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Infectious Disease Clinics of North America

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https://www.readbyqxmd.com/read/27979686/legionnaire-s-disease-and-immunosuppressive-drugs
#1
REVIEW
Tin Han Htwe, Nancy M Khardori
Immunosuppressive agents predispose patients to legionnaire's disease. Patients receiving tumor necrosis factor antagonists are generally not severely immunocompromised by the underlying disease. In patients with malignancy receiving immunosuppressive therapies, it is difficult to balance the underlying disease versus the therapy used. Transplant recipients are often on multiple drugs, including immunosuppressants. It seems that immunosuppressive drugs add to the risk for legionella infection. The index of suspicion should be high for legionella infection early during a compatible clinical syndrome...
December 12, 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27979685/nervous-system-abnormalities-and-legionnaire-s-disease
#2
REVIEW
John J Halperin
Although patients with Legionnaire's disease frequently develop alterations of consciousness, this is no more frequent than in patients hospitalized with other, equally severe forms of bacterial pneumonia. Legionella meningitis occurs rarely, if ever. Patients with Legionnaire's are susceptible to critical illness polyneuropathy/myopathy, as are other critically ill patients. Legionnaire's patients may develop MRI hyperdensities in the splenium of the corpus callosum, as may other patients with severe infections...
December 12, 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27979684/laboratory-tests-for-legionnaire-s-disease
#3
REVIEW
W Michael Dunne, Nathalie Picot, Alex van Belkum
Legionella pneumophila is one of the more recently discovered bacterial pathogens of humans. The last 2 decades have seen tremendous progress in the evolution of diagnostic tests, for detection and characterization of this pathogen and for defining the host response to infection. This has generated several diagnostic tools that span the range from simple immunologic assays to modern genome sequencing. This review describes the state of affairs of this continuously evolving field regarding the diagnosis of Legionnaire's disease and covers detection, assessment of antibiotic susceptibility, and epidemiologic characterization of isolates of L pneumophila and other pathogenic species within the genus...
December 12, 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159180/legionnaire-s-disease-and-its-protean-clinical-manifestations-the-ongoing-challenges-of-the-most-interesting-atypical-pneumonia
#4
EDITORIAL
Cheston B Cunha, Burke A Cunha
No abstract text is available yet for this article.
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159179/legionnaire-s-disease-and-its-mimics-a-clinical-perspective
#5
REVIEW
Burke A Cunha, Cheston B Cunha
Whenever the cardinal manifestations of a disorder occur in similar disorders, there is potential for a disease mimic. Legionnaire's disease has protean manifestations and has the potential to mimic or be mimicked by other community acquired pneumonias (CAPs). In CAPs caused by other than Legionella species, the more characteristic features in common with legionnaire's disease the more difficult the diagnostic conundrum. In hospitalized adults with CAP, legionnaire's disease may mimic influenza or other viral pneumonias...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159178/legionnaire-s-disease-a-clinical-diagnostic-approach
#6
REVIEW
Burke A Cunha, Cheston B Cunha
Legionnaire's disease is a nonzoonotic atypical pneumonia caused by Legionella sp that occurs sporadically or in outbreaks. Legionnaire's disease pneumonia is accompanied by several extrapulmonary clinical and laboratory findings. Rather than testing all pneumonias for Legionnaire's disease, the clinical challenge is to recognize the diagnostic significance of Legionnaire's disease's. The pretest probability of Legionnaire's disease is increased if several characteristic extrapulmonary findings are present...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159177/microbiology-and-epidemiology-of-legionnaire-s-disease
#7
REVIEW
Almudena Burillo, MarĂ­a Luisa Pedro-Botet, Emilio Bouza
Legionnaire's disease (LD) is the pneumonic form of legionellosis caused by aerobic gram-negative bacilli of the genus Legionella. Individuals become infected when they inhale aerosolized water droplets contaminated with Legionella species. Forty years after the identification of Legionella pneumophila as the cause of the 1976 pneumonia outbreak in a hotel in Philadelphia, we have non-culture-based diagnostic tests, effective antibiotics, and preventive measures to handle LD. With a mortality rate still around 10%, underreporting, and sporadic outbreaks, there is still much work to be done...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159176/legionnaire-s-disease-cardiac-manifestations
