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Legionnaires' disease in renal transplant patients
Abstract:
Legionnaires disease, which is commonly manifested as pneumonia, was only recently recognized to be a bacterial infection. Diagnosis can be difficult because Gram's stain does not readily stain the bacterium in pulmonary secretions, the organism is not readily cultured, and legionellae is not affected by many commonly used antibiotics. In a retrospective review of all of our transplant patients, we identified 14 cases of Legionnaires' disease after 101 renal transplants. The patients characteristically had high fever, polymorphonuclear leukocytosis, dyspnea and an unproductive cough accompanied by radiographic changes of consolidating pneumonia. Legionnaires' disease can be diagnosed by direct immunofluorescent antibody staining, culture on special media or increases in serum titers of legionella antibodies in surviving patients. Since the recognition of Legionnaires' disease in 1977, we have successfully treated seven renal transplant patients using erythromycin with or without rifampin.
Insights
Legionnaires disease, a bacterial pneumonia, poses diagnostic challenges in renal transplant patients. Early diagnosis and treatment with erythromycin, often with rifampin, are crucial for successful outcomes.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Transplant Medicine
Background:
- Legionnaires disease is a bacterial pneumonia with diagnostic difficulties.
- The bacterium is challenging to culture and identify in patient samples.
- Many common antibiotics are ineffective against Legionella.
Purpose of the Study:
- To identify cases of Legionnaires disease in renal transplant recipients.
- To characterize the clinical presentation of Legionnaires disease in this patient group.
- To evaluate treatment strategies for Legionnaires disease in transplant patients.
Main Methods:
- Retrospective review of 101 renal transplant patients.
- Analysis of clinical symptoms, laboratory findings, and radiographic data.
- Review of diagnostic methods including immunofluorescent antibody staining, culture, and serology.
Main Results:
- 14 cases of Legionnaires disease were identified in renal transplant patients.
- Patients presented with fever, leukocytosis, dyspnea, and pneumonia on radiographs.
- Diagnosis was confirmed via specific tests; successful treatment was achieved.
Conclusions:
- Legionnaires disease occurs in renal transplant recipients and presents with characteristic symptoms.
- Prompt diagnosis using specialized methods is essential.
- Erythromycin, with or without rifampin, is an effective treatment for Legionnaires disease in these patients.