Legionella Pneumophila Pneumonia Research Articles

Distinction of clinical features and microbiological methods between Chlamydia psittaci and Legionella pneumophila pneumonia confirmed by metagenomic next-generation sequencing

Objectives Detection and diagnosis of Chlamydia psittaci (C. psittaci) pneumonia is often overlooked due to conventional methods limitations and similarity to other atypical community acquired pneumonia (CAP). Using mNGS, we aimed to distinguish psittacosis from legionellosis for early C. psittaci pneumonia diagnosis and better prognosis. Methods Thirty-seven patients diagnosed with atypical CAP were enrolled in this retrospective study, including 14 C. psittaci pneumonia and 23 Legionella pneumophila (L. pneumophila) pneumonia. We collected and compared baseline, lab results, radiology imaging, conventional microbiological methods and more importantly, mNGS results of clinical samples, as well as the treatments and prognosis between psittacosis and legionellosis. Results Patients with C. psittaci and L. pneumophila had similar symptoms and were presented with high levels of inflammatory markers. However, patients with C. psittaci pneumonia were more likely to have exposure to birds or parrots [11 (78.6%) vs. 2 (8.7%), p < 0.001], had higher proportions of fever and chill (p = 0.015 and 0.035), higher levels of hemoglobin and albumin (p = 0.002 and 0.018) compared with those with L. pneumophila. Of 14 C. psittaci patients, only one had positive IgM antibody, with no positive cultures. Early identification of pathogens by mNGS method contributed to timely antibiotics’ adjustment and better outcomes then, yet with similar hospital mortality between two groups [7.1% (1/14) vs. 34.8% (8/23), p = 0.112]. Conclusion Early mNGS detection of atypical pathogens in multiple samples improves on traditional methods, promptly adjust empirical antimicrobial treatment to pathogen-targeted antibiotics, further improve prognosis.

Omadacycline for the treatment of patients with Legionella pneumophila pneumonia after experiencing liver dysfunction: case series.

Antibiotics frequently induce abnormal liver function. Omadacycline is a novel aminomethylcycline antibiotic, which shows potent activity against Gram-positive and Gram-negative aerobic, anaerobic, and atypical (including Legionella pneumophila) bacteria. Of note, omadacycline is tolerable in most patients with liver impairment. However, evidence regarding the application of omadacycline in patients with Legionella pneumophila pneumonia after experiencing liver dysfunction is scarce. The current study reported 6 cases of patients with Legionella pneumophila pneumonia receiving omadacycline as subsequent antibiotics after experiencing liver dysfunction. These 6 cases were admitted to the hospital for pneumonia and received antibiotic therapy, including piperacillin-tazobactam, imipenem, meropenem, and moxifloxacin. After receiving these antibiotics, increased liver enzymes were noted. Although hepatoprotective therapy (such as magnesium isoglycyrrhizinate and glutathione) was given, the liver function was still abnormal. According to metagenomic next-generation sequencing, these patients were diagnosed with Legionella pneumophila pneumonia. Considering the abnormal liver function, the antibiotic therapy was switched to omadacycline-containing antibiotic therapy. After that, liver function was improved, and the infection was ameliorated. Ultimately, all patients discharged from the hospital, including 2 patients who achieved complete clinical symptomatic improvement and 4 patients who achieved partial clinical symptomatic improvement. This study emphasizes the successful treatment of switching to omadacycline after experiencing abnormal liver function in patients with Legionella pneumophila pneumonia. This study suggests that omadacycline may serve as an optional antibiotic for patients with Legionella pneumophila pneumonia, especially when occurring liver dysfunction. However, more clinical studies are required to validate our findings.

Noninvasive respiratory support with high-flow nasal cannula in endoscopic surgery in a patient with Legionella Pneumophila pneumonia: a case report

Noninvasive respiratory support with high-flow nasal cannula in endoscopic surgery in a patient with Legionella Pneumophila pneumonia: a case report

