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Future Microbiology 2014Macrophages are the front line of immune defense against invading microbes. Microbes, however, have evolved numerous and diverse mechanisms to thwart these host immune... (Review)
Review
Macrophages are the front line of immune defense against invading microbes. Microbes, however, have evolved numerous and diverse mechanisms to thwart these host immune defenses and thrive intracellularly. Legionella pneumophila, a Gram-negative pathogen of amoebal and mammalian phagocytes, is one such microbe. In humans, it causes a potentially fatal pneumonia referred to as Legionnaires' disease. Armed with the Icm/Dot type IV secretion system, which is required for virulence, and approximately 300 translocated proteins, Legionella is able to enter host cells, direct the biogenesis of its own vacuolar compartment, and establish a replicative niche, where it grows to high levels before lysing the host cell. Efforts to understand the pathogenesis of this bacterium have focused on characterizing the molecular activities of its many effectors. In this article, we highlight recent strides that have been made in understanding how Legionella effectors mediate host-pathogen interactions.
Topics: Animals; Autophagy; Bacterial Secretion Systems; Biological Transport; Cytoplasmic Vesicles; Host-Pathogen Interactions; Humans; Legionella pneumophila; Legionnaires' Disease; Membrane Lipids; Phagocytes; Transcriptome
PubMed: 24762308
DOI: 10.2217/fmb.13.162 -
Journal of Clinical Pathology Nov 1979
Topics: Aged; Antibodies, Bacterial; Humans; Immunoglobulin M; Legionnaires' Disease; Male; Middle Aged; Retrospective Studies
PubMed: 512034
DOI: 10.1136/jcp.32.11.1191 -
Canadian Medical Association Journal May 1979
Topics: Diagnosis, Differential; Humans; Legionnaires' Disease; Male; Middle Aged
PubMed: 445298
DOI: No ID Found -
British Medical Journal Nov 1978
Topics: Adult; Aged; Disease Outbreaks; Female; Humans; Legionnaires' Disease; Male; Middle Aged; United Kingdom; United States
PubMed: 719378
DOI: No ID Found -
Revista Portuguesa de Pneumologia 2005Legionella, as a cause of community-acquired pneumonia, is probably under-recognized because the diagnosis relies on the use of specific tests as well the existence of... (Review)
Review
Legionella, as a cause of community-acquired pneumonia, is probably under-recognized because the diagnosis relies on the use of specific tests as well the existence of an in-numerous species and serogroups not easily identify by the tests available. In studies from Europe and North America, it ranged from 2 to 15 percent of all community-acquired pneumonias that required hospitalisation, in the first four causes when culture methods were done and the second cause of those admitted in the intensive care units. We do a case report of 43 year-old man with history of cigarette smoking and corticosteroid therapy for a ocular disease, that presents with a pneumonia complicated with a Acute Respiratory Distress Syndrome (ARDS), that leaded to his admission to an intensive care unit were he was mechanical ventilated. The epidemiological investigation identified Legionella pneumophila serogroup 1. The authors present this case doing a brief review of this disease and discussing the epidemiology, clinical features, laboratory diagnosis as well as therapeutic options.
Topics: Adult; Humans; Legionnaires' Disease; Male
PubMed: 15947860
DOI: 10.1016/s0873-2159(15)30499-2 -
Euro Surveillance : Bulletin Europeen... Mar 2013The surveillance of Legionnaires' disease (LD) in Europe is carried out by the European Legionnaires' Disease Surveillance Network (ELDSNet) and coordinated by the...
The surveillance of Legionnaires' disease (LD) in Europe is carried out by the European Legionnaires' Disease Surveillance Network (ELDSNet) and coordinated by the European Centre for Disease Prevention and Control (ECDC). All cases reported in 2009 and 2010 and meeting the European case definition were electronically transmitted to The European Surveillance System (TESSy) database. A total of 5,551 and 6,305 cases were reported by 29 European countries in 2009 and 2010, respectively. The age-standardised rate of all cases was 1.20 per 100,000 inhabitants in 2010, 12% higher than in 2009, which was consistent with the increasing trend observed since 2005. Most of this increase consisted of community-acquired cases reported by France, Germany and the Netherlands with dates of onset in August–September. The exceptionally hot summer of 2010 in some parts of Europe may have played a role in this increase.
Topics: Adult; Age Distribution; Cluster Analysis; Demography; Disease Notification; Europe; Female; Humans; Legionella pneumophila; Legionnaires' Disease; Male; Middle Aged; Population Surveillance; Seasons; Sex Distribution; Travel
PubMed: 23515061
DOI: 10.2807/ese.18.10.20417-en -
Revista Chilena de Infectologia :... Jun 2008
Topics: Humans; Legionella pneumophila; Legionnaires' Disease
PubMed: 18581001
DOI: No ID Found -
BMC Infectious Diseases May 2022Legionella-related community acquired pneumonia (CAP) is a disease with an increasing incidence and a high mortality rate, especially if empirical antibiotic therapy is...