#8
REVIEW
John L Brusch
Most cardiac infections with Legionella are secondary to bacteremias arising from a pulmonary focus. Other possible sites of origin are infected sternotomy wounds or equipment contaminated by Legionella spp. Legionella endocarditis is truly a "stealth" infection, with almost no hallmarks of bacterial endocarditis. The key step in making the diagnosis of Legionella endocarditis is for the physician to be aware of the clinical causes of culture-negative infective endocarditis and to include Legionella cardiac involvement in this differential...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159175/thoracic-imaging-features-of-legionnaire-s-disease
#9
REVIEW
Sameer Mittal, Ayushi P Singh, Menachem Gold, Ann N Leung, Linda B Haramati, Douglas S Katz
Imaging examinations are often performed in patients with Legionnaires' disease. The literature to date has documented that the imaging findings in this disorder are relatively nonspecific, and it is therefore difficult to prospectively differentiate legionella pneumonia from other forms of pneumonia, and from other noninfectious thoracic processes. Through a review of clinical cases and the literature, our objective is for the reader to gain a better understanding of the spectrum of radiographic manifestations of Legionnaires' disease...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159174/antimicrobial-therapy-for-legionnaire-s-disease-antibiotic-stewardship-implications
#10
REVIEW
Cheston B Cunha, Burke A Cunha
Legionnaire's disease is a common cause of community-acquired pneumonia (CAP). Although no single clinical feature is diagnostic, if characteristic extrapulmonary findings are present a presumptive clinical syndromic diagnosis is possible. Depending on geographic location, season, and physician awareness, Legionnaire's disease may be included in the differential diagnosis of CAP. Some antibiotics effective against Legionella sp are also effective in treating the typical bacterial causes of CAP. From an antimicrobial stewardship program (ASP) perspective, monotherapy is preferred to double-drug therapy...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159173/legionnaire-s-disease-and-influenza
#11
REVIEW
Eleni E Magira, Sryros Zakynthinos
Legionella pneumophila and influenza types A and B viruses can cause either community-acquired pneumonia with respiratory failure, or Legionella infection could attribute to influenza infection with potentially fatal prognosis. Copathogenesis between pandemic influenza and bacteria is characterized by complex interactions between coinfecting pathogens and the host. Understanding the underlying reason of the emersion of the secondary bacterial infection during an influenza infection is challenging. The dual infection has an impact on viral control and may delay viral clearance...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159172/legionnaire-s-disease-in-compromised-hosts
#12
REVIEW
Fanny Lanternier, Florence Ader, Benoit Pilmis, Emilie Catherinot, Sophie Jarraud, Olivier Lortholary
Legionnaire's disease (LD) is mainly reported in apparently immunocompetent patients. Among them, risk factors include chronic lung disease and smoking. However, LD is also well reported among immunocompromised patients, particularly those treated with anti-tumor necrosis factor alpha therapy, patients with hematological malignancy, and transplant patients. This article discusses the available data on immunity against Legionella spp, epidemiology, clinical presentation, diagnosis, and treatment of LD in immunocompromised patients...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28159171/severe-pneumonia-caused-by-legionella-pneumophila-differential-diagnosis-and-therapeutic-considerations
#13
REVIEW
Abdullah Chahin, Steven M Opal
Severe legionella pneumonia poses a diagnostic challenge and requires early intervention. Legionnaire's disease can have several presenting signs, symptoms, and laboratory abnormalities that suggest that Legionella pneumophila is the pathogen, but none of these are sufficient to distinguish L pneumophila pneumonia from other respiratory pathogens. L pneumophila is primarily an intracellular pathogen and needs treatment with antibiotics that efficiently enter the intracellular space.