Legionella associated rhabdomyolysis: a case report

BackgroundInfections have been recognized as an uncommon cause of rhabdomyolysis, with evidence indicating a worse prognosis when compared to rhabdomyolysis caused by other etiologies. Diseases caused by Legionella pneumophila can present variably, ranging from mild to severe illness, as is sometimes the case with pneumonia. In particular, the triad of Legionnaire’s disease, rhabdomyolysis, and acute kidney injury is associated with a significant increase in the morbidity and mortality, with most patients requiring initiation of renal replacement therapy such as hemodialysis. While the exact mechanism of both the muscle and kidney injury in this setting remains unknown, several hypotheses exist, with some research suggesting multiple yet distinct processes occurring in both target organs.Case presentationIn this case report, we describe a 53-year-old African American man who presented with Legionella pneumophila pneumonia complicated by rhabdomyolysis and acute kidney injury. He was treated with aggressive fluid resuscitation and a 2-week course of azithromycin. His clinical status improved without necessitating renal replacement therapy or mechanical ventilation. We postulate that early recognition and treatment were key to his recovery. He was discharged 10 days later without recurrence of rhabdomyolysis at the time of this report.ConclusionWhile there are several well-established and more common causes of rhabdomyolysis, clinicians should recognize Legionella sp. as an etiology, given its association with significant morbidity and mortality.

Community Acquired Pneumonia in Bangladesh: Sensitivity Pattern, Clinical Courses and Outcome of a Cross Sectional Population

Background: Pneumonia acquired outside the hospital by an immune-competent individual is defined as community acquired pneumonia (CAP). It is to be distinguished, on the basis of a wider spectrum of pathogens, from nosocomial pneumonia from pneumonia in an immune-compromised host. Community-acquired pneumonia is associated with a significant mortality and morbidity. Etiology of CAP varies geographically and the understanding of local epidemiology plays an important role in decision making for empirical treatment before test results are available. Primary decisions about empirical antimicrobial treatment required knowledge of predominant microbial patterns and their sensitivities.&#x0D; Objectives: The aim of this study was to identify the bacterial etiology of CAP, their sensitivity towards empirical therapy and to observe the clinical course as well as short term outcome in hospitalized adult patients.&#x0D; Methodology: It was one year-long observational prospective study on 87 patients diagnosed with CAP admitted in Chattogram Medical College Hospital, second largest tertiary care hospital during August 2018 to July 2019. Sputum for Gram and Z-N staining, culture and sensitivity, blood for culture, sensitivity and PCR for Streptococcus pneumonia, Mycoplasma pneumoniae, Legionella pneumophila and Chlamydophila pneumonia were done. Patients were followed up for in-hospital outcome and 30-day mortality.&#x0D; Results: The mean age was 49.59 years and male - female ratio was 1.56: 1. Fever, chest pain and cough were the most common clinical findings. Klebsiella pneumoniae was identified (39.1%) in the majority of the patients, followed by Pseudomonas aeruginosa (10.3%), Staphylococcus aureus and Escherichia coli (5.7%). Staphylococcus aureus was positive in blood culture of one patient. Four samples were positive in PCR and identified Streptococcus pneumoniae. The sensitivity to meropenem, levofloxacin and amikacin was highest. The mean duration of hospital stay was 6.34 ± 2.37 days along with in-hospital mortality and 30-day mortality was 6.9% and 16.1% respectively.&#x0D; Conclusion: The bacteriologic profile of community acquired pneumonia revealed Gram-negative bacteria as pre-dominant organism by conventional sputum and blood culture. But need for further serologic tests for atypical and viral pathogens and development of institutional antibiogram to facilitate the choice for empirical therapy is required.

Epidemic of Legionella Pneumophila Pneumonia South of Brescia (Italy)

In September 2018, a serious epidemic of Legionella Pneumophila serotypes 1-2-14, diagnosed by the Istituto Superiore Sanita (ISS), occurred in the low plain south of Brescia. This resulted in a considerable number of hospitalizations in the hospitals of the ATS of Brescia and Valpadana (Mantua) with high mortality rate. It was an anomalous situation both for the spread and for the Legionella serotypes which alarmed the Istituto Superiore Sanita and the local health structures. This epidemic is an expressions of the malaise of the geographical area in question caused by the impact of various environmental degradations. Some environmental criticalities: 1-the low water flow of the Chiese river in the summer of 2018 due to the exploitation of water by intensive agriculture and the presence of 22 hydroelectric power plants along its course. 2-the presence of numerous industrial cooling towers with a lack of mapping of the same towers by the political bodies (Region and Municipalities). 3-the abnormal disposal of sludge on the countryside surrounding the agricultural area adjacent to the river bed of the Chiese river as a consequence of the enormous production of livestock waste by pig, cattle and chicken farms in the same area. 4-In the lower Brescia plain there are numerous disposal companies that receive sewage sludge from 15 regions of Italy and also from abroad. 5-different and numerous types of landfills in the municipalities of Montichiari, Rezzato, Ghedi, Calcinato and Bedizzole filled with 12 million cubic meters of toxic-harmful waste. 6- the Lombardy region allows an excessive number of CERs (Catalog European Waste). It concludes by emphasizing how everyone, citizens and institutions, have a great responsibility in the management of the territory and a change of direction is hoped for an economy that has reached limits that it can no longer tolerate. This calls the various responsibilities of Politics, Public Health, the industrial and agricultural world in the management of a territory that continues to send signs of suffering and which is reflected on the health of men, animals and the plant world.

