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Tidsskrift For Den Norske Laegeforening... Sep 2005
Topics: Communicable Disease Control; Disease Outbreaks; Humans; Legionella pneumophila; Legionnaires' Disease; Norway; Polymerase Chain Reaction; Water Microbiology; Water Supply
PubMed: 16186884
DOI: No ID Found -
Infectious Disease Clinics of North... Mar 2010This article describes the clinical differentiation of legionnaires' disease from typical and other atypical pneumonias, with reference to the history, microbiology,... (Review)
Review
This article describes the clinical differentiation of legionnaires' disease from typical and other atypical pneumonias, with reference to the history, microbiology, epidemiology, clinical presentation (including radiologic manifestations, clinical extrapulmonary features, nonspecific laboratory findings, clinical syndromic diagnosis, and differential diagnosis), therapy, complications, and prognosis of the disease.
Topics: Anti-Bacterial Agents; Diagnosis, Differential; Humans; Legionella pneumophila; Legionnaires' Disease; Prognosis
PubMed: 20171547
DOI: 10.1016/j.idc.2009.10.014 -
The European Respiratory Journal Dec 2013
Topics: Anti-Bacterial Agents; Europe; Geography; Humans; Legionella; Legionnaires' Disease; Risk Factors
PubMed: 24293418
DOI: 10.1183/09031936.00089113 -
Emerging Infectious Diseases Jul 2020We describe 2 cases of healthcare-associated Legionnaires' disease in patients in France hospitalized 5 months apart in the same room. Whole-genome sequencing analyses...
We describe 2 cases of healthcare-associated Legionnaires' disease in patients in France hospitalized 5 months apart in the same room. Whole-genome sequencing analyses showed that clinical isolates from the patients and isolates from the room's toilet clustered together. Toilet contamination by Legionella pneumophila could lead to a risk for exposure through flushing.
Topics: Bathroom Equipment; Cross Infection; France; Humans; Legionella pneumophila; Legionnaires' Disease
PubMed: 32568063
DOI: 10.3201/eid2607.190941 -
American Journal of Physiology. Lung... Mar 2023is the main etiological agent of Legionnaires' disease, a severe bacterial pneumonia. is initially engulfed by alveolar macrophages (AMs) and subvert normal cellular...
is the main etiological agent of Legionnaires' disease, a severe bacterial pneumonia. is initially engulfed by alveolar macrophages (AMs) and subvert normal cellular functions to establish a replicative vacuole. Cigarette smokers are particularly susceptible to developing Legionnaires' disease and other pulmonary infections; however, little is known about the cellular mechanisms underlying this susceptibility. To investigate this, we used a mouse model of acute cigarette smoke exposure to examine the immune response to cigarette smoke and subsequent infection. Contrary to previous reports, we show that cigarette smoke exposure alone causes a significant depletion of AMs using enzymatic digestion to extract cells, or via imaging intact lung lobes by light-sheet microscopy. Furthermore, treatment of mice deficient in specific types of cell death with smoke suggests that NLRP3-driven pyroptosis is a contributor to smoke-induced death of AMs. After infection, smoke-exposed mice displayed increased pulmonary loads and developed more severe disease compared with air-exposed controls. We tested if depletion of AMs was related to this phenotype by directly depleting them with clodronate liposomes and found that this also resulted in increased loads. In summary, our results showed that cigarette smoke depleted AMs from the lung and that this likely contributed to more severe Legionnaires' disease. Furthermore, the role of AMs in infection is more nuanced than simply providing a replicative niche, and our studies suggest they play a major role in bacterial clearance.
Topics: Mice; Animals; Legionella pneumophila; Macrophages, Alveolar; Legionnaires' Disease; Cigarette Smoking; Lung
PubMed: 36719079
DOI: 10.1152/ajplung.00268.2022 -
BMC Infectious Diseases Sep 2018Legionellosis is a well-known cause of pneumonia. Primary cutaneous and subcutaneous infection caused by Legionella pneumophila is rare and the diagnosis is challenging. (Review)
Review
BACKGROUND
Legionellosis is a well-known cause of pneumonia. Primary cutaneous and subcutaneous infection caused by Legionella pneumophila is rare and the diagnosis is challenging.
CASE PRESENTATION
A 38-year-old Thai woman with systemic lupus erythematosus and myasthenia gravis treated with prednisolone and azathioprine presented to our hospital with low-grade fever, diarrhea, and indurated skin lesions on both thighs. Initial examination showed plaques on both inner thighs. Magnetic resonance imaging showed myositis and swelling of the skin and subcutaneous tissue. Diagnosis of panniculitis due to L. pneumophila was carried out by histopathology, Gram stain, and 16S rRNA gene sequencing method of tissue biopsy from multiple sites on both thighs. Myocarditis was diagnosed by echocardiography. The final diagnosis was disseminated extrapulmonary legionellosis. Treatment comprised intravenous azithromycin for 3 weeks and the skin lesions, myositis and myocarditis resolved. Oral azithromycin and ciprofloxacin were continued for 3 months to ensure eradication of the organism. The patient's overall condition improved.
CONCLUSIONS
To our knowledge, we report the first case of L. pneumophila infection manifesting with panniculitis, possible myositis, and myocarditis in the absence of pneumonia. The diagnosis of extrapulmonary Legionella infection is difficult, especially in the absence of pneumonia. A high index of suspicion and appropriate culture with special media or molecular testing are required. Initiation of appropriate treatment is critical because delaying therapy was associated with progressive infection in our patient.
Topics: Adult; Female; Humans; Legionella pneumophila; Legionnaires' Disease; Lupus Erythematosus, Systemic; Panniculitis; Skin Diseases, Bacterial
PubMed: 30223775
DOI: 10.1186/s12879-018-3378-0 -
BMJ Case Reports Jul 2015We present an interesting case of Legionnaires' disease masquerading as acute pyelonephritis, with complete absence of respiratory symptoms on admission. A 45-year-old...
