Legionella pneumophila usually causes pneumonia with extrapulmonary manifestations. Diagnosis requires special media, serologic tests or PCR testing. The treatment is macrolide antibiotics called fluoroquinolones or doxycycline.
This pathogen was first in 1976 after an outbreak at a meeting of the “American Legion” in Philadelphia, Pennsylvania, notes, hence the name Legionnaires’ disease. This disease is the pulmonary form of infection, which is typically caused by serogroup 1 of Legionella pneumophila. Infection without pneumonia is known as Pontiac fever, which manifests as febrile viral-like illness.
Legionella pneumophila usually causes pneumonia with extrapulmonary manifestations. Diagnosis requires special media, serologic tests or PCR testing. The treatment is macrolide antibiotics called fluoroquinolones or doxycycline. This pathogen was first in 1976 after an outbreak at a meeting of the “American Legion” in Philadelphia, Pennsylvania, notes, hence the name Legionnaires’ disease. This disease is the pulmonary form of infection, which is typically caused by serogroup 1 of Legionella pneumophila. Infection without pneumonia is known as Pontiac fever, which manifests as febrile viral-like illness. The pathogens are often found in the soil and drinking water. In freshwater existing Amebas are a natural reservoir for these bacteria. The water supply of a building is often the source of a Legionella outbreak. Legionella are pathogens in a biofilm that forms on the inside of water pipes and containers embedded. The infection is usually caused by the inhalation of aerosols (or rarely aspiration) purchased from contaminated water (eg., By shower heads, Misters, hot tubs and cooling towers for air conditioning r generated). usually a nosocomial infection include a contaminated hot water supply. The infection is not transmitted from person to person. By Legionella sp. diseases caused Legionella infection is more common and more severe in the following: patients <1 year elderly patients with diabetes or COPD Cigarette smoking Immunocompromised patients (typically with reduced cell vermitteltee immunity) The lungs are the most common sites of infection; it can be a patient or nosocomial acquired pneumonia occur. Extrapulmonary Legionellosis is rare; Symptoms include sinusitis, wound infection of the hip, myocarditis, pericarditis and endocarditis of the prosthetic valve, often without pneumonia. Symptoms and complaints Legionnaires' disease is a flu-like illness with acute fever, chills, malaise, headache, or confusion. Nausea, loose stool or aqueous diarrhea, abdominal pain, cough and arthralgia are also commonly. Pneumonic symptoms may consist of dyspnea, pleuritic and hemoptysis. Bradycardia relative to fever may occur, especially in severe cases. The overall mortality rate is low (about 5%), but can reach 40% in patients with hospital-acquired infections, elderly and immunocompromised patients. Diagnostic Direct fluorescent antibody staining sputum Rapid urine antigen test (only for serogroup 1) Occasionally a direct immunofluorescence staining is applied by means of antibodies with sputum or lavage fluid, which requires expertise. In addition, a PCR for detection of DNA is available and may be useful in identifying the transmission paths. The antigen detection in urine has 3 days after initiation of complaints a sensitivity of 60-95% and a specificity of> 99%, but has only L. pneumophila (serogroup 1) by and not non-pneumophile Legionella. A paired serum sample with acute and convalescent serum can retrospectively lead to a diagnosis. A 4-fold increase in titer or an acutely increased titer of ?1: 128 is considered to be diagnostic conclusive. The diagnosis of Legionnaires’ disease is provided by the culture of sputum or bronchoalveolar fluid; Blood cultures are not reliable. Because of sluggish growth on nutrient media, the identification may be delayed by 3-5 days. A radiograph of the chest should be performed; this is usually incomplete and rapidly progressive asymmetrical infiltrates (even if an effective antibiotic therapy is applied), with or without small pleural effusions. Laboratory Chemical variations often include hyponatremia, hypophosphatemia and elevated aminotransferase levels. Therapy fluoroquinolones, macrolides (azithromycin preferred) Sometimes doxycycline The preferred treatment is a fluoroquinolone, the i.v. or p.o. for 7 to 14 days and for highly immunocompromised patients sometimes up to 3 weeks is given. Azithromycin (for 5 to 10 days) is effective, but erythromycin may be less effective. Erythromycin should be used only for a slight pneumonia in patients who are not immunocompromised. Doxycycline is an alternative for immunocompetent patients with mild pneumonia. The addition of rifampicin is no longer recommended because no benefit was detected, and there is a potential for damage. Important points L. pneumophila causes a pulmonary infection usually; but rarely it can (usually with cardiac involvement) cause extrapulmonary infections. The L. pneumophila infection (often or less by aspiration) usually acquired through the inhalation of aerosols from contaminated water; it is not transmitted from person to person. The diagnosis is made by direct fluorescent antibody staining or PCR tests; Sputum cultures are accurate, but can last 3 to 5 days. The treatment is carried out with a fluoroquinolone or azithromycin; Doxycycline is an alternative.