Legionella causes 2–15% of community acquired pneumonia cases that require hospitalization and it is the second most common cause of serious pneumonia that needs admission in an intensive care unit. Since the first published case in 1980, there are a further 22 published case reports on the direct correlation between rhabdomyolysis, renal failure and Legionnaires' disease. All but two patients survived with antibiotics and dialysis. Clinicians should be cognisant of this established triad and correlation of Legionnaires’ disease, renal failure and rhabdomyolysis, as failure to do so and initiate treatment early has proven to increase mortality significantly in affected patients.
Forty-four subjects with classic or definite rheumatoid arthritis who were on individualized chrysotherapy were observed for changes in serum protein electrophoresis, immunoglobulins, and circulating lymphocyte counts. By paired variate analysis, significant declines from pretreatment values were recorded for the following-electrophoretic protein fractions: gamma, alpha-1, alpha-2, (P < 0.05); immunoglobulins: IgM-53% (P < 0.001), IgG-37% (P < 0.01), IgA-34% ( P < 0.001). Rheumatoid factor decreased in 29 of 39 subjects, 15 becoming seronegative (P < 0.001); circulating lymphocytes decreased by 27% ( P < 0.001). The maximal suppressive effect on IgC and IgM was not achieved until the third and fourth years of therapy by sustained weekly administration of gold sodium thiomalate (one year cumulative dosage, mean 2106 mg, range 1065-2,885; 2 4 year cumulative dosage, mean 8747 mg, range 5,385-15,160 mg). An immunosuppressive effect is suggested by these results.
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