Clinical Characteristics of 8 Sporadic Cases of Community-Acquired Legionella Pneumonia in Advanced Age

Sugihara, Eiichiro; Dambara, Takashi; Aiba, Miyoji; Okamoto, Masaki; Yonemitsu, Junko; Sonobe, Satoshi; Koga, Hideyuki; Inui, Akihiro; Hada, Naoko; Matsumoto, Naomi; Gotö, Yökö; Naito, Toshio; Isonuma, Hiroshi; Hayashida, Yasuo

doi:10.2169/internalmedicine.46.6084

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…The maximum degree of the temperature, for example, is of some value in differentiating M. pneumoniae or C. pneumoniae. [8][9][10] A pulse temperature deficit (Faget's sign) is termed "relative bradycardia." Relative bradycardia refers to an inappropriate pulse response for a given degree of temperature greater than 102°F in patients without arrhythmias, pacemaker rhythms, or pulse-modifying medications (␤-blockers, diltiazem, verapamil).…”

Section: Clinical Diagnosis Of Legionnaires' Diseasementioning

confidence: 99%

“…Studies comparing clinical signs and symptoms in Legionnaires' disease versus other CAPs have found no single parameter that clearly identifies Legionella CAP. [8][9][10][11][12] Both Legionella and M. pneumoniae, for example, often present with loose stools and watery diarrhea. Other causes of CAP are not associated with these findings, but gastrointestinal manifestations are not always present in all cases of Legionella or mycoplasma CAP.…”

Section: Clinical Diagnosis Of Legionnaires' Diseasementioning

confidence: 99%

“…Because pneumonia may be associated with hyponatremia, per se, it is not specific for Legionella in patients with CAP. [6][7][8][9][10]…”

Section: Clinical Diagnosis Of Legionnaires' Diseasementioning

confidence: 99%

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Severe Legionella pneumonia: Rapid presumptive clinical diagnosis with Winthrop-University Hospital's weighted point score system (modified)

Cunha

2008

Heart & Lung

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Legionnaires' disease is a systemic infection involving the lungs and accompanied by a characteristic pattern of extrapulmonary organ involvement. Legionnaires' disease is one of the non-zoonotic causes of atypical community-acquired pneumonia (CAP). Legionnaires' disease commonly presents as severe CAP requiring hospitalization and intensive care. Each atypical CAP has its own characteristic pattern of extrapulmonary laboratory clinical findings and abnormalities that are the basis of clinical syndromic diagnosis. Studies have been unsuccessful in identifying individual clinical and laboratory parameters that are specific for Legionella. Individually, clinical and laboratory abnormalities lack diagnostic specificity. The diagnostic specificity of clinical and laboratory findings is increased when combined and are the basis of a clinical syndromic diagnosis. The importance of serial nonspecific laboratory abnormalities with Legionnaires' disease is emphasized. The sensitivity and specificity of a clinical syndromic diagnosis are enhanced if they are based on a weighted point score system. A diagnostic weighted point score system is based on the varying diagnostic importance of clinical and laboratory diagnostic findings. The Winthrop-University Hospital's Infectious Disease Division's rapid clinical diagnostic weighted point system is based on a weighted point score of clinical and laboratory findings. The case presented is that of a 55-year-old man with severe CAP who required hospitalization and intensive care admission. The presumptive clinical diagnosis of Legionella CAP was based on the Winthrop-University Hospital Infectious Disease Division's weighted point score system, which permitted early empiric anti-Legionella antimicrobial therapy and prompted specific Legionella testing. Legionnaires' disease is definitively diagnosed by serology or a urinary Legionella antigen test. This case of severe Legionnaires' CAP was confirmed by urinary antigen test reported on hospital day 6. The Winthrop-University Hospital is weighted point score system (modified) permits a rapid clinical presumptive diagnosis of Legionnaires' disease and is an accurate predictor of Legionella CAP.

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Section: Clinical Diagnosis Of Legionnaires' Diseasementioning

confidence: 99%

Section: Clinical Diagnosis Of Legionnaires' Diseasementioning

confidence: 99%

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Severe Legionella pneumonia: Rapid presumptive clinical diagnosis with Winthrop-University Hospital's weighted point score system (modified)

Cunha

2008

Heart & Lung

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“…The clinical presentation of LD pneumonia can be atypical, particularly among elderly patients [6,30]. Therefore, a heightened index of suspicion among clinicians and healthcare providers is also indicated to accelerate diagnosis and effective treatment of Legionella pneumonia among residents and visitors to facilities with colonization or the occurrence of LD cases.…”

Section: Discussionmentioning

confidence: 99%

Legionnaires’ disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study

et al. 2013

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BackgroundDuring a Legionnaires’ disease (LD) outbreak, combined epidemiological and environmental investigations were conducted to identify prevention recommendations for facilities where elderly residents live independently but have an increased risk of legionellosis.MethodsSurvey responses (n = 143) were used to calculate attack rates and describe transmission routes by estimating relative risk (RR) and 95% confidence intervals (95% CI). Potable water collected from five apartments of LD patients and three randomly-selected apartments of residents without LD (n = 103 samples) was cultured for Legionella.ResultsEight confirmed LD cases occurred among 171 residents (attack rate = 4.7%); two visitors also developed LD. One case was fatal. The average age of patients was 70 years (range: 62–77). LD risk was lower among residents who reported tub bathing instead of showering (RR = 0.13, 95% CI: 0.02–1.09, P = 0.03). Two respiratory cultures were characterized as L. pneumophila serogroup 1, monoclonal antibody type Knoxville (1,2,3), sequence type 222. An indistinguishable strain was detected in 31 (74%) of 42 potable water samples.ConclusionsManagers of elderly-housing facilities and local public health officials should consider developing a Legionella prevention plan. When Legionella colonization of potable water is detected in these facilities, remediation is indicated to protect residents at higher risk. If LD occurs among residents, exposure reduction, heightened awareness, and clinical surveillance activities should be coordinated among stakeholders. For prompt diagnosis and effective treatment, clinicians should recognize the increased risk and atypical presentation of LD in older adults.

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“…Pulmonary infiltrates on chest radiographs have been documented in 97% of children with Legionnaires' disease (Greenberg 2005). Another chest radiograph clue to Legionnaires' disease are worsening pulmonary infiltrates appearing in spite of an appropriate antimicrobial therapy (Cunha 2006a; Sugihara et al 2007). In chest computed tomography scans, the most frequent appearances of Legionella pneumonia are multilobar or multisegmental consolidations and ground-glass opacity (GGO) (Kim et al 2007).…”

Section: Radiographic Changesmentioning

confidence: 99%

Pathogenicity of the family Legionellaceae

Palusińska-Szysz

Cendrowska-Pinkosz

2009

Arch. Immunol. Ther. Exp.

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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.

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Clinical Characteristics of 8 Sporadic Cases of Community-Acquired Legionella Pneumonia in Advanced Age

Abstract: Abstract

Cited by 8 publications

References 20 publications

Severe Legionella pneumonia: Rapid presumptive clinical diagnosis with Winthrop-University Hospital's weighted point score system (modified)

Severe Legionella pneumonia: Rapid presumptive clinical diagnosis with Winthrop-University Hospital's weighted point score system (modified)

Legionnaires’ disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study

Pathogenicity of the family Legionellaceae

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