Neurologic Manifestations of Legionnairesʼ Disease

Johnson, Judith D.; Raff, Martin J.; Arsdall, J. A. Van

doi:10.1097/00005792-198409000-00004

Cited by 83 publications

(62 citation statements)

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“…Prior underlying illness (spinocerebellar degeneration) could modify such a condition. However, consciousness disturbance from confusion to comawas sometimes one of the clinical manifestations in Legionnaires' disease (15), suggesting that there could be neurologic manifestations also in Pontiac fever. Moreover, confusion wasone of the neurologic findings in the first report (3).…”

Section: Discussionmentioning

confidence: 99%

First Sporadic Cases of Non-pneumonic Legionellosis, Pontiac Fever in Japan.

Sakai¹,

Kobayashi²,

Misawa³

et al. 1998

Intern. Med.

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Pontiac fever has rarely been found in sporadic cases. Here, we report the first sporadic cases of non-pneumonic legionellosis, Pontiac fever in Japan. Case 1. A 53-year-old man with spinocerebellar degeneration was presented to our hospital. He had an acute onset of high fever and consciousness disturbance. A chest X-ray film on admission was normal, but transient bilateral pleural effusions were revealed on hospital day 14. Case 2. A 77-year-old womanwith gastric ulcer was presented to our hospital. She had an acute onset of high fever. Achest X-ray film on admission was normal, but transient bilateral pleural effusions were revealed on hospital day 7. High fever, resistant to (3-lactam antibiotics, continued in both cases. Both had serologic confirmation of legionellosis by indirect fluorescent antibody assay for Legionella pneumophila without seroconversion for Mycoplasmapneumoniae, and Chlamydiapneumoniae, and had a good prognosis. Both were thought to be sporadic community-acquired cases rather than epidemics.

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Section: Discussionmentioning

confidence: 99%

First Sporadic Cases of Non-pneumonic Legionellosis, Pontiac Fever in Japan.

Sakai¹,

Kobayashi²,

Misawa³

et al. 1998

Intern. Med.

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“…3,10,18 -21 Together, L pneumophila, C pneumoniae, and M pneumoniae share similar microbiological and clinical features, including neurological manifestations. 18,19,[22][23][24] They are important atypical respiratory pathogens that cause 8% to 50% of cases of community-acquired pneumonia. 18 Serological methods such as indirect fluorescence antibody (IFA) and ELISA have test sensitivity of 40% to 80% and specificity of 95% to 99%.…”

Section: Ngeh Et Al Atypical Respiratory Infectious Burden In Strokementioning

confidence: 99%

Chlamydia pneumoniae, Mycoplasma pneumoniae , and Legionella pneumophila in Elderly Patients With Stroke (C-PEPS, M-PEPS, L-PEPS)

Ngeh

Goodbourn

2005

Stroke

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Background and Purpose-Multiple studies have suggested an association between Chlamydia pneumoniae andMycoplasma pneumoniae infection and cardiovascular disease. We investigated whether the risk of cerebrovascular disease is associated with Legionella pneumophila infection and the aggregate number/infectious burden of these atypical respiratory pathogens. Methods-One hundred patients aged Ͼ65 years admitted with acute stroke or transient ischemic attack (TIA) and 87 control patients admitted concurrently with acute noncardiopulmonary, noninfective conditions were recruited prospectively. Using enzyme-linked immunosorbent assay (ELISA) kits, we previously reported the seroprevalences of C pneumoniae and M pneumoniae in these patients. We have now determined the seroprevalences of L pneumophila IgG and IgM in this cohort of patients using ELISA. Results-The seroprevalences of L pneumophila IgG and IgM were 29% (nϭ91) and 12% (nϭ81) in the stroke/TIA group and 22% (nϭ86) and 10% (nϭ72) in the controls, respectively. Using logistic regression to adjust for age, sex, hypertension, smoking, diabetes, ischemic heart disease, and ischemic ECG, the odds ratios for stroke/TIA in relation to L pneumophila IgG and IgM were 1.52 (95% CI, 0.70 to 3.28; Pϭ0.29) and 1.49 (95% CI, 0.45 to 4.90; Pϭ0.51), respectively. The odds ratios in relation to IgG seropositivity for 1, 2, or 3 atypical respiratory pathogens after adjustment were 3.89 (95% CI, 1.13 to 13.33), 2.00 (95% CI, 0.64 to 6.21), and 6.67 (95% CI, 1.22 to 37.04), respectively (Pϭ0.06). Conclusions-L pneumophila seropositivity is not significantly associated with stroke/TIA. However, the risk of stroke/TIA appears to be associated with the aggregate number of chronic infectious burden of atypical respiratory pathogens such as C pneumoniae, M pneumoniae, and L pneumophila.

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“…A further, less severe respiratory tract manifestation is an acute, self-limited febrile illness called Pontiac fever [2]. About 50% of patients with legionellosis present with encephalopathy [3], the nature of which is not clear. Acute disseminated encephalopathy (ADEM) is an inflammatory demyelinating leukencephalopathy frequently associated with infections (especially the exanthematous viruses rubeola, varicella, vaccinia, and rubella) or immunizations [4].…”

Section: Introductionmentioning

confidence: 99%

Acute Disseminated Encephalomyelitis following Pontiac Fever

et al. 1998

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We report the case of a 35-year-old woman who developed headache and psychosis and gradually became comatose within 3 weeks after a flu-like infection. MRI revealed bifrontal demyelination consistent with acute disseminating encephalomyelitis (ADEM). Two different cerebrospinal fluid samples were positively tested for Legionella cincinnatiensis by direct sequencing of a PCR-amplified Legionella-specific fragment. This result made it possible to interpret the initial symptoms as Pontiac fever. We think it most likely that this is a case of ADEM following the very rare situation of a systemic infection with L. cincinnatiensis. A review of the literature on Legionella-associated encephalopathy suggests that some of these cases may also have had ADEM.

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Neurologic Manifestations of Legionnairesʼ Disease

Cited by 83 publications

References 0 publications

First Sporadic Cases of Non-pneumonic Legionellosis, Pontiac Fever in Japan.

First Sporadic Cases of Non-pneumonic Legionellosis, Pontiac Fever in Japan.

Chlamydia pneumoniae, Mycoplasma pneumoniae , and Legionella pneumophila in Elderly Patients With Stroke (C-PEPS, M-PEPS, L-PEPS)

Acute Disseminated Encephalomyelitis following Pontiac Fever

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