Legionella: Difference between revisions
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==Evaluation<ref>Cunha BA. Legionnaires' disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin N Am. 2010;24(1):73-105.</ref>== | ==Evaluation<ref>Cunha BA. Legionnaires' disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin N Am. 2010;24(1):73-105.</ref>== | ||
[File:PMC5258191 cureus-0008-00000000937-i01.png|thumb|Severe case of Legionellosis on CXR]] | |||
*Na: Low in CAP but mostly frequently associated with Legionella | *Na: Low in CAP but mostly frequently associated with Legionella | ||
*AST/ALT: Mildly increased 2-5x normal | *AST/ALT: Mildly increased 2-5x normal | ||
Revision as of 06:59, 6 March 2019
Background
- Gram negative aerobe
- L. pneumophila: associated with pneumonia and Pontiac Fever
- Increased incidence with hot, humid, weather and thundershowers; outbreaks have been associated with cooling towers.
- Most commonly found in patients age > 50 years, smokers, immunocompromised.[1]
Differential Diagnosis
Causes of Pneumonia
Bacteria
Viral
- Common
- Influenza
- Respiratory syncytial virus
- Parainfluenza
- Rarer
- Adenovirus
- Metapneumovirus
- Severe acute respiratory syndrome (SARS)
- Middle east respiratory syndrome coronavirus (MERS)
- 2019-nCoV (COVID-19)
- Cause other diseases, but sometimes cause pneumonia
Fungal
- Histoplasmosis
- Coccidioidomycosis
- Blastomycosis
- Pneumocystis jirovecii pneumonia (PCP)
- Sporotrichosis
- Cryptococcosis
- Aspergillosis
- Candidiasis
Parasitic
Evaluation[2]
[File:PMC5258191 cureus-0008-00000000937-i01.png|thumb|Severe case of Legionellosis on CXR]]
- Na: Low in CAP but mostly frequently associated with Legionella
- AST/ALT: Mildly increased 2-5x normal
- Phosphate: Decreased
- CK: Increased
- CRP: > 35
- Ferritin: Increased >2x normal
Management
- First line
- Alternatives:
- Doxycycline
- Tigecycline
- Respiratory fluoroquinolone for severe disease[3]
Antibiotic Sensitivities[4]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
Table Overview
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See Also
References
- ↑ Cunha BA. Legionnaires' disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin N Am. 2010;24(1):73-105.
- ↑ Cunha BA. Legionnaires' disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin N Am. 2010;24(1):73-105.
- ↑ Burke et Al. Legionnaires Disease Treatment & Management. Aug 18, 2014. http://emedicine.medscape.com/article/220163-treatment#d11
- ↑ Sanford Guide to Antimicrobial Therapy 2014