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American Journal of Respiratory and... Oct 2019This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. A multidisciplinary panel...
Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America.
This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. 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. The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.
Topics: Adult; Ambulatory Care; Anti-Bacterial Agents; Antigens, Bacterial; Blood Culture; Chlamydophila Infections; Community-Acquired Infections; Culture Techniques; Drug Therapy, Combination; Haemophilus Infections; Hospitalization; Humans; Legionellosis; Macrolides; Moraxellaceae Infections; Pneumonia, Bacterial; Pneumonia, Mycoplasma; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Radiography, Thoracic; Severity of Illness Index; Sputum; United States; beta-Lactams
PubMed: 31573350
DOI: 10.1164/rccm.201908-1581ST -
Clinical Microbiology Reviews Jul 2002There is still a low level of clinical awareness regarding Legionnaires' disease 25 years after it was first detected. The causative agents, legionellae, are freshwater... (Review)
Review
There is still a low level of clinical awareness regarding Legionnaires' disease 25 years after it was first detected. The causative agents, legionellae, are freshwater bacteria with a fascinating ecology. These bacteria are intracellular pathogens of freshwater protozoa and utilize a similar mechanism to infect human phagocytic cells. There have been major advances in delineating the pathogenesis of legionellae through the identification of genes which allow the organism to bypass the endocytic pathways of both protozoan and human cells. Other bacteria that may share this novel infectious process are Coxiella burnetti and Brucella spp. More than 40 species and numerous serogroups of legionellae have been identified. Most diagnostic tests are directed at the species that causes most of the reported human cases of legionellosis, L. pneumophila serogroup 1. For this reason, information on the incidence of human respiratory disease attributable to other species and serogroups of legionellae is lacking. Improvements in diagnostic tests such as the urine antigen assay have inadvertently caused a decrease in the use of culture to detect infection, resulting in incomplete surveillance for legionellosis. Large, focal outbreaks of Legionnaires' disease continue to occur worldwide, and there is a critical need for surveillance for travel-related legionellosis in the United States. There is optimism that newly developed guidelines and water treatment practices can greatly reduce the incidence of this preventable illness.
Topics: Animals; Humans; Legionella; Legionnaires' Disease; Research; Virulence
PubMed: 12097254
DOI: 10.1128/CMR.15.3.506-526.2002 -
Respiratory Medicine Aug 2014Biologic therapies are widely used in inflammatory diseases, and they are associated to an increased infection risk, especially to granulomatous and intracellular... (Review)
Review
BACKGROUND
Biologic therapies are widely used in inflammatory diseases, and they are associated to an increased infection risk, especially to granulomatous and intracellular infections such as Legionella.
RESULTS
A review of the literature revealed 105 cases of Legionella pneumonia in patients taking biologic therapies. Sixty-four patients (65.3%) were treated with infliximab, 23 (23.5%) with adalimumab, 5 (5%) with etanercept and 3 (3%) with rituximab. Seventy-one per cent of the patients were treated for rheumatologic diseases and 16% for inflammatory bowel diseases. The majority of the patients received one or more concomitant immunosuppressive drugs, especially steroids (43%). Overall mortality was 19%. Legionella pneumonia might complicate therapy with biologic therapies, especially in patients being treated with infliximab or adalimumab given concomitantly with other immunosuppressive medications during their first 6 months of treatment.
CONCLUSION
Physicians should be aware of this potentially severe association. Early recognition and treatment would likely result in reduced morbidity and mortality.
Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Biological Factors; Biological Therapy; Female; Humans; Inflammatory Bowel Diseases; Legionellosis; Male; Middle Aged; Rheumatic Diseases
PubMed: 24975288
DOI: 10.1016/j.rmed.2014.04.017 -
Communicable Diseases Intelligence... Jun 2022This study describes characteristics of the legionellosis cases occurring between 2010 and 2021 in the Northern Territory (NT), Australia.
OBJECTIVE
This study describes characteristics of the legionellosis cases occurring between 2010 and 2021 in the Northern Territory (NT), Australia.
METHODS
We retrospectively reviewed 53 cases of legionellosis during the defined period and documented patient and clinical characteristics, diagnostics, and seasonality of infection.
