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Legionella pneumophila
Dr.T.V.Rao MD
                                                            
                                                                    
                            							
														
						 
											
                            Слайд 2History
The bacterium got its name after a 1976 outbreak, when many
                                                            
                                    people who went to a Philadelphia convention of the American Legion suffered from this disease, a type of pneumonia (lung infection). Although this type of bacterium was around before 1976, more illness from Legionnaires' disease is being detected now.
                                
                            							
							
							
						 
											
                            Слайд 3Disease Patterns
Each year, between 8,000 and 18,000 people are hospitalized with
                                                            
                                    Legionnaires' disease in the U.S. However, many infections are not diagnosed or reported, so this number may be higher. More illness is usually found in the summer and early fall, but it can happen any time of year.
                                
                            							
														
						 
											
                            Слайд 4Legionella pneumophila 
Legionella pneumophila is a thin, aerobic, pleomorphic, flagellated, non-spore
                                                            
                                    forming, Gram-negative bacterium of the genus Legionella. L. pneumophila is the primary human pathogenic bacterium in this group and is the causative agent of legionellosis or Legionnaires' disease.
                                
                            							
														
						 
											
                            Слайд 5Legionella pneumophila 
Legionella pneumophila is a thin, aerobic, pleomorphic, flagellated, non-spore
                                                            
                                    forming, Gram-negative bacterium of the genus Legionella.  L. pneumophila is the primary human pathogenic bacterium in this group and is the causative agent of legionellosis or Legionnaires' disease
                                
                            							
														
						 
											
                            Слайд 6Morphology
Thin, Non capsulated Gram negative bacilli
2 – 3 microns Coccobacillary 
Long
                                                            
                                    forms in culture
Motile with polar Bipolar flagella
Staining with Silver impregnation methods
                                
 
                            							
														
						 
											
											
                            Слайд 8Culturing 
Grown on Buffered charcoal yeast extract agar with L cysteine
                                                            
                                    with antibiotics
When observed under microscope appear as cut glass
L.pneumphila catalase +
                                
                            							
														
						 
											
                            Слайд 9Bacterial spread
Legionella are present in stagnant water mud and hot springs
Live
                                                            
                                    also in free living ameba 
Human infection is typically by inhalation of aerosols provided by cooling towers and air conditioners
Shower heads
Out come of infection depends on size of infective dose
                                
                            							
														
						 
											
											
                            Слайд 11Transmission
Legionella come from natural fresh water reservoirs, such as lakes, ponds,
                                                            
                                    and puddles, where they parasitize on a broad range of protozoan species as hosts. The availability of the hosts plays a major role in the reproduction and mass release of highly infectious Legionella forms into environments where they can be spread by airborne water caplets and inhaled by people
                                
                            							
														
						 
											
                            Слайд 12Pathogenesis
In humans, L. pneumophila invades and replicates in macrophages. The internalization
                                                            
                                    of the bacteria can be enhanced by the presence of antibody and complement, but is not absolutely required. Internalization of the bacteria appears to occur through phagocytosis however L. pneumophila is also capable of infecting non-phagocytic cells through an unknown mechanism. Once internalized, the bacteria surround themselves in a membrane-bound vacuole that does not fuse with lysosomes that would otherwise degrade the bacteria. In this protected compartment, the bacteria multiply.
                                
                            							
														
						 
											
                            Слайд 13Who are at Risk
Most healthy individuals do not become infected with
                                                            
                                    Legionella bacteria after exposure. People at higher risk of getting sick are:  
                                                            Older people (usually 50 years of age or older)
 Current or former smokers
  Those with a chronic lung disease (like COPD or emphysema)
  Those with a weak immune system from diseases like cancer, diabetes, or kidney failure
  People who take drugs that suppress (weaken) the immune system (like after a transplant operation or chemotherapy)
                                
                            							
														
						 
											
                            Слайд 14Facts on Legionnaires Disease 
Legionella bacteria are not transmitted from person
                                                            
                                    to person.
People get Legionnaires' disease or Pontiac fever when they breathe in a mist or vapor (small droplets of water in the air) that has been contaminated with Legionella bacteria.
Keeping Legionella bacteria out of water is the key to preventing infection.
Most people with Legionnaires' disease will have pneumonia (lung infection) since the Legionella bacteria grow and thrive in the lungs.
                                
                            							
														
						 
											
                            Слайд 15Pathogenesis
Bacteria enter through alveoli
Legionella multiply inside the Monocytes and Macrophages
CMI effective
                                                            
                                                                    
                            							
														
						 
											
                            Слайд 16Predisposing factors
Smoking
Alcohol
Age,
Hospitalization
Immunodeficiency status
Can be Community acquired or Hospital acquired
                                                            
                                                                    
                            							
														
						 
											
                            Слайд 17Reservoirs of Infection 
L. pneumophila is a facultative intracellular bacterium that
                                                            
                                    can invade and replicate inside amoebae in the environment, which can thus serve as a reservoir for L. pneumophila, as well as provide protection from environmental stresses, such as chlorination.
                                