Community-Acquired Legionella pneumophila Pneumonia Progressing to Acute Respiratory Distress Syndrome: A Case Report

Community-Acquired Legionella pneumophila Pneumonia Progressing to Acute Respiratory Distress Syndrome: A Case Report

Epidemiologic Survey of Legionella Urine Antigen Testing Within a Large Wisconsin-Based Health Care System.

Legionella pneumophila pneumonia is a life-threatening, environmentally acquired infection identifiable via Legionella urine antigen tests (LUAT). We aimed to identify cumulative incidence, demographic distribution, and undetected disease outbreaks of Legionella pneumonia via positive LUAT in a single eastern Wisconsin health system, with a focus on urban Milwaukee County. A multilevel descriptive ecologic study was conducted utilizing electronic medical record data from a large integrated health care system of patients who underwent LUAT from 2013 to 2017. A random sample inclusive of all positive tests was reviewed to investigate geodemographic differences among patients testing positive versus negative. Statistical comparisons used chi-squared or 2-sample t-tests; stepwise regression followed by binary logistic regression was used for multivariable analysis. Positive cases identified by LUAT were mapped to locate hotspots; positive cases versus total tests performed also were mapped by zip code. Of all LUAT performed (n=21,599), 0.68% were positive. Among those in the random sample (n=11,652), positive cases by LUAT were more prevalent in the June-November time period (86.2%) and younger patients (59.4 vs 67.7 years) and were disproportionately male (70.3% vs 29.7%) (P<0.0001 for each). Cumulative incidence was higher among nonwhite race/ethnicity (1.91% vs 1.01%, P<0.0001) but did not remain significant on multivariable analysis. Overall, 5507 tests were performed in Milwaukee County zip codes, yielding 82 positive cases by LUAT (60.7% of all positive cases in the random sample). A potential small 2016 outbreak was identified. Cumulative incidence of a positive LUAT was less than 1%. LUAT testing, if done in real time by cooperative health systems, may complement public health detection of Legionella pneumonia outbreaks.

