The chest radiograph in Legionnaires' disease. Further observations.

Fairbank, Jonathan T.; Mamourian, Alexander C.; Dietrich, Peter A.; Girod, John C.

doi:10.1148/radiology.147.1.6828756

Cited by 46 publications

(12 citation statements)

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“…Radiographic appearances lag behind the clinical picture in Legionella infection and imaging deterioration occurs despite clinical improvement. Long-term follow-up has shown persisting abnormalities several months later: a variety of slowly resolving or permanent abnormalities are seen [19]. Owing to this lack of correlation, imaging severity cannot be used to predict or monitor the clinical severity [14,20,21].…”

Section: Lobar Pneumoniamentioning

confidence: 99%

Pneumonia in the immunocompetent patient

Reynolds

McDonald²,

Alton³

et al. 2010

BJR

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Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond.

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Section: Lobar Pneumoniamentioning

confidence: 99%

Pneumonia in the immunocompetent patient

Reynolds

McDonald²,

Alton³

et al. 2010

BJR

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“…Most commonly, patchy unilateral infiltrates are seen initially. Extension of the infiltrates produces consolidation in one or more lobes; infiltrates may be bilateral in as many as two-thirds of patients (91,155). In some cases distinctive nodular lesions, which resemble those produced in some fungal infections, are produced ( Fig.…”

Section: Radiographic Appearancementioning

confidence: 99%

Legionnaires disease: historical perspective

1988

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In the summer of 1976, a mysterious epidemic of fatal respiratory disease in Philadelphia launched an intensive investigation that resulted in the definition of a new family of pathogenic bacteria, the Legionellaceae. In retrospect, members of the family had been isolated from clinical specimens as early as 1943. Unsolved epidemics of acute respiratory disease dating to the 1950s were subsequently attributed to the newly described pathogens. In the intervening years, the Legionellaceae have been firmly established as important causes of sporadic and epidemic respiratory disease. The sources of the infecting bacteria are environmental, and geographic variation in the frequency of infection has been documented. Airborne dissemination of bacteria from cooling towers and evaporative condensers has been responsible for some epidemics, but potable water systems are perhaps more important sources. The mode of transmission from drinking water is unclear. The Legionellaceae are gram-negative, facultative, intracellular pathogens. The resident alveolar macrophage, usually an effective antibacterial defense, is the primary site of growth. Cell-mediated immunity appears to be the most important immunological defense; the role of humoral immunity is less clear. Erythromycin remains the antibiotic of choice for therapy of infected patients, but identification and eradication of environmental sources are also essential for the control of infection.

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“…9,109 The most common chest roentgenographic abnormality in patients with Legionella pneumonia is a unilobar patchy alveolar infiltrate, usually present at the initial radiographic evaluation. [110][111][112] As the disease progresses, the infiltrate tends to enlarge and consolidate ( Fig. 1).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…110 Multilobe pulmonary involvement was seen in 85% of 26 immunocompromised patients with L. micdadei infection. 8 Abscess formation and cavitation are uncommon but not rare complications of both L. pneumophila 113 and L. micdadei 8 pneumonia and occur in both normal 111,114,115 and immunocompromised patients. 8,64,116 About one-third of all patients will develop small pleural effusions, but these are not a prominent part of the radiologic picture.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…8,64,116 About one-third of all patients will develop small pleural effusions, but these are not a prominent part of the radiologic picture. 110,111,117 Rapidly expanding peripheral nodules have been reported as the radiographic presentation for some cases of L. micdadei 6,118 and L. pneumophila, 117 which may suggest the diagnosis of septic pulmonary embolism. There does not appear to be any major radiologic differences between Legionella pneumonia in the immunocompromised and normal host.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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