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Atypical Organisms Legionella

What is Legionella

Explanation

  • Gram Negative
  • Rod shaped
  • Flagellated
  • Has a very thin peptidoglycan layer

Where infection spreads

Infection

Legionella transmission is thought to occur via inhalation of aerosolized mist from water sources such as....

  • Cooling systems
  • Decorative fountains
  • Humidifiers
  • Hot tubs and pools

The perfect condition for Legionella to grow

Perfect Conditions

  • Temperature of 25-42°C
  • Stagnation
  • Presence of certain free-living aquatic amoebae capable of supporting intracellular growth of legionella

Legionella pneumophila

First seen at a convention of the American Legion at the Bellevue-Stratford Hotel in Philadelphia where 182 cases were reported, and 29 died

Legionella pneumophila is the causative agent of Pontiac Fever

In the U.S. there are an estimated 6000 cases a year

Atypical Organisms cause 10-20% of community acquired pneumonia

Interesting Cases

Interesting cases of Legionaires disease

A hot tub exhibit is suspected to have developed and spread the bacteria

In September of this year (2019) there was a Legionella pneumophila outbreak in the mountains of North Carolina following the Western North Carolina Mountain State Fair

  • 141 were diagnosed
  • 88 hospitalized
  • 4 have died
  • age range between 39 and 90
  • >50% diagnosed were males

Clinical Syndromes

Clinical Syndromes

Cough is present in ~90% of cases

About 33% of cases report dyspnea, pleuritic chest pain, and hemoptysis (coughing up blood)

GI symptoms (nausea, vomiting, watery diarrhea, pain)

Neurologic Symptoms

(headache, lethargy, encephalopathy, altered mental status-which is the most common)

Musculoskeletal symptoms include myalgias

Who is at risk?

Who is at risk

  • Elderly
  • Smokers
  • Chronic heart or lung disease
  • Immunocompromised hosts
  • Diabetics
  • Hematologic malignancies
  • End-stage renal disease
  • Heavy Drinkers

Legionella pneumophila

compared to other Atypical Organisms

  • Higher virulence
  • More severe in most cases

Legionella

Mycoplasma pneumoniae

Chlamydia pneumoniae

Diagnosis

  • Can test mucus for the bacteria

  • Can find antigens in a urine sample (simple, quick, reliable, but only tests for serogroup 1 ~70% of cases)

  • Two blood samples take 3-6 weeks apart

Diagnosis

Treatment

Treatment

initiating an aggressive antibiotic therapy

  • fluoroquinolone
  • azithromycin (Z-pack)

For more severe cases: consider IV administration and progression to oral therapy

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