HOLY MOLY! A RARE CASE OF A CAVITARY LESION SECONDARY TO LEGIONELLA PNEUMOPHILA IN AN IMMUNOCOMPETENT PATIENT

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Legionella pneumophila has been increasing in prevalence as a cause of community acquired pneumonia, especially in hospitalized patients. It is seen in both immunocompetent and immunocompromised patients. Immunocompromised patients have rare presentations, including lung abscesses and cavitary lesions. However, we present a case in which an immunocompetent patient with legionella pneumophila which was complicated with cavitary lesions and abscess formation. CASE PRESENTATION: A 75-year-old man with no past medical history presents to the emergency department with complaints of shortness of breath and generalized fatigue. The patient was febrile and saturating 91% on 2L nasal cannula. Laboratory testing was remarkable for leukocytosis with a white blood cell count of 14.7, hyponatremia with a sodium of 128, lactic acid of 2.9 and an elevated C-reactive protein of 39.4. Chest x-ray showed consolidation throughout the right lung as well as patchy consolidation in the left perihilar region. The patient was admitted and started on broad spectrum antibiotics. The following day, patient’s respiratory status deteriorated requiring intubation. Computed tomography revealed multifocal pneumonia with cavitation in the superior segment of the right lower lobe and left lower lobe. Legionella urine antigen was later found to be positive. The patient eventually developed acute respiratory distress syndrome requiring lung protective ventilation and prone positioning to help with hypoxia. DISCUSSION: In the case reported here, we had a patient with no findings suggesting immunosuppression, who initially presented with multifocal pneumonia and was later found to be legionella positive. Legionella pneumophila is a frequent cause of ICU admission, resulting in a high morbidity and an important public health problem worldwide. There are many case reports of immunocompromised patients that have rare complications including cavitary lesions and abscesses. This is likely secondary to depression of cell mediated immunity. These patients had poor outcomes, and many patients were diagnosed at the time of autopsy. Therefore, it is thought that early detection be implemented in immunocompromised patients. However, this case report shows that legionella pneumophila complications can be seen in immunocompetent patients as well. CONCLUSIONS: Despite complications of legionella pneumophila seen more common in immunocompromised patients, it should be considered in immunocompetent patients as well, especially those with worsening infiltrates and hypoxia despite broad spectrum antibiotics. Legionella pneumophila should be prophylactically treated in these patients, as it is difficult to isolate legionella in all commercially available tests. Reference #1: Girard, L. and Gregson, D. (2007). Community-Acquired Lung Abscess Caused by Legionella micdadei in a Myeloma Patient Receiving Thalidomide Treatment. Journal of Clinical Microbiology, 45(9), pp.3135-3137. Reference #2: Kumpers, P., Tiede, A., Kirschner, P., Girke, J., Ganser, A. and Peest, D. (2008). Legionnaires' disease in immunocompromised patients: a case report of Legionella longbeachae pneumonia and review of the literature. Journal of Medical Microbiology, 57(3), pp.384-387. Reference #3: Viasus, D., Di Yacovo, S., Garcia-Vidal, C., Verdaguer, R., Manresa, F., Dorca, J., Gudiol, F. and Carratalà, J. (2013). Community-Acquired Legionella pneumophila Pneumonia. Medicine, 92(1), pp.51-60. DISCLOSURES: No relevant relationships by William McGee, source=Web Response No relevant relationships by Peters Okonoboh, source=Web Response No relevant relationships by Kamran Sherwani, source=Web Response No relevant relationships by Quazi Kamran Uddin, source=Web Response

Severe Legionella pneumophila pneumonia treated with extracorporeal membrane oxygenation (ECMO): A case report

Severe Legionella pneumophila pneumonia treated with extracorporeal membrane oxygenation (ECMO): A case report

TOLLIP deficiency is associated with increased resistance to Legionella pneumophila pneumonia.

Legionella pneumophila (Lp) is a flagellated, intracellular bacterium that can cause Legionnaires’ disease (LD). Lp activates multiple innate immune receptors, and TOLLIP dampens MyD88-dependent signaling and may influence susceptibility to LD. We evaluated the effect of TOLLIP on innate immunity, pneumonia severity, and LD susceptibility in mouse lungs and human populations. To accomplish this, we evaluated the effect of TOLLIP on lung-specific Lp control and immune response and associated a common functional TOLLIP variant with Lp-induced innate immune responses and LD susceptibility in humans. After aerosol Lp infection, Tollip−/− mice demonstrated significantly fewer bacterial CFU and increased cytokine responses from BAL fluid. Tollip−/− macrophages also suppressed intracellular Lp replication in a flagellin-independent manner. The presence of a previously characterized, functionally active SNP associated with decreased TOLLIP mRNA transcript in monocytes was associated with increased TNF and IL-6 secretion after Lp stimulation of PBMC ex vivo. This genotype was separately associated with decreased LD susceptibility (309 controls, 88 cases, p = 0.008, OR 0.36, 95% CI 0.16 – 0.76) in a candidate gene association study. These results suggest that TOLLIP decreases lung-specific TLR responses to increase LD susceptibility in human populations. Better understanding of TOLLIP may lead to novel immunomodulatory therapies.

Molecular detection of bacterial pathogens in intensification of chronic obstructive pulmonary disease by polymerase chain reaction methods

