Prevalence of Opportunistic Pathogens and Diversity of Microbial Communities in the Water System of a Pulmonary Hospital / 生物医学与环境科学（英文）

Objective@#Our objective was to investigate the occurrence of opportunistic pathogens and characterize the bacterial community structures in the water system of a pulmonary hospital.@*Methods@#The water samples were collected from automatic and manual faucets in the consulting room, treatment room, dressing room, respiratory ward, and other non-medical rooms in three buildings of the hospital. Quantitative polymerase chain reaction was used to quantify the load of several waterborne opportunistic pathogens and related microorganisms, including spp., spp., and . Illumina sequencing targeting 16S rRNA genes was performed to profile bacterial communities.@*Results@#The occurrence rates of spp., spp., and were 100%, 100%, and 76%, respectively in all samples. Higher occurrence rates of were observed in the outpatient service building (building 1, 91.7%) and respiration department and wards (building 2, 80%) than in the office building (building 3), where no was found. were more abundant in automatic faucets (average 2.21 × 10 gene copies/L) than in manual faucets (average 1.03 × 10 gene copies/mL) ( < 0.01). , , , , , and were the dominant bacterial phyla. Disinfectant residuals, nitrate, and temperature were found to be the key environmental factors driving microbial community structure shifts in water systems.@*Conclusion@#This study revealed a high level of colonization of water faucets by opportunistic pathogens and provided insight into the characteristics of microbial communities in a hospital water system and approaches to reduce risks of microbial contamination.

Presencia de especies de Legionaella en reservorios domciliarios de agua de Resistencia Chaco, Argentina / Presence of Legionella Species in Residential Water Reservoirs of Resistencia Chaco, Argentina

INTRODUCCIÓN: : El género Legionella comprende especies que se encuentran en ambientes acuáticos, pero se deben incorporar a aerosoles e inhalar para producir enfermedad. Si bien la mayoría de los casos de neumonía son causados por L. pneumophila, de las 58 especies que constituyen este género, 24 se relacionaron a enfermedad humana. El objetivo del trabajo fue evaluar la presencia de especies de Legionella en reservorios domiciliarios de agua potable de Resistencia, Chaco. MÉTODOS: Se estudiaron 46 muestras de agua tomadas en diferentes puntos de la ciudad. La detección de Legionella se realizó por cultivo según lo establecido en la norma ISO 11731:1998. La técnica molecular de reacción en cadena de la polimerasa en tiempo real con colorante intercalante (Syber Green) se aplicó a los aislamientos obtenidos por cultivo e identificados como Legionella spp. Las secuencias diana utilizadas correspondieron a fragmentos conservados del gen 23S rRNA para la confirmación del género y el gen mip específico para la especie L. pneumophila. RESULTADOS: En 16 (34,9%) de las 46 muestras estudiadas se recuperaron cepas de Legionella spp. Por la técnica molecular se confirmó la presencia de Legionella pneumophila en 15 de las muestras positivas por cultivo. Además, 3 de estas muestras (6,5%) también resultaron positivas para otras especies del género Legionella. CONCLUSIONES: Este trabajo demostró la presencia de L. pneumophila y otras especies en los reservorios domiciliarios de agua potable en Resistencia

Legionelosis ocupacional en mayores de 18 años: revisión sistemática / Occupational legionella in adults over 18 years pf age: a systematic review

Resumen El objetivo es revisar la literatura científica sobre los problemas de salud derivados de la exposición laboral a Legionella spp. Revisión sistemática de la literatura científica recogida en las bases de datos MEDLINE (Pubmed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library Plus, Literatura Latinoamericana de Información en Ciencias de la Salud (LILACS) y SCOPUS, hasta febrero 2015. Los descriptores utilizados fueron: "Legionnaires' Disease" "Legionellosis" "Occupational Exposure" "Occupational Diseases". Se obtuvieron 222 referencias, que tras aplicar los criterios de inclusión y exclusión, se seleccionaron 13 artículos a texto completo. De ellos 9 artículos describen la aparición de neumonía, 4 Fiebre de Pontiac, 1 legionelosis o presunta legionelosis y 3 muerte. El principal agente causal en los profesionales expuestos fue Legionella pneumophila serogrupo 1. La infección por legionela está ligada a las profesiones donde existe nebulización por agua, principalmente en los trabajadores sometidos a largas exposiciones o incluso a la re-exposición. Los brotes se producen de forma estacional, sobre todo en los meses más cálidos.