RESULTS
All cases were sporadic. The incidence rate in the NT was higher than the Australian median rate (2.1 and 1.5 per 100,000 population per year respectively). Aboriginal and Torres Strait Islander patients presented at a younger age than did non-Indigenous patients (median 41 and 60 years of age respectively), and overall there was a male preponderance. There was a higher proportion of legionellosis in the months with increased humidity, with a greater number of L. longbeachae infections detected overall (59%) than of L. pneumophila (41%). The majority of cases were diagnosed serologically (57% of L. pneumophilia and 93% of L. longbeachae ).
CONCLUSIONS
Legionellosis in the NT is more common, seasonal, and may be underreported due to current reliance on serological testing for diagnosis. The higher incidence of legionellosis, and the younger age of Aboriginal and Torres Strait Islander patients of the NT, have public health implications, given that the clinical presentation of legionellosis is indistinguishable from other forms of pneumonia.
Topics: Adult; Humans; Incidence; Legionellosis; Male; Middle Aged; Native Hawaiian or Other Pacific Islander; Northern Territory; Retrospective Studies
PubMed: 35739069
DOI: 10.33321/cdi.2022.46.34 -
Biomedica : Revista Del Instituto... Mar 2021Introduction: Legionellosis is a bacterial respiratory disease with an environmental origin in the community or in hospitals; it is usually associated with devices,...
Introduction: Legionellosis is a bacterial respiratory disease with an environmental origin in the community or in hospitals; it is usually associated with devices, facilities, and buildings. The most common clinical form is the pneumonic, known as legionnaires’ disease. Objective: To determine the evolution of legionellosis cases in Spain from 2010 to 2015. Materials and methods: This was a descriptive study of time series with an analysis of the legionellosis cases notified to the Centro Nacional de Epidemiología (Government of Spain). Case distribution was determined according to sex, the autonomous community of origin, month, and age groups differentiating in the latter between men and women. Results: Case count in men was more than double compared to that in women. The cases notified by nine of the autonomous communities showed an increase at the end of the period, especially in Castilla y León, Navarra, and the Basque Country but also notable in Castilla-La Mancha. A seasonal pattern was identified with an epidemic peak in July-September and a greater number of cases among 50-years old people from both sexes. Conclusion: Despite its low prevalence compared to other respiratory diseases, legionellosis has a great impact on public health. Its distribution in Spain is global and heterogeneous with cases increasing in the last two years. Therefore, better disease prevention and control measures are recommended.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Legionellosis; Male; Middle Aged; Spain; Time Factors; Young Adult
PubMed: 33761200
DOI: 10.7705/biomedica.5367 -
The American Journal of Pathology Jun 1981
Review
Topics: Agglutination Tests; Antibody Specificity; Culture Media; Enzyme-Linked Immunosorbent Assay; Fluorescent Antibody Technique; Humans; Legionella; Legionnaires' Disease; Risk; Serologic Tests; Tissue Preservation; United States
PubMed: 7015873
DOI: No ID Found -
Emerging Infectious Diseases Apr 2011Reported cases of legionellosis attributable to Legionella longbeachae infection have increased worldwide. In Australia and New Zealand, L. longbeachae has been a known...
Reported cases of legionellosis attributable to Legionella longbeachae infection have increased worldwide. In Australia and New Zealand, L. longbeachae has been a known cause of legionellosis since the late 1980s. All cases for which a source was confirmed were associated with potting mixes and composts. Unlike the situation with other Legionella spp., L. longbeachae-contaminated water systems in the built environment that cause disease have not been reported. Spatially and temporally linked outbreaks of legionellosis associated with this organism also have not been reported. Sporadic cases of disease seem to be limited to persons who have had direct contact with potting soil or compost. Long-distance travel of the organism resulting in infection has not been reported. These factors indicate emergence of an agent of legionellosis that differs in etiology from other species and possibly in route of disease transmission.