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality all around the world, and research indicates that it will become more prevalent in future. Patients with COPD may sometimes also catch bacterial infections, including infections with Streptococcus Pneumonia, Mycoplasma Pneumonia, and Legionella Pneumophila. The purpose of this study is to use PCR as more sensitive, supplementary method for detection of these infections. METHODS: The study is of the cross-sectional-descriptive type. 109 specimens were collected under supervision of pulmonologists from the respiratory secretions of patients with COPD and suspicion of bacterial infections. The specimens entered the DNA extraction process. Then, molecular experiments were performed, and their results were finally analyzed with statistical tests. RESULTS: There was no significant difference in terms of gender (P value>0.05). The patients’ average age was 62.4±12.2. In the case of Legionella Pneumophila, 4 of the 109 patients were identified as positive using the kit, and 2 of them were reported as positive with the second PCR method using the designed primers. As for Streptococcus Pneumonia, 8 of the 109 patients were identified as positive with the standard kit me thod, and 5 of them were reported as positive with the second PCR method. Relative frequency was calculated for Legionella Pneumophila and Streptococcus Pneumonia as 4% and 7%, respectively. CONCLUSIONS: In general, the methods employed in this study have good sensitivity and accuracy as compared to the conventional and common methods and to those in similar studies. Of course, it is suggested that the experiments be performed on more samples and with other genes.

Validation of a diagnostic score model for the prediction of Legionella pneumophila pneumonia

BackgroundCommunity-acquired pneumonia (CAP) due to Legionella has a high mortality rate in patients who do not receive adequate antibiotic therapy. In a previous study, we developed a simple Legionella Score to distinguish patients with Legionella and non-Legionella pneumonia based on clinical information at diagnosis. In the present study, we validated this Legionella Score for the presumptive diagnosis of Legionella CAP. MethodsThis validation cohort included 109 patients with Legionella CAP and 683 patients with non-Legionella CAP. The Legionella Score includes six parameters by assigning one point for each of the following items: being male, absence of cough, dyspnea, C-reactive protein (CRP) ≥ 18 mg/dL, lactate dehydrogenase (LDH) ≥ 260 U/L, and sodium < 134 mmol/L. ResultsWhen the Legionella CAP and non-Legionella CAP were compared by univariate analysis, most of the evaluated symptoms and laboratory test results differed substantially. The six parameters that were used for the Legionella Score also indicated clear differences between the Legionella and non-Legionella CAP. All Legionella patients had a score of 2 points or higher. The median Legionella Scores were 4 in the Legionella CAP cases and 2 in the non-Legionella CAP cases. A receiver operating characteristics curve showed that the area under the curve was 0.93. The proposed best cutoff, total score ≥3, had sensitivity of 93% and specificity of 75%. ConclusionOur Legionella Score was shown to have good diagnostic ability with a positive likelihood of 3.7 and a negative likelihood of 0.10.

A Novel Diagnostic Scoring System to Differentiate between Legionella pneumophila Pneumonia and Streptococcus pneumoniae Pneumonia.

Objective We investigated a novel diagnostic scoring system to differentiate Legionella pneumophila pneumonia from Streptococcus pneumoniae pneumonia. Methods We retrospectively reviewed the clinical data of 62 patients with L. pneumophila pneumonia (L-group) and 70 patients with S. pneumoniae pneumonia (S-group). Results The serum sodium (Na) levels tended to be lower according to the severity [age, dehydration, respiratory failure, orientation disturbance, low blood pressure (A-DROP)] score in the L-group. On a multivariate analysis, we found that four factors were independent predictive markers for inclusion in the L-group: relative bradycardia [hazard ratio (HR) 5.177, 95% confidence interval (CI): 1.072-24.993, p=0.041], lactate dehydrogenase (LDH) levels ≥292 IU/L (HR 6.804, 95% CI: 1.629-28.416, p=0.009), C-reactive protein (CRP) levels ≥21 mg/dL (HR 28.073, 95% CI: 5.654-139.462, p<0.001), and Na levels ≤137 meq/L (HR 5.828, 95% CI: 1.411-24.065, p=0.015). Furthermore, a total score [ranging from 0 to 4, the sum of the points for each factor (0 or 1)] ≥3 points indicated a higher probability of inclusion in the L-group than in the S-group. The diagnostic accuracy of a total score of 3 had a sensitivity of 36.3%, specificity of 100%, and area under the curve of 0.682 (95% CI: 0.558-0.806, p=0.004), and that of a total score of 4 had a sensitivity 27.4%, specificity of 98.2%, and area under the curve (AUC) of 0.627 (95% CI: 0.501-0.754, p=0.045). The diagnostic accuracy had low sensitivity but high specificity. Conclusions We found four markers that might be useful for differentiating L-group from S-group and created a novel diagnostic scoring system.

