The incubation menses is from 2 to 10 days in the legionnaires disease . The initial symptoms of both Legionnaire disease and Pontiac fever are characterized by anorexia , malaise , myalgia(muscle infliction ) andheadache . In the condition of a day , fever can seem rising cursorily , with temperatures between 39 ºC and 40.5 ºC accompany by chills . wry coughandchest pain in the neck , occasionally pleuritic , may be prominent and when combined with haemoptysis ( blood expectoration ) , can mistakenly hint apulmonary embolism . Gastrointestinal symptoms are important , especially looseness , which occurs between 20 % and 40 % of cases ; the dejection are more liquid than bloody .
The clinical spectrum of the disease due to Legionella coinage is broad and rate from asymptomatic infection to quickly progressivepneumonia . Legionnaire ’ disease can not be distinguished clinically or radiologically from pneumonia have by other agent , and evidence of contagion by other respiratory pathogen does not exclude the possibility of resultant contagion with Legionella .
The Diagnosis Of Legionnaires Disease Can Be Confirmed By Any Of These method acting :
-Isolation by Legionella culture in respiratory secernment or tissues .
-Microscopic visualization of the bacteria in the respiratory secernment or tissues by immunofluorescent microscopy .
-Detection of antigen in urine in the case of Legionellosis due to L. pneumophila serogroup 1 by radioimmunoassay .
-Detection of EL of the antibody titer up to = 1 : 128 in paired sample of sera by the collateral immunofluorescence test .
Because each of the legionnaires disease test mentioned above complements each other , the completion of these , when the disease is suspected , increases the chance of confirming the diagnosis . However , since none of the laboratory tests is 100 % sore , the diagnosis of Legionellosis is not except if one or more of these are negative . Of the available tests , the most specific is the isolation in the culture of the Legionella metal money from any sample of the respiratory pathway .
Can Legionnaires Disease Be Cured?
The legionnaires disease can be cure . The handling for legionnaire disease is free-base on the use of antibiotic drug , which should be chosen from the group of macrolides ( erythromycin , clarithromycin , azithromycin … ) which are wide used antibiotic in respiratory infections . Recently , another group of antibiotic drug ( quinolones ) have also shown their activeness . In worldwide , hospital admission is normally required due to the severity of the legionnaires disease .
The delay of an appropriate treatment against Legionella pneumonia contribute to significantly increase mortality from this disease ; that is why a specific therapy should be initiated in the face of severe case of residential district - acquired pneumonia .
Historically , the medicine of choice for legionnaire disease has been Erythromycin , but gastrointestinal intolerance and ototoxicity ( being toxic to the pinna ) triggered by doses of up to 4 grams of this drug have made it in recent years considered less attractive equate to the new existing macrolides , specially Azithromycin , which is more participating in vitro and imbue more easily in lung tissue paper . Other antibiotics such as clarithromycin , josamycin , and roxithromycin have been effectual in anecdotal reports .
The quinolones also have higher in vitro activity and higher intracellular penetration than the macrolides . legion cases have been successfully treated with quinolones , especially with ciprofloxacin .
Due to the pharmacologic interaction of macrolides and rifampicin with immunosuppressive drug after transplantation , ciprofloxacin or levofloxacin is recommend for case of Legionnaires ’ Disease in transplant recipients .
Other legionnaires disease drugs such as Tetracycline , Minocin , Vibramycin , imipenem , trimetropim sulfamethoxazole , and ofloxacin are very effectual for the intervention of this disease .
The presidency of intravenous antibiotic should not be substituted by the oral route until a clinical improvement of the legionnaires disease patient is observed , which in most case ordinarily occurs after three days when the feverishness disappears .
The total duration of legionnaires disease intervention is 10 to 14 days , although it can be sustain up to 21 years in those immunosuppressed patients or with grounds of the disease on bureau radiography , for this a 5- to 10 - day treatment with Azithromycin is recommended .
In general , it is possible to verify that macrolides and quinolones are the antibiotic drug of choice in immunosuppressed patients , both with nosocomial pneumonia and community - acquired pneumonia , as well as in case of pneumonia due to other morbific broker .
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