zithromax and Legionellosis

The goal of the study was to analyze the clinical characteristics of Legionella cases caused by Legionella micdadei and explore the diagnosis and treatment.. The pathogen was identified by routine isolation and culture, biochemical identification, serum agglutination test, mass spectrometry identification, and routine PCR. Combined with the related literature review, the clinical diagnosis and treatment of Legionella micdadei were analyzed.. The patient suffered from pulmonary infection caused by Legionella micdadei. After treatment with moxi-floxacin for 2 weeks, the body temperature dropped and the shadow of the lung was completely absorbed after 2 months. Combined with literature analysis, 8 cases of Legionella micetidis, including 7 males and 1 female, aged from 27 to 57 years old, 6 cases with basic diseases, which were treated with azithromycin, erythromycin or levofloxacin, and all of them achieved good therapeutic effect.. The detection of Legionella should be strengthened in patients with pneumonia whose symptoms have no obvious improvement after antibiotic treatment. Azithromycin, erythromycin or levofloxacin are effective in the treatment of Legionella spp.

Topics: Adult; Azithromycin; Erythromycin; Female; Humans; Legionella; Legionellaceae; Legionellosis; Levofloxacin; Male; Middle Aged; Pneumonia

Legionella species are ubiquitous in aquatic environments. About 50 years ago they entered the engineered (technical) environment, i.e. warm water systems with zones of stagnation. Since that time they represent a hygienic problem. After transmission to humans via aerosols legionellae might cause Legionella pneumonia (legionnaires' disease) or influenza-like respiratory infections (Pontiac fever). Epidemiological data suggest that Legionella strains might differ substantially in their virulence properties. Although the molecular basis is not understood L. pneumophila serogroup 1 especially MAb 3/1-positive strains cause the majority of infections. The main virulence feature is the ability to multiply intracellularly. After uptake into macrophages legionellae multiply in a specialized vacuole and finally lyse their host cells. Several bacterial factors like surface components, secretion systems and iron uptake systems are involved in this process. Since the clinical picture of Legionella pneumonia does not allow differentiation from pneumoniae caused by other pathogens, microbiological diagnostic methods are needed to establish the diagnosis. Cultivation of legionellae from clinical specimens, detection of antigens and DNA in patients' samples and detection of antibodies in serum samples are suitable methods. However, none of the diagnostic tests presently available offers the desired quality with respect to sensitivity and specificity. Therefore, the standard technique is to use several diagnostic tests in parallel. Advantages and disadvantages of the diagnostic procedures are discussed. Therapeutic options for Legionella infections are newer macrolides like azithromycin and chinolones (ciprofloxacin, levofloxacin and moxifloxacin).

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Antigens, Bacterial; Aza Compounds; Azithromycin; Ciprofloxacin; Diagnosis, Differential; DNA, Bacterial; Fluoroquinolones; Humans; Incidence; Legionella; Legionella pneumophila; Legionellosis; Legionnaires' Disease; Levofloxacin; Moxifloxacin; Ofloxacin; Polymerase Chain Reaction; Quinolines; Serotyping; Virulence

Due to recent safety concerns regarding fluoroquinolones and the potential medical and economic benefits, we investigated the efficacy of a single intravenous dose of 1.5 g azithromycin for the treatment of pulmonary legionellosis.. Using a nationwide legionellosis registry for pre-selection, 74 patients admitted from 2000-2018 to a tertiary care hospital owing to pneumonia caused by Legionella pneumophila were retrospectively included in this study.. Conventional treatment regimens consisting of fluoroquinolones (n = 20), macrolides (n = 30) or combinations of both (n = 24) and a single intravenous dose of azithromycin (n = 12) have been demonstrated to be equally effective. Single-dose azithromycin treatment was well tolerated and resulted in a shorter hospital stay (P = 0.0464) and shorter antibiotic treatment duration (P = 0.0004) allowing earlier discharge.. A single intravenous dose of azithromycin might be a valuable treatment alternative for patients with legionellosis.

