1/143. Concurrent infection with legionella pneumophila and pneumocystis carinii in a patient with adult T cell leukemia.A 48-year-old woman was admitted to our hospital with high fever, chills, cough, and exertional dyspnea. On admission, the chest roentgenogram and computed tomography scan showed bilateral alveolar infiltration in the middle and lower lung fields. Microscopic examination of the bronchial lavage fluid showed flower cells typical for adult T-cell leukemia (ATL) and cysts of pneumocystis carinii, and legionella pneumophila serogroup 1 grew on buffered charcoal yeast extract (BCYE)-alpha agar. The patient was successfully treated with antibiotics including trimethoprim/sulfamethoxazole, erythromycin, and sparfloxacin. Remission of ATL was achieved after three courses of antileukemic chemotherapy. Mixed infection of opportunistic pathogens should be considered in patients with ATL.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/143. 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 = 1.6keywords = infection (Clic here for more details about this article) |
3/143. Legionella pneumonia from a novel industrial aerosol.After a worker from a plastics factory was diagnosed with legionella pneumonia it was learnt that a retired employee at the factory had been in hospital with a serious chest infection six months before and legionella pneumonia was diagnosed in retrospect from stored serum. The likeliest common source was a machine cooling system that took water from an uncovered water tank outdoors (from which legionella pneumophila was isolated) and which generated an aerosol through a crack in the flow meter sight glass.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
4/143. Acid-fast-positive legionella pneumophila: a possible pitfall in the cytologic diagnosis of mycobacterial infection in pulmonary specimens.The acid-fast stain is commonly used in the rapid cytologic assessment of bronchoalveolar lavage (BAL) fluid to detect pulmonary mycobacterial infections, particularly in immunocompromised patients. The identification of acid-fast, rod-shaped organisms may be taken as presumptive evidence of such an infection, in the appropriate clinical setting. However, this determination is made less specific by the occasional acid-fast positivity of microorganisms other than mycobacteria. We report on the occurrence of a fatal pneumonia caused by acid-fast positive legionella pneumophila detected by BAL. This is a potential pitfall in the rapid diagnosis of pulmonary mycobacterial infections.- - - - - - - - - - ranking = 1.4keywords = infection (Clic here for more details about this article) |
5/143. Epstein-Barr virus-associated Hodgkin's lymphoma and legionella pneumophila infection complicating treatment of juvenile rheumatoid arthritis with methotrexate and cyclosporine A.We describe the case of a 53-month-old girl with juvenile rheumatoid arthritis (JRA), complicated by the occurrence of Hodgkin's lymphoma and legionella pneumophila infection during immunosuppressive treatment with methotrexate (MTX) and cyclosporine A (CSA). The girl had received variable anti-inflammatory combination therapy, including MTX for 28 months and CSA for 3 months. Thirty-six months after the onset of arthritis, the girl presented with an enlargement of the lymph nodes of the mediastinum, the hilum of the lungs, and the abdomen. Concomitantly, a diagnosis of Legionella pneumonia was rendered. autopsy showed Epstein-Barr virus (EBV)-associated nodular sclerosing Hodgkin's lymphoma. The neoplastic cells were positive for CD15, CD 30, and latent membrane protein 1 (LMP 1). The present case is the second reported to occur in a child, and it lends support to the hypothesis that immunosuppressive treatment may contribute to an increased risk of the development of EBV-associated lymphoproliferative disorders (LPD) in pediatric patients suffering from JRA.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
6/143. Legionnaire's disease complicating pregnancy: a case report with intrauterine fetal demise.OBJECTIVE: Legionnaire's disease complicating pregnancy is an unusual event that can seriously compromise both the mother and the fetus. CASE REPORT: We describe one case of such association, with an unfavourable intrauterine fetal outcome, secondary to acute placental insufficiency, related to infection. DISCUSSION: It is important in these high risk pregnancies complicated by acute pneumonia to take into consideration the diagnosis, as early as possible, and the appropriate treatment or the careful monitoring of fetal wellbeing.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
7/143. legionnaires' disease associated with potting soil--california, oregon, and washington, May-June 2000.Since legionnaires' disease (LD) was first reported in 1976, outbreaks have been associated with airborne transmission of Legionella bacteria through cooling towers, showers, and other aerosolizing devices (1). However, most LD cases are sporadic, and the source and mode of infection in many cases are unknown. Infections with one species, legionella longbeachae, have been associated with gardening and use of potting soil in australia and japan (2,3). This report summarizes the findings of LD investigations in california, oregon, and washington, that suggest that transmission from potting soil has occurred for the first time in the united states, and that active surveillance and case finding are warranted to explore this association.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
8/143. Persistent Legionella infection in a patient after bone marrow transplantation.We report on a patient who developed Legionella pneumonia after bone marrow transplantation. Despite appropriate antibiotic treatment, disease progressed. The patient developed a lung abscess from which Legionella and prevotella were isolated. Cure was achieved by surgical resection. The resected material was sterile, but 16S ribosomal dna analysis revealed Legionella dna.- - - - - - - - - - ranking = 0.8keywords = infection (Clic here for more details about this article) |
9/143. Acute pancreatitis caused by severe legionella pneumophila infection.We report three cases of severe community-acquired legionella pneumophila pneumonia with acute pancreatitis. pancreas involvement is unusual. The clinical presentations consisted of painless pancreatitis with only elevation of serum pancreatic enzymes (case 1), tender abdomen with edematous pancreas on computed tomography scan (case 2) and necrosis (case 3). We discuss the possible mechanisms of L. pneumophila associated acute pancreatitis for which the pathophysiology is still undetermined: infection, toxin release or cytokine secretion.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
10/143. legionnaires' disease in a patient with rheumatoid arthritis.A 62-year-old male with rheumatoid arthritis (RA) who was taking nonsteroid anti-inflammatory drug for controlling synovitis developed a flare of his arthritis, hepatitis, and pneumonia due to infection with legionella pneumophila serotype 1. adult respiratory distress syndrome (ARDS) occurred following the development of pneumonia. After the introduction of erythromycin and ventilator support with positive end expiratory pressure (PEEP), his condition stabilized and he recovered gradually. We suggest that L. pneumophila should be considered early in the differential diagnosis of pneumonia in RA patients due to their immunocompromised status.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
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