1/6. A case of legionella pneumophila pneumonia complicated by miliary tuberculosis.A 47-year-old woman was admitted to hospital with severe Legionella pneumonia. The respiratory symptoms improved dramatically and the x-rays revealed a decrease in the diffuse chest infiltrates after treatment with erythromycin and rifampicin. However, chest CT scans showed that the reticulonodular opacities persisted for several weeks after the onset of pneumonia. Two months after admission, the chest x-rays showed the progression of small nodules in both lungs and there was increasing respiratory distress. A diagnosis of miliary tuberculosis was confirmed. The present case should alert physicians to this potentially confusing combination of respiratory pathogens.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Recurrent legionnaires' disease: a case report.In 1979, an isolated case of legionnaires' disease in a 46 year old Caucasian male ohio physician was reported. diagnosis was later confirmed by a fourfold increase in indirect immunofluorescent antibody titer level. Recovery began rapidly after the administration of erythromycin therapy and appeared to be complete. The following year the same patient suffered an apparent reinfection, once again realizing prompt and total recovery upon receiving erythromycin therapy. Although not commonly reported, the possibility of reinfection with the Legionella bacterium is a reality. The source of human innoculation need not necessarily be a common water supply or large cooling system reservoir (as was previously thought). erythromycin continues to be widely regarded as the treatment of choice for infections with the Legionella bacterium even though this case demonstrates that it does not prevent reinfection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Brief communication: Legionnaire's disease successfully treated in acute myelocytic leukemia during severe neutropenia.A patient with acute nonlymphocytic leukemia developed progressive lung infiltrates and unremitting fevers during a profound neutropenic state. Legionnaire's disease was diagnosed by simple immunologic studies and successfully treated with erythromycin. This index case alerts physicians toward a treatable infection which would not normally be susceptible to the empiric antibiotic regimens given neutropenic patients with fevers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. legionnaires' disease: report of sixty-five nosocomially acquired cases of review of the literature.Sixty-five cases of nosocomially acquired legionnaires' disease are reported and the world literature is reviewed. The etiologic agent, Legionnella pneumophila, has been isolated from several environmental sources at outbreak sites. legionnaires' disease appears to be acquired by inhalation and is primarily manifested by severe, potentially fatal, pneumonia. Characteristic clinical disease consists of high fever with relative bradycardia, dry cough, chills, diarrhea, and pleuritic pain. Although no single feature is pathognomonic, the clinical presentation is usually sufficiently characteristic to suggest the diagnosis. The diagnosis of legionnaires' disease during acute illness may be established by culture of legionella pneumophila, or by demonstration of the bacterium using special stains. However, in most instances, the physician must make a presumptive diagnosis based on the clinical presentation in order to institute appropriate antimicrobial therapy. Retrospective confirmation of the diagnosis may be made by serologic studies in most instances. erythromycin is, at this time, the drug of choice for the treatment of legionnaires' disease. A prompt salutory response following institution of erythromycin therapy is typical.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Hemodialysis fistula infections caused by legionella pneumophila.legionella pneumophila was found in the infected hemodialysis fistulas of two patients. The first patient developed an infection of the fistula during acute illness with Legionnaires' pneumonia. Legionella organisms were shown to be present in the graft by direct immunofluorescent staining. The second patient developed an infection of the hemodialysis fistula 3 weeks after completing a course of erythromycin therapy for Legionnaires' pneumonia. Legionella organisms were found by direct immunofluorescence in purulent material that was obtained from the graft, and serogroup 1 L. pneumophila was isolated from the pus. The frequency with which the organism causes infection of hemodialysis access sites is unknown. Increased awareness by physicians that L. pneumophila produces extrapulmonary disease may result in more frequent detection of these infections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Legionella and Pneumocystis pneumonias in asthmatic children on high doses of systemic steroids.asthma is increasingly treated as an inflammatory disease with inhaled and/or systemic corticosteroids. We report 3 cases of unusual pneumonias associated with high doses of oral steroids. Two patients contracted Legionella pneumonia and one patient contracted pneumocystis carinii pneumonia. With increasing usage, it is important for physicians to be aware of the possible infectious complications of high dose steroids. This report highlights the risk of corticosteroid treatment in asthma in predisposing to opportunistic infections that have not heretofore been readily associated with asthma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |