ABSTRACT
Chest radiographs of 70 patients with Legionnaires' disease were evaluated and compared to the authors' previous series of 24 patients as well as others in the literature. A larger number of patients in the more recent survey had pleural effusion, and there were 3 with cavitation whereas none was seen previously. Analysis of the radiograph showing the most marked changes in survivors versus patients who died showed no consistent pattern, indicating that the radiograph cannot be used as a prognostic indicator. On long-term follow-up (mean, 104.2 days), the radiograph remained abnormal for many months and demonstrated a variety of slowly resolving or permanent abnormalities.
Subject(s)
Legionnaires' Disease/diagnostic imaging , Lung/diagnostic imaging , Adolescent , Adult , Aged , Female , Humans , Legionnaires' Disease/mortality , Male , Middle Aged , RadiographyABSTRACT
An enzyme-linked immunosorbent assay was developed to detect urinary antigen excreted by patients with Legionnaires' disease. Of 47 patients tested, antigen was detected in 39. Of these 39 specimens, 35 gave clearly positive results by visual analysis; four others required spectrophotometric verification of positive results. Antigen was not detected in any of 178 urine specimens from patients with other pulmonary, bacteremic or urinary tract infections after a quick and simple confirmatory test. The assay required more time to perform than a previously described radioimmunoassay but was of equivalent sensitivity and specificity and did not require expensive equipment or contract with radioactive reagents. We conclude that enzyme-linked immunosorbent assay is a rapid, sensitive and specific means for rapidly diagnosing legionnaires' disease that can be performed in clinical laboratories unwilling or unable to use radioisotopes.
Subject(s)
Antigens, Bacterial/urine , Legionnaires' Disease/diagnosis , Enzyme-Linked Immunosorbent Assay , Humans , Legionella/immunology , Legionnaires' Disease/immunology , Legionnaires' Disease/urine , Radioimmunoassay/methodsABSTRACT
Two male maintenance workers contracted legionellosis while cleaning the interior of a cooling tower contaminated with Legionella pneumophila. In one man severe, life-threatening Legionnaires' disease developed, whereas the other experienced a comparatively mild, self-limiting illness that was consistent with previous descriptions of cases of Pontiac fever. This report represents the first documentation of the development of both of these syndromes following exposure to a common source of the organism. The implications of this observation for the pathogenetic mechanisms that underly the different clinical manifestations of legionellosis are discussed.
Subject(s)
Legionnaires' Disease/diagnosis , Occupational Diseases/transmission , Anti-Bacterial Agents/therapeutic use , Humans , Legionella/isolation & purification , Legionnaires' Disease/therapy , Legionnaires' Disease/transmission , Male , Middle Aged , Oxygen/therapeutic use , Respiration, ArtificialABSTRACT
Legionella pneumophila was found in the infected hemodialysis fistulas of two patients. The first patient developed an infection of the fistula during acute illness with Legionnaires' pneumonia. Legionella organisms were shown to be present in the graft by direct immunofluorescent staining. The second patient developed an infection of the hemodialysis fistula 3 weeks after completing a course of erythromycin therapy for Legionnaires' pneumonia. Legionella organisms were found by direct immunofluorescence in purulent material that was obtained from the graft, and serogroup 1 L. pneumophila was isolated from the pus. The frequency with which the organism causes infection of hemodialysis access sites is unknown. Increased awareness by physicians that L. pneumophila produces extrapulmonary disease may result in more frequent detection of these infections.
Subject(s)
Arteriovenous Shunt, Surgical , Legionnaires' Disease/complications , Renal Dialysis , Surgical Wound Infection/etiology , Adult , Aged , Female , Humans , Legionella/isolation & purification , Male , Suppuration/microbiologyABSTRACT
An enzyme linked immunosorbent assay was developed to detect urinary antigen excreted by patients with Legionnaires' disease. Of 47 patients tested, antigen was detected in 39. Antigen was not detected in any of 178 urine specimens from patients with other pulmonary, bacteremic, or urinary tract infections after performance of a quick and simple confirmatory test. The assay required more time to perform than a previously described radioimmunoassay but was of equivalent sensitivity and specificity and did not require expensive equipment of contact with radioactive reagents. We conclude that enzyme linked immunosorbent assay is a rapid, sensitive, and specific means for rapidly diagnosing Legionnaires' disease which can be performed in clinical laboratories unwilling or unable to use radioisotopes.