We present an interesting case of Legionnaires' disease masquerading as acute pyelonephritis, with complete absence of respiratory symptoms on admission. A 45-year-old man was diagnosed with Legionnaires' disease 2 days after presenting to hospital with dysuria and right loin pain. He became critically unwell during the hospital admission, with headache, uncontrolled fever, breathlessness, decreasing oxygen saturations and increasing oxygen requirements. A CT pulmonary angiography demonstrated right upper lobar consolidation and Legionella urinary antigen was positive. He was treated with ciprofloxacin and rifampicin and made a full recovery.
Topics: Anti-Bacterial Agents; Antigens, Bacterial; Ciprofloxacin; Community-Acquired Infections; Diagnosis, Differential; Dysuria; Flank Pain; Humans; Legionnaires' Disease; Male; Middle Aged; Pneumonia; Pyelonephritis; Rifampin
PubMed: 26135485
DOI: 10.1136/bcr-2013-201337 -
Frontiers in Cellular and Infection... 2014
Review
Topics: Amino Acids; Animals; Host-Pathogen Interactions; Humans; Legionella pneumophila; Legionnaires' Disease; Vacuoles; Virulence
PubMed: 25207263
DOI: 10.3389/fcimb.2014.00111 -
Swiss Medical Weekly Apr 2022The number of reported cases of Legionnaires' disease has increased significantly over the last decade in Switzerland and abroad. Along with the number of cases, the...
BACKGROUND
The number of reported cases of Legionnaires' disease has increased significantly over the last decade in Switzerland and abroad. Along with the number of cases, the volume of testing has increased as well, which has been partially attributed to a change in awareness of the disease. Yet, while there are numerous guidelines and recommendations for the case management of community-acquired pneumonia, little is known about how physicians in Switzerland perceive and manage Legionnaires' disease.
METHODS
This study aimed to investigate physicians' awareness of Legionnaires' disease, their information resources and their approach to the diagnosis and treatment of pneumonia (and thus Legionnaires' disease). Using a semi-structured interview guide, we conducted in-depth interviews with physicians from different levels of care and from the German-, French- and Italian-speaking regions of Switzerland.
RESULTS
We conducted 46 interviews with physicians from university, cantonal and regional hospitals as well as with general practitioners (GPs) from all three language regions. Overall, the physicians working in hospitals indicated a similar level of awareness of Legionnaires' disease, and comparable diagnosis and treatment approaches. The Legionella urine antigen test (UAT) was reported to be routinely performed in inpatients. In contrast, GPs indicated lower levels of awareness, reflecting the fact that they treat pneumonia cases empirically without identification of the causative agent, in accordance with current guidelines. The value of the diagnostic tests in general and the Legionella UAT in particular was considered to be dependent on the (preferred) antibiotic treatment approach. Some physicians saw the test as redundant, as its result would not influence treatment. This was tied to concerns about the UAT's sensitivity and its limited use for the detection of Legionella pneumophila serogroup 1. Lastly, extrinsic constraints, such as financial and time considerations also affected physicians' testing and treatment preferences.
CONCLUSION
Awareness of Legionnaires' disease is overall high, yet cases are mainly diagnosed and reported by hospitals. Improved diagnostic tools are needed to support physicians in reducing underestimation of Legionnaires' disease and optimise antibiotic stewardship without compromising patient health outcomes.
Topics: Community-Acquired Infections; Humans; Legionnaires' Disease; Physicians; Pneumonia; Switzerland
PubMed: 35633636
DOI: 10.4414/smw.2022.w30157 -
BMC Pulmonary Medicine May 2022Acute fibrinous and organizing pneumonia (AFOP) is a rare clinicopathological condition. Studies in the literature have reported that AFOP may be associated with... (Review)
Review
BACKGROUND
Acute fibrinous and organizing pneumonia (AFOP) is a rare clinicopathological condition. Studies in the literature have reported that AFOP may be associated with respiratory infections, such as respiratory syncytial virus, influenza virus, Pneumocystis jirovecii, Penicillium citrinum, and Chlamydia infections. However, AFOP associated with Legionella infection has not been reported previously. Here, we report a case of a patient with AFOP secondary to Sjögren's syndrome and Legionella infection.
CASE PRESENTATION
A 47-year-old man was admitted to the hospital because of fever, expectoration, and shortness of breath. Lung imaging showed irregular patchy consolidation. A diagnosis of Legionella pneumonia was initially considered on the basis of the patient's history of exposure to soil before disease onset, signs of extrapulmonary involvement, and a positive Legionella urine antigen test result. However, the patient's symptoms and lung imaging did not improve after treatment with levofloxacin, moxifloxacin, and tigecycline for Legionella infection. In addition, Sjögren's syndrome was diagnosed on the basis of clinical manifestations and immunological indicators. Pathological changes associated with AFOP were confirmed from the results of ultrasound-guided percutaneous lung biopsy. The patient's clinical symptoms improved rapidly after a short course of low-dose corticosteroid therapy, and lung imaging showed significant improvement.
CONCLUSIONS
The possibility of secondary AFOP should be considered when Legionella pneumonia does not improve after standard antibiotic therapy. Lung biopsy and histopathological examination are important for the adjustment of treatment strategy. Our case also highlights the importance of screening for autoimmune diseases in patients with AFOP.
Topics: Humans; Image-Guided Biopsy; Legionella; Legionnaires' Disease; Lung; Male; Middle Aged; Pneumonia; Sjogren's Syndrome
PubMed: 35610634
DOI: 10.1186/s12890-022-01997-x