The association of underlying chronic liver disease as a more common risk factor for the non-Legionella group with the higher incidence of abnormal hepatic tests in these patients seems to be evident. The finding of severe hypoxemia in almost 50 percent of the patients in both groups is in agreement with respiratory failure as being the usual cause of death in both Legionella and non-Legionella pneumonia patients.
Continue reading " Comparative Study of Legionella pneumophila: Discussion (8) "
The early evaluation of chest x-ray abnormalities showed a predominance of unilateral and unilobar involvement that was common to both groups of pneumonia. This presenting roentgenographic feature has usually been reported in most legionellosis series. However, it is worthwhile to emphasize that, even in such an early stage, 10 out of 27 Legionella pneumonia patients and 9 out of 28 non-Legionella pneumonia patients showed initial bilateral lung involvement. Cavitation has been stressed as more frequent in legionellosis when involving seriously immunocompromised hosts. In fact, our two cases of cavitation were found in patients with severe immunosuppressive disease. Pleural effusion was significantly more frequent in the non-Legionella group. Although pleural effusion has been reported to be relatively common in legionellosis, usually it is not a presenting […]
Continue reading " Comparative Study of Legionella pneumophila: Discussion (7) "
Other comparative studies have not found significant differences in the prevalence of any risk factors for Legionella vs non-Legionella pneumonia. Our relatively low incidence of severe underlying immunosuppression in the Legionella pneumonia group, when compared to other series of nosocomial legionellosis, can have influenced the mortality rate, as we discuss later. Chronic hver disease was more common in the non-Legionella group, and one can speculate, to suggest an explanation for this finding, on the possibility of subclinical encephalopathy favoring aspiration of oropharyngeal flora in non-Legionella pneumonia patients. ampicillin antibiotic
Continue reading " Comparative Study of Legionella pneumophila: Discussion (6) "
Hospital-acquired Legionnaires’ disease is said to occur very infrequently in the absence of underlying disease, but this statement can also be applied to other etiologies of hospital-acquired pneumonia. In fact, in our study, the lack of severe underlying disease was more frequent in Legionella pneumonia patients.
Continue reading " Comparative Study of Legionella pneumophila: Discussion (5) "
The real utility of mean age and sex differences between Legionella and non-Legionella pneumonia cases, despite their statistical significance, can probably be considered low from a practical point of view. A seasonal pattern of distribution has been described in some outbreaks of nosocomial legionellosis. A preference for the summer months has generally been reported. The water temperature during these months can be most favorable to the amplifying mechanisms of Legionella. A Legionella-favoring influence of certain algae, aquatic protozoa and plants such as MyriophtUum spicatum (which tends to show a seasonal relationship with legionella), has been hypothesized.
Continue reading " Comparative Study of Legionella pneumophila: Discussion (4) "
A common point to all hospital-acquired legionellosis series has been the discovery of contamination of the water supply system, which was also observed in our hospital. Routine culturing of the water supply system was not performed, but Lpneumophila was frequently isolated at different locations. The irregular basis of our environmental cultures and the absence of molecular subtyping of linked patient and environmental isolates hampered our ability to draw conclusions on this particular point.
Continue reading " Comparative Study of Legionella pneumophila: Discussion (3) "
In some series, the control, non-Legionella group is formed by nosocomial pneumonia cases diagnosed on the basis of cultures from samples obtained without avoiding contamination with the saprophyte oropharyngeal flora, such as sputum or tracheal aspirates. In our opinion and that of others, these diagnoses are not completely reliable, so we used the strictest criteria for inclusion of a case in our non-Legionella group. birth control yasmin We were also concerned about the unusual but well-referenced possibility of a false positive DFA Legionella test, especially that due to some Pseudomo-nas species. Therefore, we confirmed almost all our Legionella cases by positive culture or serology. Some series of legionellosis show significant percentages of their diagnoses based exclusively on the DFA test.
Continue reading " Comparative Study of Legionella pneumophila: Discussion (2) "
The aim of our study was to obtain clinically relevant conclusions from the comparison, in a prospective way, of the characteristics of hospital-acquired pneumonia due to Lpneumophila and other, non-Legionella bacteria. It has been suggested that community- and hospital-acquired legionellosis tend to be similar in many aspects. However, it seems logical to expect that the population admitted to a hospital usually has a compromising underlying condition that could modify clinical response to this infection and induce some significant discrepancies between the features of these two forms of Legionella pneumonia. That is why we have restricted this comparative study to the nosocomial setting. buy flovent inhaler
Continue reading " Comparative Study of Legionella pneumophila: Discussion (1) "
Treatment and Outcome Since the discovery of the first cases of Legionella pneumonia in.our hospital, erythromycin has been included in the initial therapeutic approach to nosocomial pneumonia. So, all patients belonging to the Legionella group were treated with 4 g/day of erythromycin from the moment of diagnosis of pneumonia.’ Patients of the non-Legionella group were treated according to culture and antibiogram results. Before the isolation of the causative bacteria was performed, patients of the non-Legionella group were treated with a combination of erythromycin, 4 g/day, and a third-generation cephalosporine, or sometimes, an aminoglycoside,
Continue reading " Comparative Study of Legionella pneumophila: Results (6) "
Roentgenographic Features We analyzed the following roentgenographic data (Table 3): (1) extent of shadowing, involving one lung, both lungs, one lobe or two or more lobes; (2) homogeneous consolidation; (3) cavitation; and (4) pleural effusion. We looked specifically for the presence of blunting of the costophrenic angle which was considered as evidence of pleural effusion and was subsequently confirmed by thoracocentesis in each case. buy yasmin online Unilateral and unilobar involvement was the most frequent initial roentgenographic finding in both groups. The only feature that showed a statistically significant difference was pleural effusion (p<0.02), which was much more common in the non-Legionella group. The two cases of cavitation in the Legionella group were detected in patients with severe immunosuppression.
Continue reading " Comparative Study of Legionella pneumophila: Results (5) "