Potential Role of Gr-1+ CD8+ T Lymphocytes as a Source of Interferon-γ and M1/M2 Polarization during the Acute Phase of Murine Legionella pneumophila Pneumonia

In this study, we analyzed interferon (IFN)-γ-producing cells and M1/M2 macrophage polarization in Legionella pneumophila pneumonia following anti-Gr-1 antibody treatment. Anti-Gr-1 treatment induced an M1-to-M2 shift of macrophage subtypes in the lungs and weakly in the peripheral blood, which was associated with increased mortality in legionella-infected mice. CD8⁺ T lymphocytes and natural killer cells were the dominant sources of IFN-γ in the acute phase, and anti-Gr-1 treatment reduced the number of IFN-γ-producing CD8⁺ T lymphocytes. In the CD3-gated population, most Gr-1-positive cells were CD8⁺ T lymphocytes in the lungs and lymph nodes (LNs) of infected mice. Additionally, the number of IFN-γ-producing Gr-1⁺ CD8⁺ T lymphocytes in the lungs and LNs increased 2 and 4 days after L. pneumophila infection, with anti-Gr-1 treatment attenuating these populations. Antibody staining revealed that Gr-1⁺ CD8⁺ T lymphocytes were Ly6C-positive cells rather than Ly6G, a phenotype regarded as memory type cells. Furthermore, the adoptive transfer of Gr-1⁺ CD8⁺ T lymphocytes induced increases in IFN-γ, M1 shifting and reduced bacterial number in the Legionella pneumonia model. These data identified Ly6C⁺ CD8⁺ T lymphocytes as a source of IFN-γ in innate immunity and partially associated with reduced IFN-γ production, M2 polarization, and high mortality in anti-Gr-1 antibody-treated mice with L. pneumophila pneumonia.

Intracellular Pharmacokinetics of Antibacterials and Their Clinical Implications.

The intracellular pharmacokinetics of the different classes of antimicrobials into surrogate markers of tissue accumulation (alveolar macrophages and/or total alveolar cells collected by means of bronchoalveolar lavage or peripheral white blood cells) was reviewed. The aim of this review was to discuss the clinical implications of the intracellular pharmacokinetics of antibacterials, either from the therapeutic or toxicological perspective. The different pharmacokinetic behaviour of antimicrobials within cells is mainly related to their physicochemical properties (hydrophilicity and lipophilicity), and may have several clinical implications. Therapeutic efficacy against intracellular pathogens has been correlated mainly with the intracellular concentrations achieved by the different antimicrobial agents. This is relevant especially for macrolides, tetracyclines, fluoroquinolones and rifampicin in the treatment of bacterial infections such as Legionella pneumophila pneumonia, Mycoplasma pneumoniae pneumonia, non-gonococcal urethritis and chronic staphylococcal infections. Additionally, intracellular accumulation of antibacterials was correlated with the possibility of causing organ-specific toxicity, as in the case of aminoglycosides in regard to the risk of nephrotoxicity. Finally, it should be kept in mind that intracellular accumulation may also represent a drug reservoir in the case of lipophilic antimicrobials. This may become extremely relevant from the clinical standpoint when treating critically ill patients with sepsis with antibacterials. The pathophysiology of sepsis may explain why it is necessary to start therapy with an increased loading dose of hydrophilic antimicrobials to promptly achieve therapeutically effective concentrations.

Pulmonary Sarcoidosis in Behçet's Disease Treated with Adalimumab.

TNF-α antagonists are used to treat various rheumatic diseases including sarcoidosis. However, there have been increasing reports of sarcoidosis in relation to treatment using these drugs. The pathogenesis of this reaction remains unknown.This is a report of a clinical case of sarcoidosis in Behçet’s disease (DB) with mucocutaneous and intestinal involvement in treatment using adalimumab, with improvement after anti-TNF suspension and corticosteroid therapy.LEARNING POINTSThis clinical case demonstrates the efficacy of the anti-TNFa adalimumab in the treatment of Behçet with intestinal manifestations and not responsive to other therapeutics.To our knowledge it is the first time it is described a case of sarcoid reaction in a patient with Behçet treated with adalimumab.It shows how two complications of the use of immunosuppressants (sarcoid reaction and Legionella pneumophila pneumonia) in the same patient can difficult the correct diagnosis because of the many and overlapping clinical manifestations.