Abstract The scope of this paper is to review the available scientific literature about the effects on health of occupational exposure to Legionella spp. A systematic review of the scientific literature retrieved from the MEDLINE (via PubMed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library, LILCAS and SCOPUS databases through February 2015 was conducted. The key words used were ««Legionnaires' Disease¼ «Legionellosis¼ «Occupational Exposure¼ «Occupational Diseases¼. Two hundred and twenty-two references were retrieved of which, after applying inclusion/exclusion criteria, 13 complete articles were selected. Of these, 9 describe pneumonia, 4 list Pontiac Fever, 1 reveals legionellosis and 3 result in death. The main causative agent of disease in workers exposed was Legionella pneumophila serogroup 1. Legionella spp infection is closely related to professions where there is nebulization with water, mainly among workers subjected to long exposure or even re-exposure. Outbreaks occurs seasonally, especially in the hottest months.

Epidemiology of Legionella and Climatic Variables in Seoul, Korea

Legionella species are abundant in the built environment and are increasingly recognized as a cause of Legionnaires' disease (LD). As the number of cases of Legionnaires' disease acquired by local communities in the Seoul metropolitan area in Korea has been increased, there was concern that changes in environmental factors could affect disease outbreaks. We described the association between climatic variables and occurrence of legionellosis in Korea and Legionella detection rate in Seoul area. A total of 418 cases of legionellosis were reported between 2014 and 2017. There was a seasonal peak in summer. LD continuously occurred from early spring to winter every year and rapidly increased in summer. In the regression analysis, the primary variables of interest- PM2.5 (µg/m³), NO₂ (ppb), and a number of the date of issue O₃ warning were not significant except for average temperature (R²=0.8075). The Legionella detection rate in Seoul, Korea showed a trend similar to precipitation (P=0.708, ANOVA). A relatively high proportion of Legionella detection rate was shown, especially cooling tower (17.7%) and public bath (19.3%). This finding is in line with current understanding of the ecological profile of this pathogen and supports the assertion that legionellosis occurs through contamination of water sources.

Omadacycline, a Magic Antibiotics for Bacterial Infections

Nowadays antibiotic resistance is a worldwide serious problem that mainly affects public health. Omadacycline is a unique antibiotic which has two available dosage forms such as intravenous (IV) and oral that development for community-acquired bacterial infectious disease treatment. It is a modified form of older tetracycline at C-9 aminomethyl substituent of 6-member core ring of tetracycline. Modification form shows its activity against efflux pump and ribosomal protein protection mechanism of tetracycline resistance. Generally, omadacycline is effective against methicillin-resistant S. aureus (MRSA), Streptococcus pneumoniae, vancomycin-resistant Enterococcus (VRE), Legionella and Chlamydia spp. Efficacy, safety and tolerability profile of omadacycline those compares with recent antibiotics shows that omadacycline is less resistant than others. One derivative from tetracycline derivatives is 9-neopentylaminomethylminocycline called omadacycline was discovered and ongoing phase III clinical experiments as a therapy for acute bacterial skin and skin structure infections (ABSSSI) as well as community-acquired bacterial pneumonia (CABP). Omadacycline seems to be a strong drug candidate for future promising new antibacterial agent that is effective against ABSSSI and CABP.