                            							
														
						 
											
                            Слайд 18Clinically Manifest with 
Legionnaires Disease
Epidemic
Sporadic
Incubation 2- 10 days
Fever, non productive cough
Dyspnea
                                                            
                                    Pneumonia
Diarrhea Encephalopathy
Fatal if not treated in 15 – 20 %
Respiratory failure
                                
                            							
														
						 
											
                            Слайд 19Pontiac fever 
Pontiac fever is a non-pneumonic form of L. pneumophila
                                                            
                                    infection Symptoms are flu-like, including fever, tiredness, myalgia, headache, sore throat, nausea, and cough may or may not be present. Pontiac fever is self limited and requires no hospitalization or antibiotic therapies. There are no reported deaths associated with Pontiac fever.
                                
                            							
														
						 
											
											
                            Слайд 21Clinically Pontiac Fever manifests with 
A milder infection, also caused by
                                                            
                                    Legionella bacteria, is called Pontiac fever. The symptoms of Pontiac fever are similar to those of Legionnaires’ disease and usually last for 2 to 5 days. Pontiac fever is different from Legionnaires' disease because the patient does not have pneumonia.
Symptoms go away on their own without treatment.
                                
                            							
														
						 
											
                            Слайд 22Laboratory Diagnosis
Specimens 
    Sputum
    Bronchial
                                                            
                                    aspirate
    Lung biopsy
    Florescent methods
Serology ELISA
                                
                            							
														
						 
											
                            Слайд 23Diagnosis
Most people with Legionnaires' disease will have pneumonia (lung infection) since
                                                            
                                    the Legionella bacteria grow and thrive in the lungs. Pneumonia is confirmed either by chest x-ray or on physical exam.
                                
                            							
														
						 
											
                            Слайд 24Urine Antigen Test
The most commonly used laboratory test for diagnosis is
                                                            
                                    the urinary antigen test, which detects a part of the Legionella bacteria in urine (pee). If the patient has pneumonia and the test is positive, then the patient is considered to have Legionnaires' disease.
                                
                            							
														
						 
											
                            Слайд 25Culture
If the Legionella bacteria are cultured (isolated and grown on special
                                                            
                                    media) from sputum (phlegm), a lung biopsy specimen, or various other sites, the diagnosis of Legionnaires’ disease is also considered confirmed.
                                
                            							
														
						 
											
                            Слайд 26Blood Specimens
Testing the Serum 
Paired sera (blood specimens) that show a
                                                            
                                    four-fold increase in antibody levels when drawn shortly after illness and several weeks following recovery, can also be used to confirm the diagnosis.
                                
                            							
														
						 
											
                            Слайд 27Pontiac Fever
Pontiac fever can be confirmed by urine antigen or paired
                                                            
                                    sera (blood specimens), but a negative test doesn’t rule out the diagnosis. It is often diagnosed clinically in the setting of other laboratory-confirmed legionellosis cases. Culture (isolating and growing the bacteria on special media) cannot be used to diagnose Pontiac fever.
                                
                            							
														
						 
											
                            Слайд 28Detection
Sera have been used both for slide agglutination studies as well
                                                            
                                    as for direct detection of bacteria in tissues using fluorescent-labelled antibody. Specific antibody in patients can be determined by the indirect fluorescent antibody test. ELISA and micro agglutination tests have also been successfully applied
Legionella stains poorly with gram stain, stains positive with silver, and is cultured on charcoal yeast extract with iron and cysteine.
                                
                            							
														
						 
											
                            Слайд 29Treatment & Complications
Treatment
Legionnaires' disease requires treatment with antibiotics (drugs that kill
                                                            
                                    bacteria in the body), and most cases of Legionnaires’ disease can be treated successfully with antibiotics. Healthy people usually get better after being sick with Legionnaires’ disease, but hospitalization is often required. Pontiac fever goes away without specific treatment. Antibiotics provide no benefit for a patient with Pontiac fever.
                                
                            							
														
						 
											
                            Слайд 30Treatment
Respiratory fluoroquinolones and the newer macrolides are used to treat L.
                                                            
                                    pneumophila pneumonia. Treatment typically lasts 7-10 days or in the case of immunosuppressed patients, 21 days. Pontiac fever usually does not require antimicrobial therapy. 
                                
                            							
														
						 
											
                            Слайд 31Treatment
Macrolides
Ciprofloxacin
Tetracycline's
Rifampicin
                                                            
                                                                    
                            							
														
						 
											
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                                    Global education on Infectious Diseases
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