Is Google Trends a reliable tool for digital epidemiology? Insights from different clinical settings

Internet-derived information has been recently recognized as a valuable tool for epidemiological investigation. Google Trends, a Google Inc. portal, generates data on geographical and temporal patterns according to specified keywords. The aim of this study was to compare the reliability of Google Trends in different clinical settings, for both common diseases with lower media coverage, and for less common diseases attracting major media coverage. We carried out a search in Google Trends using the keywords “renal colic”, “epistaxis”, and “mushroom poisoning”, selected on the basis of available and reliable epidemiological data. Besides this search, we carried out a second search for three clinical conditions (i.e., “meningitis”, “Legionella Pneumophila pneumonia”, and “Ebola fever”), which recently received major focus by the Italian media. In our analysis, no correlation was found between data captured from Google Trends and epidemiology of renal colics, epistaxis and mushroom poisoning. Only when searching for the term “mushroom” alone the Google Trends search generated a seasonal pattern which almost overlaps with the epidemiological profile, but this was probably mostly due to searches for harvesting and cooking rather than to for poisoning. The Google Trends data also failed to reflect the geographical and temporary patterns of disease for meningitis, Legionella Pneumophila pneumonia and Ebola fever. The results of our study confirm that Google Trends has modest reliability for defining the epidemiology of relatively common diseases with minor media coverage, or relatively rare diseases with higher audience. Overall, Google Trends seems to be more influenced by the media clamor than by true epidemiological burden.

Is Google Trends a reliable tool for digital epidemiology? Insights from different clinical settings

Internet-derived information has been recently recognized as a valuable tool for epidemiological investigation. Google Trends, a Google Inc. portal, generates data on geographical and temporal patterns according to specified keywords. The aim of this study was to compare the reliability of Google Trends in different clinical settings, for both common diseases with lower media coverage, and for less common diseases attracting major media coverage. We carried out a search in Google Trends using the keywords “renal colic”, “epistaxis”, and “mushroom poisoning”, selected on the basis of available and reliable epidemiological data. Besides this search, we carried out a second search for three clinical conditions (i.e., “meningitis”, “Legionella Pneumophila pneumonia”, and “Ebola fever”), which recently received major focus by the Italian media. In our analysis, no correlation was found between data captured from Google Trends and epidemiology of renal colics, epistaxis and mushroom poisoning. Only when searching for the term “mushroom” alone the Google Trends search generated a seasonal pattern which almost overlaps with the epidemiological profile, but this was probably mostly due to searches for harvesting and cooking rather than to for poisoning. The Google Trends data also failed to reflect the geographical and temporary patterns of disease for meningitis, Legionella Pneumophila pneumonia and Ebola fever.The results of our study confirm that Google Trends has modest reliability for defining the epidemiology of relatively common diseases with minor media coverage, or relatively rare diseases with higher audience. Overall, Google Trends seems to be more influenced by the media clamor than by true epidemiological burden.

Legionnaires' disease caused by Legionella longbeachae: Clinical features and outcomes of 107 cases from an endemic area

Legionella longbeachae is a predominant cause of Legionnaires' disease in some parts of the world, particularly in Australasia. Clinical reports of L. longbeachae infection are limited to case reports or small case series, and culture-confirmed cases. We reviewed the clinical characteristics and outcomes of L. longbeachae pneumonia in a large case series from Christchurch, New Zealand during a 4-year period when both PCR and cultures were used as routine diagnostic tools for Legionnaires' disease. Cases of Legionella pneumophila pneumonia were reviewed for comparison. A total of 107 cases of L. longbeachae infection were identified by PCR and/or culture. The median age was 65 years (range 25-90 years), 63% were male, and most became unwell during spring or summer. Presenting clinical features were similar to those reported for community-acquired pneumonia, with headache, myalgia and diarrhoea being common. Elevated C-reactive protein, hyponatraemia and abnormal liver function tests were also common. History of productive cough, involvement of both lungs, and high bacterial load were independently associated with culture of Legionella from lower respiratory samples. One quarter required intensive care unit admission, and 5% died. Among patients given antimicrobial therapy before admission, those given agents without anti-Legionella activity were more likely to be admitted to the intensive care unit. Limited comparisons were made with the 19 L. pneumophila cases over the same time period. Characteristics of L. longbeachae pneumonia are broadly similar to those reported for community-acquired pneumonia from a variety of other populations, except for the spring/summer seasonality.