Why has a large Legionnaires' disease outbreak been absent from public debate? / Um grande surto de Legionella ausente do debate público / Un gran brote de Legionella ausente del debate público

The Legionnaires' disease outbreak that hit Portugal in November 2014 was the third largest worldwide and was declared a "great public health emergency". Nonetheless, the Portuguese outbreak, despite killing 12 people and infecting 375 others did not promote extensive media coverage, nor did it make it into the political debate. We conducted a quantitative analysis of 83 news pieces on Legionella published in four national newspapers, and interviewed the journalists who covered this outbreak. The communication process was controlled by a small group of official sources and the outbreak was pushed away from news lineups due to two political scandals. The production of another news wave made the outbreak's news wave to break prematurely.

O surto de Legionella que atingiu Portugal em novembro de 2014 foi o terceiro maior em nível mundial, constituindo "uma grande emergência de saúde pública". Ainda assim, o surto português não promoveu uma longa cobertura mediática, apesar das 12 mortes e 375 pessoas infetadas. Nem entrou no debate político. Fizemos uma análise quantitativa das 83 notícias sobre Legionella publicadas em quatro jornais nacionais, e conduzimos entrevistas com os jornalistas que cobriram este surto. O processo comunicativo foi controlado por um pequeno grupo de fontes oficiais, e o surto foi rapidamente afastado dos alinhamentos noticiosos, sendo substituído por dois escândalos políticos. A produção de outra onda noticiosa fez com que a onda noticiosa do surto de Legionella se quebrasse prematuramente.

El brote de Legionella desencadenado en Portugal en noviembre de 2014 fue el tercero mayor en el ámbito mundial, constituyendo "una gran emergencia de salud pública". Aún así, el brote portugués no promovió una gran cobertura de los medios, a pesar de las 12 muertes y 375 personas infectadas. Tampoco entró en el debate político. Realizamos un análisis cuantitativo de las 83 noticias sobre Legionella publicadas en cuatro periódicos nacionales y realizamos entrevistas con los periodistas que cubrieron el brote. El proceso comunicativo fue controlado por un pequeño grupo de fuentes oficiales y el brote fue rápidamente alejado de los alineamientos de noticias, siendo sustituido por dos escándalos políticos. La producción de otra onda de noticias hizo que la onda de noticias del brote de Legionella se rompiera prematuramente.

Community-acquired Legionnaires’ Disease in a Newly Constructed Apartment Building / 예방의학회지

OBJECTIVES: Legionnaires' disease (LD) is a severe type of pneumonia caused by inhalation of aerosols contaminated with Legionella. On September 22, 2016, a single case of LD was reported from a newly built apartment building in Gyeonggi province. This article describes an epidemiologic investigation of LD and identification of the possible source of infection. METHODS: To identify the source of LD, we interviewed the patient's husband using a questionnaire based on the Legionella management guidelines from the Korea Centers for Disease Control and Prevention. Water samples from the site were collected and analyzed. An epidemiological investigation of the residents and visitors in the apartment building was conducted for 14 days before the index patient's symptoms first appeared to 14 days after the implementation of environmental control measures. RESULTS: Legionella pneumophila serogroup 1 was isolated from the heated-water samples from the patient's residence and the basement of the apartment complex. Thirty-two suspected cases were reported from the apartment building during the surveillance period, yet all were confirmed negative based on urinary antigen tests. CONCLUSIONS: The likely source of infection was the building's potable water, particularly heated water. Further study of effective monitoring systems in heated potable water should be considered.

Evaluation of EuDx™-PN MLC Detection Kit for Detection of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila in Respiratory Specimens / 대한임상미생물학회지

