCR results was observed, with both techniques having high discriminatory powers. However, it was not possible to differentiate the isolates by means of ribotyping and analysis of rrn operon polymorphism. Environmental strains that antigenically and chromosomally matched the infecting organism were present at the time of infection in hot-water samples taken from the ward where the patients had stayed. Interpretation of the temporal sequence of events on the basis of the typing results for clinical and environmental isolates enabled the identification of the ward where the patients became infected and the modes of transmission of Legionella infection. The long-term persistence in the hot-water system of different clones of L. pneumophila serogroup 6 indicates that repeated heat-based control measures were ineffective in eradicating the organism.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/25. Failure to produce detectable antibodies to legionella pneumophila by an immunocompetent adult.A case of legionella pneumonia diagnosed by co-culture with amoebae and urinary antigen detection is described. Diagnostic antibody tests remained negative despite prolonged follow-up. Investigation showed no evidence of an under-lying immunodeficiency. The value of culture-based diagnosis and consequences of missed diagnoses are discussed.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/25. pericarditis after allogeneic peripheral blood stem cell transplantation caused by legionella pneumophila (non-serogroup 1).A case of Legionella pericarditis caused by a legionella pneumophila isolate other than serogroup 1 is reported in a 59-year-old man after allogeneic peripheral blood stem cell transplantation. On admission a 5 mm pericardial effusion was detected on echocardiography. antibodies were detected against L. pneumophila serogroups 7 to 14 using the antigen pool and against serogroup 12 alone. antibodies were not detected against the serogroup 1 to 6 antigen pool. The patient's clinical condition improved dramatically after treatment with clarithromycin and an echocardiography revealed the total disappearance of the pericardial effusion.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
4/25. Legionnaires disease with bacteremic coinfection.We describe 6 patients who had bacteremic community-acquired pneumonia and unsuspected legionella pneumophila coinfection. We reviewed case records of patients who were diagnosed as having a recent Legionella infection on the basis of either the presence of L. pneumophila serogroup 1 antigen in urine or a 4-fold increase in L. pneumophila antibody level and with a blood culture that yielded a bacterium other than L. pneumophila. Three patients were diagnosed with legionellosis on the basis of the presence of antigen in urine, and 3 were diagnosed on the basis of a 4-fold increase in antibody titer. Of these 6 patients, 4 were infected with streptococcus pneumoniae, 1 with streptococcus pyogenes, and 1 with enterobacter cloacae. L. pneumophila infection in these patients may have predisposed them to concomitant bacteremia. Initial empiric antimicrobial therapy for patients who live in areas of endemicity and who are smokers should be treated with antimicrobial agents that have activity against pneumococcus and Legionella species.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
5/25. culture proven legionella pneumophila pneumonia in a hiv-infected patient: case report and review.We report the first culture proven case of Legionella pneumonia in a hiv-positive patient in italy. The laboratory diagnosis was obtained by isolation of legionella pneumophila serogroup 1, serology, urinary antigen detection and PCR. culture first allowed diagnosis of the infection, that probably would have been unrecognized. Since legionellosis in hiv-positive patients with respiratory symptoms is rare and difficult to confirm, we strongly suggest that all available laboratory tests, and particularly culture, should be performed. A review of literature on culture proven cases is also provided.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/25. legionella pneumophila pneumonia successfully treated with intravenous ciprofloxacin.A 69-year-old man developed a cough and fever during treatment with corticosteroid (p.o. and external use) for erythroderma. Chest X-ray films revealed a consolidation shadow in the right upper lung field. Initial treatment with sulbactam sodium/ampicillin followed by imipenem/cilastatin was not effective. A urinary antigen test for Legionella was positive, making for a diagnosis of Legionella pneumonia. Intravenous treatment with ciprofloxacin (CPFX) was remarkably effective. His symptoms, chest X-ray and laboratory data rapidly improved after its initiation. Our findings strongly suggest that intravenous treatment with fluoroquinolones including CPFX should also be a first choice for Legionella pneumonia in japan.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/25. sinoatrial block complicating legionnaire's disease.A 59 year old woman presented with acute onset of fever, chills, diaphoresis, vague chest discomfort, and was found to be hypotensive and tachypnoeic. An electrocardiogram demonstrated sinoatrial block with a junctional rhythm between 50 and 80 beats/min. All cultures were negative and imaging studies unrevealing. Her urine tested positive for legionella pneumophila antigen serotype 1 and she improved with antibiotic therapy.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/25. A case of breathlessness, confusion and diarrhoea.A 61-year-old woman presented to the emergency department with acute-onset breathlessness, fever, sore throat and confusion. Her initial investigations revealed hyponatremia and middle lobe consolidation. In view of the atypical symptoms and signs, erythromycin was commenced. Urinary legionella antigen was requested and that tested positive. She was one of the first few patients whose findings alerted us to a possible outbreak of legionnaire' disease. We drew the following conclusions from our experience with this and other cases that we saw during the legionnaires' outbreak: an atypical presentation is common, as seen in this lady with confusion. If two cases of atypical pneumonias test positive for legionella within a period of a week, we suggest that public health authorities should be notified to identify the source and contain it. There is a need for continuous and high vigilance for legionnaires' disease.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/25. Legionella pneumonia associated with adult respiratory distress syndrome caused by legionella pneumophila serogroup 3.A 68-year-old man developed pneumonia 2 days after nearly drowning in a bathtub of a hot spring spa. Chest radiography revealed bilateral consolidation shadows associated with adult respiratory distress syndrome. Initial treatment with antibiotics and pulse therapy with methylprednisolone was not effective. The patient died on the 4th hospital day. A urinary antigen test for Legionella was positive. legionella pneumophila serogroup 3 was recovered from an intratracheal specimen. The same serotype of Legionella was isolated from the hot spring water. Restriction enzyme analysis by pulse-field gel electrophoresis revealed identical restriction fragments. We conclude that the water at the hot spring spa could have been the source of infection.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/25. Fatal legionella pneumophila pneumonia: treatment failure despite early sequential oral-parenteral amoxicillin-clavulanic acid therapy.A 68-year-old male, having just returned from a two-week holiday on the Island of Ischia, developed unilateral pneumonia for which he was treated with oral amoxicillin-clavulanic acid and hospitalized within three days when the disease worsened and spread to both lungs. Despite parenteral amoxicillin-clavulanic acid (up to 2.2 g i.v. t.i.d.) the pneumonia spread rapidly over the next three days. sputum cultures returned post mortem yielded legionella pneumophila serogroup 1 and urine tests revealed the presence of Legionella antigen. Disk diffusion susceptibility testing on BCYE of the causative pathogen revealed zone diameters of inhibition of the clinical isolate exceeding 50 mm, indicating high susceptibility to this antibiotic combination. The therapeutic failure of amoxicillin-clavulanic acid should stimulate further reports and studies on the efficacy against legionellosis of this drug and similar beta-lactam inhibitor combinations as well as other beta-lactamase-stable beta-lactams.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
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