单词 | legionnaire's disease |
释义 | legionnaire's diseaselegionnaire's diseaseorlegionnaires' diseaseLegionnaire's diseaseLegionnaire's disease(lē'jənârz`), infectious, sometimes fatal, disease characterized by high fever, dry cough, lung congestion, and subsequent pneumoniapneumonia, acute infection of one or both lungs that can be caused by a bacterium, usually Streptococcus pneumoniae (also called pneumococcus; see streptococcus), or by a virus, fungus, or other organism. ..... Click the link for more information. . Major organs, such as the heart, may be damaged as the disease progresses. The disease struck over 180 people attending an American Legion convention in Philadelphia in July, 1976—hence the name. The causative bacterium, later identified as Legionella pneumophilia, may enter the lungs through aspiration of contaminated water, especially in patients who smoke or have lung disease; it also may be inhaled via contaminated water that has been aerosolized. People who smoke heavily, have lung disease, or have compromised immune systems are most at risk for the disease. A milder form of the disease has also been identified. Treatment is with the antibiotic erythromycinerythromycin , any of several related antibiotic drugs produced by bacteria of the genus Streptomyces (see antibiotic). Erythromycin is most effective against gram-positive bacteria such as pneumococci, streptococci, and some staphylococci (see Gram's stain). ..... Click the link for more information. . Legionnaire's disease[‚lē·jə′nerz di‚zēz]Legionnaire's diseaseLegionnaire's diseaseLegionella pneumonia Infectious disease A lung infection caused by Legionella pneumophila, which is either sporadic or epidemic with a mortality of up to 15%; depending on the population, Legionella spp cause 1–27% of CAPs; ♂:♀ ratio, 3:1 Epidemiology MostL pneumophila infections are associated with buildings and ventilation systems; most epidemics occur during the summer with 0.5 to 5% attack rates; the only documented mode of spead is by air Risk factors Cigarettes, alcohol, renal transplant, ↑ age Clinical 2-10 day incubation, followed by an abrupt malaise, headache, myalgia, a dry, initially non-productive, later productive, cough, hemoptysis; fever to 40ºC, rigors often associated with bradycardia; less commonly, nausea, diarrhea, delirium, septicemia, abscesses, acute myocarditis, pericarditis, rhabdomyolysis DiffDx Sporadic LD mimics myoplasma pneumonia, Q fever, tularemia, plague, psittacosis, influenza and other viral pneumonias CXR Patchy, segmental, or lobar, often bilateral, alveolar infiltrates, often progressing to nodule Lab ↓ Na+, ↓ PO4–, ↑ liver enzymes, proteinuria, microscopic hematuria, relative leukocytosis, ↑ ESR, hyponatremia, ↑ ALT, ↑ AST, ↑ BR, azotemia Complications Empyema, shock, DIC, renal failure, neurologic sequelae, peripheral neuropathy Management Erythromycin, T-S, penicillin Prognosis 15-20% death w/o therapy; up to 50% death in immunocompromised Pts Poor prognostic features Tachycardia, tachypnea, WBCs ≥ 14,000/mm3, ↑ BUN, ↑ creatinine, hyponatremia, hypoxia, leukopenia, bilateral infiltrates on CXR Prevention Chlorination; UV irradiation of water supplies. See Community-acquired pneumonia, Legionella pneumophila. Cf Pontiac disease. Legionnaire's disease |
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