BACKGROUND: Infection by the intracellular bacteria Mycoplasma pneumoniae, Chamydophila pneumoniae, and Legionella pneumophila are common causes of community-acquired pneumonia (CAP). This study describes the evaluation of a new multiplex real-time PCR test, EuDx™-PN MLC Detection Kit (EUDIPIA), which allows the simultaneous detection of M. pneumoniae, C. pneumoniae, and L. pneumophila in respiratory samples. METHODS: A total of 353 samples were tested using three PCR kits: multiplex PCR (Seeplex PneumoBacter ACE Detection Kit) and two multiplex real-time PCR (EuDx™-PN MLC Detection Kit and Anyplex™ II RB5 Detection Kit). The results were considered true positives (expanded standard) for M. pneumoniae, C. pneumoniae, and L. pneumophila if they were positive according to any of the three tests. RESULTS: The sensitivity and specificity of EuDx™-PN MLC Detection Kit were 93.3–100% and 100%, respectively. The agreement rate and Cohen's kappa coefficient (value) between EuDx™-PN MLC Detection Kit and Anyplex™ II RB5 Detection Kit for M. pneumoniae, C. pneumoniae, and L. pneumophila were 70–100% and 0.82–1, respectively. CONCLUSION: These results demonstrate that the EuDx™-PN MLC Detection Kit is a sensitive, specific, and useful screening tool for the detection of atypical pathogens in respiratory samples and can be helpful in selecting appropriate antimicrobial therapy for patients with respiratory infection.

A case of Legionella pneumonia with multiple organ failure / 中南大学学报(医学版)

Legionella pneumonia (LP) is a rare systemic infectious disease, which is often misdiagnosed by clinicians due to the atypical symptoms. A middle-aged man who suffered from fever and dyspnea was diagnosed as community acquired pneumonia (CAP) in Changsha Central Hospital in March 2015. The treatment was unsatisfied firstly. The patients showed further symptoms of rhabdomyolysis, acute liver and renal failure, and impaired neural functions, who was diagnosed as LP with multiple organ failure based on a positive test for Legionella antibody. The patient was recovered after treated with moxifloxacin combined with azithromycin and continuous renal replacement therapy. LP should be paid attention when patient was diagnosed as CAP and failed to be treated. The satisfied outcome is achieved after application of macrolide, quinolones and comprehensive treatments.

Legionella dumoffii Tex-KL Mutated in an Operon Homologous to traC-traD is Defective in Epithelial Cell Invasion / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To understand the mechanism of invasion by Legionella dumoffii.</p><p><b>METHODS</b>The L. dumoffii strain Tex-KL was mutated using the Tn903 derivative, Tn903dIIlacZ. After screening 799 transposon insertion mutants, we isolated one defective mutant. We then constructed the gene-disrupted mutant, KL16, and studied its invasion of and intracellular growth in HeLa and A549 cells, and in A/J mice survival experiments. The structure of traC-traD operon was analyzed by RT-PCR.</p><p><b>RESULTS</b>The transposon insertion was in a gene homologous to Salmonella typhi traC, which is required for the assembly of F pilin into the mature F pilus structure and for conjugal DNA transmission. Results from RT-PCR suggested that the traC-traD region formed an operon. We found that when the traC gene was disrupted, invasion and intracellular growth of L. dumoffii Tex-KL were impaired in human epithelial cells. When mice were infected by intranasal inoculation with a traC deficient mutant, their survival significantly increased when compared to mice infected with the wild-type strain..</p><p><b>CONCLUSION</b>Our results indicated that the traC-traD operon is required for the invasion and intracellular growth abilities of L. dumoffii Tex-KL in epithelial cells.</p>

Detection of Legionella spp. in water samples taken from cooling tower and water holding systems in a hospital in Metro Manila

BACKGROUND: Hospitals present ideal locations for transmission of Legionnaires' disease, a pneumonia-like disease caused by Legionella spp. In these settings, hospitalized patients may be exposed to aerosols generated by cooling towers, respiratory therapy equipment, showers and faucets, that facilitate transmission of the bacterium. OBJECTIVE: The study aimed to determine the presence of Legionella spp. in water samples taken from the cooling tower and water holding systems of a hospital in Metro Manila. METHODS: A total of 12 water samples were collected: 6 samples from the cooling tower, 4 from two cisterns and 2 from the water tank. The samples were concentrated, acid-treated, gram-stained and cultured. Biochemical tests were done for identification of Legionella spp. RESULTS:  Legionella spp. was detected in 2 (16.67%) out of 12 samples, both of them from the pre-condenser sampling site of the hospital's cooling tower. CONCLUSION: The study documents the presence of Legionella spp. in the cooling tower, a potential source of infectious aerosols that can be disseminated in the hospital and affect hospitalized patients.