Topics: Administration, Intravenous; Adult; Aged; Anti-Bacterial Agents; Austria; Azithromycin; Female; Fluoroquinolones; Humans; Legionella pneumophila; Legionellosis; Male; Middle Aged; Retrospective Studies; Tertiary Care Centers; Treatment Outcome

Guidelines recommend azithromycin or a quinolone antibiotic for treatment of Legionella pneumonia. No clinical study has compared these strategies.. We performed a retrospective cohort analysis of adults hospitalized in the United States with a diagnosis of Legionella pneumonia in the Premier Perspectives database (1 July 2008-30 June 2013). Our primary outcome was hospital mortality; we additionally evaluated hospital length of stay, development of Clostridium difficile colitis, and total hospital cost. We used propensity-based matching to compare patients treated with azithromycin vs a quinolone. All analyses were repeated on a subgroup of more severely ill patients, defined as requiring intensive care unit admission or mechanical ventilation or having a predicted probability of hospital mortality in the top quartile for all patients.. Legionella pneumonia was diagnosed in 3152 adults across 437 hospitals. Quinolones alone were used in 28.8%, azithromycin alone was used in 34.0%, and 1.8% received both. Crude hospital mortality was similar: 6.6% (95% confidence interval [CI], 5.0%-8.2%) for quinolones vs 6.4% (95% CI, 5.0%-7.9%) for azithromycin (P = .87); after propensity matching (n = 813 in each group), mortality remained similar (6.3% [95% CI, 4.6%-7.9%] vs 6.5% [95% CI, 4.8%-8.2%], P = .84 for the whole cohort, and 14.9% [95% CI, 10.0%-19.8%] vs 18.3% [95% CI, 13.0%-23.6%], P = .36 for the more severely ill). There was no difference in hospital length of stay, development of C. difficile, or total hospital cost.. Use of azithromycin alone or a quinolone alone for treatment of Legionella pneumonia was associated with similar hospital mortality. Few patients receive combination therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Clostridium Infections; Cohort Studies; Colitis; Female; Hospital Costs; Hospital Mortality; Humans; Legionellosis; Length of Stay; Male; Middle Aged; Quinolones; Retrospective Studies; Treatment Outcome; United States; Young Adult

Topics: Administration, Oral; Adult; Azithromycin; Ceftriaxone; Drug Therapy, Combination; Erythromycin; Eye Infections, Bacterial; Humans; Injections, Intravenous; Legionella longbeachae; Legionellosis; Male; Retinitis; Scotoma; Tomography, Optical Coherence; Visual Acuity

Antimicrobial susceptibility of Legionella spp. has rarely been studied in Korea. Therefore, we aimed to determine the susceptibility of Legionella spp. to various antibiotics.. We assessed the antimicrobial susceptibility of 66 environmental and clinical Legionella isolates collected between January 2001 and December 2008 from Korea and Japan. The minimum inhibitory concentrations (MICs) of 6 antibiotics, namely, azithromycin, ciprofloxacin, clarithromycin, clindamycin, gatifloxacin, and gemifloxacin were determined by the broth microdilution method using buffered starch yeast extract broth.. The MIC ranges of the 6 antibiotics used against the Legionella isolates were as follows: 0.004-0.062 microg/mL (azithromycin), 0.002-0.5 microg/mL (ciprofloxacin), 0.004-0.5 microg/mL (clarithromycin), 0.12-4 microg/mL (clindamycin), 0.002-0.12 microg/mL (gatifloxacin), and 0.008-1 microg/mL (gemifloxacin).. Legionella spp. isolates from Korea and Japan were most susceptible to gatifloxacin. Azithromycin, clarithromycin, ciprofloxacin, and gemifloxacin were also effective for treating legionellosis.