BACKGROUND
Legionella-related community acquired pneumonia (CAP) is a disease with an increasing incidence and a high mortality rate, especially if empirical antibiotic therapy is inadequate. Antibiotic treatment highly relies on clinical symptoms, although proven non-specific, because currently available diagnostic techniques provide insufficient accuracy for detecting Legionella CAP on admission. This study validates a diagnostic scoring system for detection of Legionella-related CAP, based on six items on admission (Legionella prediction score).
METHODS
We included patients with Legionella-related CAP admitted to five large Dutch hospitals between 2006 and 2016. Controls were non-Legionella-related CAP patients. The following six conditions were rewarded one point if present: fever > 39.4 °C; dry cough; hyponatremia (sodium) < 133 mmol/L; lactate dehydrogenase (LDH) > 225 mmol/L; C-reactive protein (CRP) > 187 mg/L and platelet count < 171 × 10/L. The accuracy of the prediction score was assessed by calculating the area under the curve (AUC) through logistic regression analysis.
RESULTS
We included 131 cases and 160 controls. A score of 0 occurred in non-Legionella-related CAP patients only, a score of 5 and 6 in Legionella-related CAP patients only. A cut-off ≥ 4 resulted in a sensitivity of 58.8% and a specificity of 93.1%. The AUC was 0.89 (95% CI 0.86-0.93). The strongest predictors were elevated LDH, elevated CRP and hyponatremia.
CONCLUSIONS
This multi-centre study validates the Legionella prediction score, an easily applicable diagnostic scoring system, in a large group of patients and finds high diagnostic accuracy. The score shows promise for future prospective validation and could contribute to targeted antibiotic treatment of suspected Legionella CAP.
Topics: Anti-Bacterial Agents; Community-Acquired Infections; Humans; Hyponatremia; L-Lactate Dehydrogenase; Legionella; Legionella pneumophila; Legionnaires' Disease; Pneumonia
PubMed: 35534798
DOI: 10.1186/s12879-022-07433-z -
Emerging Infectious Diseases Jun 2023Legionellosis, notably Legionnaires' disease, is recognized globally and in New Zealand (Aotearoa) as a major cause of community-acquired pneumonia. We analyzed the...
Legionellosis, notably Legionnaires' disease, is recognized globally and in New Zealand (Aotearoa) as a major cause of community-acquired pneumonia. We analyzed the temporal, geographic, and demographic epidemiology and microbiology of Legionnaires' disease in New Zealand by using notification and laboratory-based surveillance data for 2000‒2020. We used Poisson regression models to estimate incidence rate ratios and 95% CIs to compare demographic and organism trends over 2 time periods (2000-2009 and 2010-2020). The mean annual incidence rate increased from 1.6 cases/100,000 population for 2000-2009 to 3.9 cases/100,000 population for 2010-2020. This increase corresponded with a change in diagnostic testing from predominantly serology with some culture to almost entirely molecular methods using PCR. There was also a marked shift in the identified dominant causative organism, from Legionella pneumophila to L. longbeachae. Surveillance for legionellosis could be further enhanced by greater use of molecular typing of isolates.
Topics: Humans; Legionnaires' Disease; New Zealand; Incidence; Legionellosis; Legionella pneumophila
PubMed: 37209673
DOI: 10.3201/eid2906.221598 -
The American Journal of Case Reports Sep 2023BACKGROUND Legionnaires' disease is one of the most common types of community-acquired pneumonia. It can cause acute kidney injury and also occasionally become severe...
BACKGROUND Legionnaires' disease is one of the most common types of community-acquired pneumonia. It can cause acute kidney injury and also occasionally become severe enough to require continuous renal replacement therapy (CRRT). Non-occlusive mesenteric ischemia (NOMI) is a condition characterized by ischemia and necrosis of the intestinal tract without organic obstruction of the mesenteric vessels and is known to have a high mortality rate. CASE REPORT A 72-year-old man with fatigue and dyspnea was diagnosed with Legionnaires' disease after a positive result in the Legionella urinary antigen test pneumonia confirmed by chest radiography and computed tomography. He developed acute kidney injury, with anuria, rhabdomyolysis, septic shock, respiratory failure, and metabolic acidosis. We initiated treatment with antibiotics, catecholamines, mechanical ventilation, CRRT, steroid therapy, and endotoxin absorption therapy in the Intensive Care Unit. Despite ongoing CRRT, metabolic acidosis did not improve. The patient was unresponsive to treatment and died 5 days after admission. The autopsy revealed myoglobin nephropathy, multiple organ failure, and NOMI. CONCLUSIONS We report a fatal case of Legionnaires' disease complicated by rhabdomyolysis, acute kidney injury, myoglobin cast nephropathy, and NOMI. Legionella pneumonia complicated by acute kidney injury is associated with a high mortality rate. In the present case, this may have been further exacerbated by the complication of NOMI. In our clinical practice, CRRT is a treatment option for septic shock complicated by acute kidney injury. Thus, it is crucial to suspect the presence of NOMI when persistent metabolic acidosis is observed, despite continuous CRRT treatment.
Topics: Male; Humans; Aged; Legionnaires' Disease; Mesenteric Ischemia; Myoglobin; Shock, Septic; Rhabdomyolysis; Acute Kidney Injury
PubMed: 37742066
DOI: 10.12659/AJCR.940792