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27979687/legionnaire-s-disease-since-philadelphia-lessons-learned-and-continued-progress
#14
REVIEW
Cheston B Cunha, Burke A Cunha
Legionnaire's disease has been recognized as a cause of severe community-acquired pneumonia (CAP). Legionnaire's disease has characteristic extrapulmonary findings that are the basis for a presumptive clinical diagnosis. The widespread use of Legionella culture, sputum DFA, serology, urinary antigen testing, and polymerase chain reaction have allowed earlier diagnosis of Legionnaire's disease. Excluding common source outbreaks, CAP caused by Legionnaire's disease is manifested as sporadic cases. In contrast, nosocomial Legionnaire's disease occurs in clusters or outbreaks from common Legionella species-contaminated water sources...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27979683/nosocomial-health-care-associated-legionnaire-s-disease
#15
REVIEW
Shanu Agarwal, Virginia Abell, Thomas M File
Nosocomial Legionnaire's disease is most frequently associated with presence of the organism in hospital water systems. Patients are often susceptible as a result of age, underlying comorbidities, or immunosuppression. Prevention focuses on reducing the reservoir within water systems and includes super heating, ultraviolent light, chlorination, silver-copper ionization, and distal filtration. This article reviews the epidemiology of health care-associated Legionnaire's disease, reviews characteristics of several health care-associated outbreaks, and discusses strategies to prevent health care-associated infection...
March 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27816145/infection-prevention-and-control-in-healthcare-part-ii-epidemiology-and-prevention-of-infections
#16
EDITORIAL
Keith S Kaye, Sorabh Dhar
No abstract text is available yet for this article.
December 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27816144/prevention-and-control-of-methicillin-resistant-staphylococcus-aureus-in-acute-care-settings
#17
REVIEW
Andie S Lee, Benedikt Huttner, Stephan Harbarth
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health care-associated infections worldwide. Controversies with regard to the effectiveness of various MRSA control strategies have contributed to varying approaches to the control of this pathogen in different settings. However, new evidence from large-scale studies has emerged, particularly with regards to MRSA screening and decolonization strategies, which will inform future control practices. The implementation as well as outcomes of control measures in the real world is not only influenced by scientific evidence but also depends on economic, administrative, governmental, and political influences...
December 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27816143/surgical-site-infections-an-update
#18
REVIEW
Bronwen H Garner, Deverick J Anderson
Surgical site infections (SSIs) lead to adverse patient outcomes, including prolonged hospitalization and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSI. In particular, improved adherence to evidence-based preventative measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI.
December 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27816142/ventilator-associated-events-and-their-prevention
#19
REVIEW
Noelle M Cocoros, Michael Klompas
The Centers for Disease Control and Prevention shifted the focus of safety surveillance in mechanically ventilated patients from ventilator-associated pneumonia to ventilator-associated events (VAEs) in 2013. The shift was designed to increase the objectivity and reproducibility of surveillance and to encourage quality-improvement programs to tackle a broader array of complications in mechanically ventilated patients. Prospective intervention studies have found that minimizing sedation, increasing the use of spontaneous awakening and breathing trials, and conservative fluid management can lower VAE rates and decrease duration of mechanical ventilation...
December 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27816141/urinary-tract-infections
#20
REVIEW
Carol E Chenoweth, Sanjay Saint
Catheter-associated urinary tract infection (CAUTI) remains one of the most prevalent, yet preventable, health care-associated infections and predominantly occurs in patients with indwelling urinary catheters. Targeted strategies for prevention of CAUTI include limiting urinary catheter use; physician reminder systems, nurse-initiated discontinuation protocols, and automatic stop orders have successfully decreased catheter duration. Alternatives to indwelling catheters should be considered in appropriate patients...
December 2016: Infectious Disease Clinics of North America
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