Rapid Identification of Legionella Pathogenicity by Surface-Enhanced Raman Spectroscopy / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To establish Surface-enhanced Raman Spectroscopy (SERS) can be used as a rapid and reliable method to distinguish virulent strain and mild strain of L. pneumophila.</p><p><b>METHODS</b>Mortality data were collected from company departments through administrative documents, death certificates, etc. Trend analyses of cancer mortality were performed on the basis of 925 cancer deaths between 2001 and 2010.</p><p><b>RESULTS</b>Our results indicated that the peaks of high virulence strains reached ⋝4000. This criterion was verified by subsequent cell experiments. In addition, we also conducted SERS rapid identification on the virulence of several collected clinical strains and obtained accurate results.</p><p><b>CONCLUSION</b>The present study indicates that the established SERS protocol can be used as a rapid and reliable method to distinguish virulent and mildly virulent strains of L. pneumophila, which can be further used in clinical samples.</p>

Chest radiographic characteristics of community-acquired Legionella pneumonia in the elderly / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Legionella is an important community-acquired pneumonia pathogen. Although the elderly are especially susceptible to Legionella, few studies have looked at comparative radiographic features of Legionella pneumonia in this population. The aim of this study was to explore the chest radiographic characteristics of community-acquired Legionella pneumonia in the elderly.</p><p><b>METHODS</b>Serial chest radiographs obtained in 34 patients hospitalized with serologically proven Legionella pneumonia were retrospectively reviewed. Chest X-ray features of an aged group of ≥ 65 years were assessed and compared with a non-aged group of <65 years old with regard to initial patterns and distributions of pulmonary abnormalities, accompanying signs, and progression.</p><p><b>RESULTS</b>The most common initial presentation was a patchy alveolar infiltrate involving a single lobe, most often the lower lobe. There was no middle or lingular lobe involvement in the aged group patients, but bilateral pleural effusion was significantly more common in this group. In the aged group patients, radiographic progression following adequate therapy, despite a clinical response, was more often noted and the radiographs were less likely to have returned to the premorbid state at discharge, but the differences were not significant between the two groups.</p><p><b>CONCLUSION</b>The discrepancy between imaging findings and clinical symptoms seems more prominent in community-acquired Legionella pneumonia in the elderly.</p>

Three quantitative methods to continuously monitor Legionella in spring water / 中华预防医学杂志

<p><b>OBJECTIVE</b>To compare the detection effect of Legionella pollution in spring water by three methods, namely traditional plating method, fluorescent quantitation PCR method and ethidium monoazide (EMA) fluorescent quantitation PCR method.</p><p><b>METHODS</b>Every month (except May), we collected 11 water samples from the 5 selected hot spring pools in one hot spring resort in Beijing in 2011. A total of 121 water samples were collected, and then were detected by the above three methods qualitatively and quantitatively.</p><p><b>RESULTS</b>In our study, the Legionella pollution rate was separately 74.4% (90/121), 100.0% (121/121) and 100.0% (121/121) by the above three methods. The quantitative value of Legionella in the 121 water samples detected by the three methods were around 0.10-216.00 colony-forming units (CFU)/ml, 1.47-1557.75 gene units (GU)/ml and 0.20-301.69 GU/ml, respectively. The median (25th and 75th percentiles) was 75.30 (32.51-192.10) GU/ml, 36.46 (16.08-91.21) GU/ml and 5.30 (0.00-33.70) CFU/ml, respectively. The difference in the quantitative value of Legionella detected by the three methods showed statistical significance (χ(2) = 187.900, P < 0.01). The quantitative value of Legionella detected by fluorescent quantitation PCR method was the highest, followed by the value Legionella detected by EMA-fluorescent quantitation PCR method and traditional plating method.</p><p><b>CONCLUSION</b>The sensitivity of the PCR methods was higher than traditional plating method, in detecting Legionella pollution in spring water, especially the EMA- fluorescent quantitation PCR method, which was more suitable for detecting Legionella in water.</p>

