An outbreak of Legionnaires’ disease associated with a circulating bathwater system at a public bathhouse. II: radiological findings of pneumonia

Matsumoto, Nobuhiro; Sasaki, Takashi; Nakao, Hiroyuki; Katoh, Takahiko; Fukuda, Yusuke; Nakazato, Masamitsu; Okayama, Akira

doi:10.1007/s10156-008-0591-6

Cited by 6 publications

(3 citation statements)

References 26 publications

(18 reference statements)

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“…Pulmonary infiltrates are predominantly seen in the lower lobe, sometimes bilaterally, and there is rapid progression and pleural effusion (Kroboth et al, 1983;Dietrich et al, 1978;Tan et al, 2000). High-resolution computed tomography also revealed that air-space consolidation, ground-glass opacity and pleural effusion were common features in patients with Legionnaires' disease and that the shadows show a peripheral and bilateral distribution in multiple segments (Yagyu et al, 2003;Matsumoto et al, 2008). In our case, we found ground-glass or light infiltrative shadows in the left middle and lower lobes.…”

Section: Discussionsupporting

confidence: 66%

Isolation of Legionella rubrilucens from a pneumonia patient co-infected with Legionella pneumophila

Matsui¹,

Fujii

Shiroiwa

et al. 2010

Journal of Medical Microbiology

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We report what we believe to be the first clinical isolation of Legionella rubrilucens from a pneumonia patient co-infected with Legionella pneumophila. L. rubrilucens strains were found in both a patient's sputum and the water of a hot spring in which the patient bathed, and DNA analysis by PFGE showed that they were indistinguishable. IntroductionSince Brenner et al. (1979) isolated the bacterium that caused pneumonia in patients with Legionnaires' disease and named it Legionella pneumophila, more than 20 species of Legionella have been implicated in human diseases (Stout et al., 2003). In 1980, an environmental strain of Legionella rubrilucens was isolated from tap water by G. W. Gorman (Brenner et al., 1985). However, to date, isolation of L. rubrilucens has not been described from patients coinfected with L. pneumophila.Here we report that L. rubrilucens strains were found in both a patient's sputum and the water of a hot spring in which the patient bathed, and DNA analysis performed by PFGE (Amemura-Maekawa et al., 2005) showed that they were indistinguishable. To our knowledge, this is the first report suggesting that L. rubrilucens can co-infect humans infected with L. pneumophila. Since the progress of Legionella pneumonia is very rapid in general, it can be fatal without early diagnosis and treatment. In this study, due to the early diagnosis, Legionella pneumonia was treated successfully. Case reportA 54-year-old Japanese man, height 165 cm, weight 72 kg, presented with a high fever, a feeling of weariness and pain in the joints. He had smoked 20 cigarettes a day for 34 years and had been drinking 350 ml beer and about 360 ml shouchu (Japanese liquor, alcohol concentration 25-30 %) daily for the past 10 years. He had been working as a caretaker for the elderly.After continuous high fever for 2 days, he was admitted for treatment and examination of the cause of the fever. He still complained of weariness throughout the body without signs of pains in the joints, cough or sputum. His vital signs were stable with blood pressure 120/70 mmHg, pulse rate 120 beats min 21 and body temperature 39.2 u C. No rale was audible in either of the lungs. The Influenza A and B Antigen test was negative. Laboratory data showed a white blood cell count of 17 100 cells ml 21 (neutrophils 87.7 %) and a Creactive protein value of 15.86 mg dl 21 in the serum. Urine analysis revealed that both a protein test and occult blood test were strongly positive (3+), assumingly due to an inflammatory response of the urinary tract from a bacterial infection. On the X-ray film, we observed minimal infiltrative shadows on the left middle and lower lobes.After admission, his febrile state did not change despite the administration of flomoxef at 2 g per day. On the 3rd day, he started to have a dry cough and fine crackles were audible in the left lower lobe. We found extended infiltrative shadows on the left middle and lower lobes in the chest X-ray (Fig. 1). The oxygen saturation by pulse oximetry (SpO 2 ) had declined to 93 % at this poi...

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Section: Discussionsupporting

confidence: 66%

Isolation of Legionella rubrilucens from a pneumonia patient co-infected with Legionella pneumophila

Matsui¹,

Fujii

Shiroiwa

et al. 2010

Journal of Medical Microbiology

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“…Supporting this possibility is the connection in this study of a number of these markers with the severity of pneumonia assessed by chest X-ray. 23 Next, we evaluated the ability of initial antimicrobial administration to improve the clinical course of patients with Legionnaires' disease. Patients were treated with several antimicrobials in various combinations during this outbreak.…”

Section: Discussionmentioning

confidence: 99%

An outbreak of Legionnaires’ disease associated with a circulating bathwater system at a public bathhouse. I: a clinical analysis

Sasaki

Matsumoto

Nakao

et al. 2008

Journal of Infection and Chemotherapy

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“…The frequency of bilateral distribution (195 out of a total of 210 cases) is higher than that seen with pneumonia caused by bacteria, Legionella or Mycoplasma [20][21][22]. Identification of the specific organism causing pneumonia cannot be made on the basis of radiological findings without laboratory testing [15].…”

Section: Radiological Findings Of Viral Pneumonia In Childrenmentioning

confidence: 99%

Radiological findings in 210 paediatric patients with viral pneumonia: a retrospective case study

Guo

Wang²,

Sheng³

et al. 2012

BJR

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Objective: The objective of this study was to assess the radiological presentations of different types of viral pneumonia in children. Methods: Nasopharyngeal swab specimens and bronchial aspirate samples from children with acute respiratory infections were obtained and tested for influenza B, adenovirus, respiratory syncytial virus and parainfluenza (Types 1, 2 and 3) by direct immunofluorescence assay, or for influenza A (Subtype H1N1) by quantitative real-time polymerase chain reaction. The chest radiographs of the 210 confirmed cases of viral pneumonia were analysed retrospectively by two independent radiologists for the identification, characterisation and description of the distribution of imaging abnormalities. The cases were divided into six groups on the basis of confirmed causative viral agent, and radiographic findings were compared, analysed and presented. Results: The abnormal chest radiograph findings consisted of bilateral patchy areas of consolidation (n5133), interstitial lung disease (n533), diffuse areas of air space consolidation (n529) and lobar consolidation (n515). The abnormalities were distributed bilaterally in 195 cases and observed more frequently in the lower zones than in other regions. The radiological findings varied significantly among the six groups (p50.0050). Pairwise comparison showed significant difference between influenza A (H1N1) and adenovirus (p50.0031) only. Conclusion: The predominant radiological finding in paediatric viral pneumonia was bilateral patchy areas of consolidation. The radiological findings differed significantly only between adenovirus and influenza A pneumonia. The diagnosis of the specific causative organism requires laboratory confirmation.

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An outbreak of Legionnaires’ disease associated with a circulating bathwater system at a public bathhouse. II: radiological findings of pneumonia

Cited by 6 publications

References 26 publications

Isolation of Legionella rubrilucens from a pneumonia patient co-infected with Legionella pneumophila

Isolation of Legionella rubrilucens from a pneumonia patient co-infected with Legionella pneumophila

An outbreak of Legionnaires’ disease associated with a circulating bathwater system at a public bathhouse. I: a clinical analysis

Radiological findings in 210 paediatric patients with viral pneumonia: a retrospective case study

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