Brainstem Involvement in Legionnaires’ Disease

Morelli, Nicoletta; Battaglia, Elvia; Lattuada, P.

doi:10.1007/s15010-006-4131-y

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…Change in mental status is the most common neurologic abnormality. 37 Suspicion should be raised in cases of pneumonia and the presence of headache, confusion, hyponatremia, elevated creatine kinase. 38 Also, the diagnosis becomes more likely if an acute consolidating pneumonia fails to respond to several days of b-lactam antimicrobial therapy, or if the pneumonia is severe enough to require intensive care unit hospitalization.…”

Section: Microbiologymentioning

confidence: 99%

Legionella spp. and Legionnaires' disease

Diederen

2008

Journal of Infection

372

348

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Section: Microbiologymentioning

confidence: 99%

Legionella spp. and Legionnaires' disease

Diederen

2008

Journal of Infection

372

348

View full text Add to dashboard Cite

“…CNS involvement is a feared and relatively common sequela of Legionellosis, as has been described in detail [7,16-23]. Neurologic problems range from peripheral neuropathy [24] to myositis [25] to isolated nerve palsies [26] to acute disseminated encephalomyelitis (ADEM) [27-29].…”

Section: Discussionmentioning

confidence: 99%

Legionella pneumophila infection presenting as headache, confusion and dysarthria in a human immunodeficiency virus-1 (HIV-1) positive patient: case report

2012

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BackgroundLegionella pneumophila is a common cause of community-acquired pneumonia. Central nervous system dysfunction is common, and diagnosis in the absence of pulmonary symptoms can be challenging. Here we describe an atypical clinical presentation of Legionella infection in a patient with HIV who was found to have an unusual neuroradiologic lesion that further served to obscure the diagnosis. This is the first such description in a patient with Legionellosis and HIV coinfection.Case presentationA 43 year-old HIV positive man presented to our hospital with dysarthria, fevers, headache, and altered mental status. Initial work-up revealed pneumonia and a lesion of the splenium of the corpus callosum on magnetic resonance imaging. He was subsequently diagnosed with Legionella pneumonia and treated with complete symptom resolution.ConclusionsNeurologic abnormalities are frequent in Legionellosis, but the diagnosis may be difficult in the absence of overt respiratory symptoms and in the presence of HIV coinfection. A high index of suspicion and early initiation of empiric antibiotics is imperative since early treatment may help prevent long-term sequelae. Neuroimaging abnormalities, though rare, can help the physician narrow down the diagnosis and avoid unnecessary invasive testing. Future studies should aim to elucidate the as yet unknown role of neuroimaging in the diagnoses and prognostication of Legionellosis, as well as the interaction between Legionella infection and HIV.

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“…Further differential diagnosis for infections causing rhombencephalitis includes legionnaires' disease [14], mycoplasma infection (Fig. 11) [15], lyme disease [16], tuberculosis, and viral infections.…”

Section: Multiple Sclerosismentioning

confidence: 99%

“…Additionally, the perimesencephalic cisterns harbor important arterial and venous channels as well as cranial ocular nerves. common pathology of the midbrain includes metabolic-toxic syndromes [1][2][3] and inflammatory diseases [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] of the deep gray matter and neurodegenerative disorders [19][20][21], especially movement disorders and anterograde or retrograde axonal degenerations. the midbrain is infrequently affected by common brain diseases like infarction [22,23] and brain tumors [24].…”

Section: Introductionmentioning

confidence: 99%

MR Imaging of Midbrain Pathologies

et al. 2010

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The spectrum of pathologic processes affecting the midbrain features some differences to other brain areas. The midbrain is exposed to traumatic alterations due to its position between the tentorial edges, and some neurodegenerative and metabolic-toxic diseases may typically involve the midbrain. Isolated midbrain ischemia is rare, whereas the midbrain is typically part of the "top of the basilar" syndrome. Primary midbrain tumors are also infrequent and often show a benign clinical course. Apart from multiple sclerosis other inflammatory autoimmune processes and some infectious agents predominantly affect the brainstem including the midbrain. This review discusses the different pathologic processes of the midbrain, i.e., infarction, hemorrhage and trauma, inflammation, toxic and metabolic diseases, neurodegeneration, neoplastic diseases, as well as pathologies typically involving the perimesencephalic cisterns.

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Brainstem Involvement in Legionnaires’ Disease

Abstract: Legionellosis should be considered in the differential diagnosis of neurologic involvement in the setting of pneumonia.

Cited by 10 publications

References 13 publications

Legionella spp. and Legionnaires' disease

Legionella spp. and Legionnaires' disease

Legionella pneumophila infection presenting as headache, confusion and dysarthria in a human immunodeficiency virus-1 (HIV-1) positive patient: case report

MR Imaging of Midbrain Pathologies

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