An Epidemiological Survey on Serological Diagnosis of Legionnella Infection in Seoul, Korea

Serological investigation of antibodies to Legionella species in 1,802 sera collected in seoul was conducted with indirect fluorescent antibody assay (IFA). With an antibody titer of > or =1:128 to be positive, 17 (0.9%) of these sera were positive and 6 (35.3%) of positive sera showed cross-reactions between Legionella species. The number of sera with antibody titers of > or =1:128 to L. pneumophila serogroup 1, L. pneumophila serogroup 4, L. pneumophila serogroup 5, L. bozemanii, L. micdadei, L. anisa were 6 (35.3%), 3 (17.6%), 3 (17.6%), 2 (11.8%), 1 (5.9%), 2 (11.8%) respectively. Among 17 positive sera, 10 (58.8%) sera were from male and 7 (41.2%) from female. An average age of them was 68.9 (+/-15.3; 27~89). Except for one serum, 16 (94.1%) of positive sera were from those older than 50 years old. The result suggests that the aged over 50 years old should be more careful of Legionella infection.

Enfoque al riesgo de Legionella sp. en centros sanitarios del sur de España / Approach to the risk of Legionella spp. in health centres in the south of Spain

La legionelosis es una enfermedad respiratoria producida por la bacteria legionella sp. Ésta al colonizar medios artificiales presenta un riesgo para la salud, especialmente en ambientes con población expuesta o especialmente sensible. El ámbito sanitario se presenta como vulnerable, en el que es usual identificar fuentes de desarrollo y proliferación del agente biológico. El objetivo del estudio es establecer la relación entre la estacionalidad de equipos de intercambio aire-agua y la presencia de legionella pneumophila, así como investigar la de ciertos métodos preventivos de desinfección del agua sobre las variables anteriores. Durante 2008 se realiza un estudio en cuatro centros sanitarios situados en Andalucía (España) incluyendo siete torres de refrigeración ubicadas en ellos. Mediante un análisis descriptivo y el empleo de medidas de asociación se identificó: un recuento elevado (>10000 UFC/l) en dispositivos de funcionamiento anual, según los métodos de desinfección empleados un riesgo menor en instalaciones estacionales, e independencia entre el recuento de la bacteria y la estacionalidad de los sistemas. A nivel sanitario y con objeto de prevenir la presencia de la bacteria en el sur de España, se considera preceptivo la realización de estudios ambientales y de control del mantenimiento higiénico de las instalaciones con riesgo de desarrollo de legionella sp.

Legionellosis is a respiratory disease caused by the bacterium Legionella spp. When this colonizes artificial mediums it shows a health risk, especially in environments with particularly sensitive or exposed population. The health centre environment is presented as vulnerable, where it is usual to identify sources of development and proliferation of biological agent. The aim of this study is to establish the relationship between seasonal use of water cooling systems and the presence of Legionella pneumophila, and to investigate certain preventive methods of water disinfection on the above variables. In 2008, a study was performed in four health centres situated in Andalusia (Spain) including seven cooling towers located on them. Through a descriptive analysis and the use of measures of association, these findings were identified: a high count (>10,000 CFU/l) in annual operating devices, according to the methods of disinfection a lower risk in seasonal facilities, and independence between the count of the bacterium and seasonal nature of the systems. At health level and in order to prevent the presence of the bacterium in southern Spain, environmental studies and routine monitoring of sanitary maintenance of facilities with risk of development of Legionella spp. are considered mandatory.