Topics: Humans; Legionella longbeachae; Legionellosis; Prevalence; Soil Microbiology
PubMed: 21470444
DOI: 10.3201/eid1704.100446 -
Environmental Science and Pollution... Nov 2022An increase in the number of reports of legionellosis in the European Union and the European Economic Area have been recorded in recent years. The increase in cases is... (Review)
Review
An increase in the number of reports of legionellosis in the European Union and the European Economic Area have been recorded in recent years. The increase in cases is significant: from 6947 reports in 2015 to 11,298 in 2019. This is alarming as genus Legionella, which comprises a large group of bacteria inhabiting various aquatic systems, poses a serious threat to human health and life, since more than 20 species can cause legionellosis, with L. pneumophila being responsible for the majority of cases. The ability to colonize diverse ecosystems makes the eradication of these microorganisms difficult. A detailed understanding of the Legionella habitat may be helpful in the effective control of this pathogen. This paper provides an overview of Legionella environments in Europe: natural (lakes, groundwater, rivers, compost, soil) and anthropogenic (fountains, air humidifiers, water supply systems), and the role of Legionella spp. in nosocomial infections, which are potentially fatal for children, the elderly and immunocompromised patients.
Topics: Child; Humans; Aged; Legionella; Ecosystem; Water Microbiology; Legionellosis; Europe; Soil; Legionella pneumophila
PubMed: 36161570
DOI: 10.1007/s11356-022-22950-9 -
Archivum Immunologiae Et Therapiae... 2009The Legionellae are Gram-negative bacteria able to survive and replicate in a wide range of protozoan hosts in natural environments, but they also occur in man-made... (Review)
Review
The Legionellae are Gram-negative bacteria able to survive and replicate in a wide range of protozoan hosts in natural environments, but they also occur in man-made aquatic systems, which are the major source of infection. After transmission to humans via aerosols, Legionella spp. can cause pneumonia (Legionnaires' disease) or influenza-like respiratory infections (Pontiac fever). In children, Legionnaires' disease is uncommon and is mainly diagnosed in children with immunosuppression. The clinical picture of Legionella pneumonia does not allow differentiation from pneumonia caused by others pathogens. The key to diagnosis is performing appropriate microbiological testing. The clinical presentation and the natural course of Legionnaires' disease in children are not clear due to an insufficient number of samples, but morbidity and mortality caused by this infection are extremely high. The mortality rate for legionellosis depends on the promptness of an appropriate antibiotic therapy. Fluoroquinolones are the most efficacious drugs against Legionella. A combination of these drugs with macrolides seems to be promising in the treatment of immunosuppressed patients and individuals with severe legionellosis. Although all Legionella species are considered potentially pathogenic for humans, Legionella pneumophila is the etiological agent responsible for most reported cases of community-acquired and nosocomial legionellosis.
Topics: Aerosols; Animals; Diagnosis, Differential; Disease Transmission, Infectious; Drug Therapy, Combination; Fever; Fluoroquinolones; Humans; Legionellaceae; Legionnaires' Disease; Macrolides; Pneumonia; Virulence
PubMed: 19578813
DOI: 10.1007/s00005-009-0035-8 -
Current Issues in Molecular Biology 2021Legionnaires' disease and Pontiac fever are both diseases with important public health implications and require prompt and thorough responses to outbreaks for future...
Legionnaires' disease and Pontiac fever are both diseases with important public health implications and require prompt and thorough responses to outbreaks for future prevention. Effective methods for defining, diagnosing, reporting and responding to legionellosis outbreaks ideally should be standardized across countries. Therefore, the European Union surveillance methods for countering Legionnaires' disease is a useful model especially for travel-associated Legionnaires' disease (TALD) cases which are on the rise. Multi-country surveillance in the EU and European Economic Area (EEA) has evolved since the first organizational efforts in the 1980's to the currently responsible, European Legionnaires' Disease Surveillance Network (ELDSNet). This chapter outlines the practices of the EU surveillance of Legionnaires' disease including their schemata, definitions, responsibilities of participating members, methods and the results of the data collected since the program's inception. Lastly, improvements must still be made as the incidence of Legionnaires' disease in the EU is likely underestimated due to underreporting and/or underdiagnosis. Nearly 70% of cases are reported from only four countries, France, Germany, Italy and Spain, which represent 50% of the EU population.
Topics: Disease Outbreaks; Europe; Humans; Legionella; Legionnaires' Disease; Public Health Surveillance
PubMed: 33284133
DOI: 10.21775/cimb.042.081