ABSTRACT
Legionnaire disease (LD) is characterized by a clinical picture of pneumonia and is usually accompanied by multisystem involvement. Neurologic manifestations tend to appear concurrently with, or soon after the onset of fever. Cases in which neurologic manifestations precede the development of pneumonia are exceedingly rare. We recently treated 3 patients with LD who presented with a clinical picture of severe viral encephalitis without pneumonia. There were high serum titres of IgG and IgM antibodies against several Legionella species. However, a positive reaction in the spinal fluid was detected only against L. bozemanii. All 3 patients were discharged without sequellae. We suggest that LD should be included in the differential diagnosis of viral encephalitis.
Subject(s)
Encephalitis/etiology , Legionellosis , Adult , Antibodies, Bacterial/analysis , Diagnosis, Differential , Encephalitis/diagnosis , Female , Humans , Legionella/immunology , Legionellosis/diagnosis , Legionnaires' Disease/diagnosis , MaleABSTRACT
The occurrence of the adult respiratory distress syndrome (ARDS) and pneumonia was assessed in 482 patients with severe burns, but without evidence of inhalation injury. The patients were resuscitated during the burn shock period with a low-volume formula consisting mainly of plasma. The incidence of ARDS was 2.5 per cent for the entire burn population, and 9.4 per cent for 65 patients with burns covering more than 50 per cent of the body surface area. The general incidence of pneumonia was 4.4 per cent but was 12.5 per cent for the 65 patients with the extensive burns. These incidences were compared with other studies, and a pathophysiological explanation has been offered to explain differences in the frequency of pulmonary complications. The present review indicates that resuscitation with a low-volume formula consisting mainly of colloids can act as prophylaxis for reducing the incidence of ARDS and pneumonia.