Contamination status and molecular biological characteristics of Legionella in cooling water samples from different places in Wuxi city / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the contamination state of Legionella in cooling water samples from different places in Wuxi city and reveal the molecular biological characteristics of Legionella strains.</p><p><b>METHODS</b>112 parallel water samples (500 ml each) were collected from 56 sites in Wuxi city during year 2009 - 2010. The samples were used for Legionella test and quantitative culture. The isolated Legionella strains were used for serotyping, pulsed-field gel electrophoresis (PFGE), sequence-based typing (SBT), and intracellular growth were tested.</p><p><b>RESULTS</b>The positive proportion of Legionella was 39. 3% (22/56) among all sampling sites. A total of 29 Legionella strains were isolated, and the serotypes include LP1, LP3, LP5 and LP6. LP1 serotype was the major one with a proportion of 65.5% (19/29). 29 Legionella strains got 17 PFGE types. There were 10 SBT types among 10 Legionella strains with different PFGE types. Comparing to LP1 strain (ATCC 33152), WX2011062 (LP6) and WX2011067 (LP5) had strong intracellular growth ability in mouse peritoneal macrophages J774 cell line (the amount of intracellular bacteria on day 0 after infection were (5.5 +/- 1.32) x 10(5), (3.9 +/- 0.60) x 10(5), (7.8 +/- 0.76) x 10(5) CFU/ml, respectively; the amount of intracellular bacteria on day 3 after infection were (58.3 +/- 1.61) x 10(5), (2700.0 +/- 655.74) x 10(5), (3066.7 +/- 208.17) x 10(5) CFU/ml, respectively).</p><p><b>CONCLUSION</b>The Legionella contamination existed in cooling water samples from different places in Wuxi city. Legionella strains isolated showed high genetic variation. Some Legionella strains had vigorous intracellular growth ability.</p>

Neumonía por Legionella enpacientes con leucemia.Presentación de dos casos / Pulmonary legionellosis in a two patients with leukemia. Case report

Presentamos dos casos de pacientes con leucemia linfoblástica en tratamiento con quimioterapia (HyperCVAD), el primero y el segundo en recaída con IdaFlag, quienes en fase de neutropenia desarrollan cuadro de neumonía adquirida hospitalariamente con consolidación neumónica fiebre alta y pocos síntomas respiratorios El antígeno urinario para Legionella pneumophila serotipo 1 resultó positivo por técnica de inmunocromatog rafía. Con tratamiento específico con claritromicina resolvieron sus síntomas.

We present two cases of patients with lymphoblastic leukemia; the first one is been treated with chemotherapy (hyperCVAD) and the second is in a relapse with IdaFlag, both, in neutropenia phase developed pneumonia acquired in the hospital with pneumonic consolidation, high fever and few respiratory symptoms. Legionella urinary antigen serogroup 1 was positive for the immunechromatography technique. Specific treatment with macrolides was given and the symptoms were solved.

Estudo do líquido pleural: uma revisão / Pleural effusion study: a review

O acúmulo de líquidos em cavidades fechadas do organismo chama-se derrame cavitário. A efusão pleural é o derrame patológico de líquido na cavidade formada pelas membranas mesoteliais que revestem os pulmões. Causas diversas podem originarestes derrames. Transudatos e exsudatos são classificações preliminares de efusões pleurais de acordo com alguns caracteresfísico-químicos. Transudatos possuem LDH, proteínas e celularidade menores do que os exsudatos. Culturas para anaeróbios, micobactérias e fungos são solicitadas de acordo com a suspeita clínica e epidemiológica. Dosagens bioquímicas e de marcadores tumorais assim como o estudo citológico, microbiológico e de biologia molecular são bastante úteis para o esclarecimento das causas dos derrames pleurais.

The accumulation of fluid in the closed cavities of the body is called spill cavity. The pleural effusion is the pathologicalspill of liquid into the cavity formed by mesotelials membranes, which recover the lungs. Many causes can origin these various spills. Transudates and exudates are preliminary classifications of pleural effusions according to some physical and chemical characteristics. Transudates have LDH, proteins and cellularity lower than the exsudates. Cultures for anaerobics, mycobacteriaand fungi are invited according to epidemiological and clinical suspicion. Biochemical and tumor markers doses rates and so the cytologic study, microbiological study and molecular biology are very helpful to clarify the causes of pleural effusions.