Topics: Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Clarithromycin; Clindamycin; Drug Resistance, Bacterial; Fluoroquinolones; Gatifloxacin; Gemifloxacin; Humans; Legionella; Legionellosis; Microbial Sensitivity Tests; Naphthyridines

The aim of this work was to study specific clinical features of legionellosis pneumonia during an epidemic outbreak of the disease in Sverdlovsk region and to assess its delayed effects. 202 patients applied for the treatment to the central hospital of the town of Verkhnyaya Pyshma in July-August 2007 Legionella pneumophila was identified in 61 adults aged 51.3-59.3 (mean 55.3) years. The following analyses were performed at admittance and discharge as well as 1 year after treatment: complete blood count, urinalysis, AST, ALT and sugar levels, breast X-ray and ECG. Patients with mild disease were given azithromycin per os (500 mg for 7days, n = 10) or levofloxacin (500 mg for 10 days, n = 5). Those with the severe form of the disease were treated with azithromycin (500 mg for 3 days, v/v, n = 17) or levofloxacin (750 mg for 2-3 days v/v and for 12 days per os, n = 29). The results were analysed using the STATA 5.0 software package (Stata Corporation, College Station, Texas, USA). Difference were considered significant at p < 0.05. It was shown that the outbreak resulted from the use of hot water from the public water supply system contaminated with L. pneumophila. The incubation period of infection was 4.48-6.01 (mean 5.3) days. Duration of hospitalization varied from 9.6-12.9 (mean 11.3) days. Most common clinical symptoms: general uneasiness, headache, non-productive cough, and fever lasting 3.8-6.6 (mean 5.2 days). Intrahospital lethality 6.6%. It is concluded that therapy with azithromycin and levofloxacin give good clinical effect leaving no systemic lesions in patients with legionellosis pneumonia.

Topics: Anti-Bacterial Agents; Azithromycin; Disease Outbreaks; Female; Humans; Legionellosis; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Russia; Treatment Outcome; Water Supply

A 56-year-old man with a history of rheumatoid arthritis presented with a 2-day history of worsening pain in his left foot. Treatment with high-dose steroids was of no benefit, hence a diagnosis of septic arthritis was considered. However, the patient's condition deteriorated despite empirical antibiotic therapy. Following persistent investigation, the cause was identified as a fastidious Legionella longbeachae infection, and appropriate antibiotic therapy led to complete resolution of the sepsis. This emphasises the importance of considering infections with atypical organisms in patients on immunosuppressive therapy.

Topics: Arthritis, Rheumatoid; Aza Compounds; Azithromycin; Drug Therapy, Combination; Fluoroquinolones; Humans; Legionella longbeachae; Legionellosis; Male; Middle Aged; Moxifloxacin; Neutropenia; Osteomyelitis; Quinolines; Steroids

Topics: Anti-Bacterial Agents; Azithromycin; Catatonia; Humans; Hyponatremia; Legionellosis

Legionella infection causes 2 to 14% of community-acquired pneumonia (CAP). Legionella micdadei constitutes <1% of these infections. We describe a case of cavitary L. micdadei CAP in a myeloma patient receiving thalidomide treatment. The importance of considering pneumonia and problems in diagnosing pneumonia caused by L. micdadei in this patient population are reviewed.

Topics: Anti-Bacterial Agents; Azithromycin; Community-Acquired Infections; Humans; Immunosuppressive Agents; Legionella; Legionellosis; Lung Abscess; Male; Middle Aged; Multiple Myeloma; Thalidomide

We compared growth characteristics of 46 Legionella strains grown on buffered charcoal yeast extract alpha (BCYE alpha) agar and buffered starch yeast extract (BSYE) agar and MICs of macrolides, azalides, and fluoroquinolones for these organisms. Growth was poor and not reproducible on BSYE agar. Growth was excellent on BCYE alpha, and MICs were easy to interpret. BCYE alpha is superior to BSYE for testing susceptibilities of Legionella species by agar dilution.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Charcoal; Ciprofloxacin; Clarithromycin; Culture Media; Erythromycin; Humans; Legionella; Legionella pneumophila; Legionellosis; Microbial Sensitivity Tests; Ofloxacin; Reproducibility of Results; Starch