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首页> 外文期刊>The Internet Journal of Emergency and Intensive Care Medicine >Legionnaires’ disease: do not forget the fluoroquinolones or macrolides.
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Legionnaires’ disease: do not forget the fluoroquinolones or macrolides.

机译：退伍军人症：不要忘记氟喹诺酮类或大环内酯类。

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Atypical community-acquired pneumonia pathogens, such as Legionella, cause systemic infections with pneumonia. As Legionella infection is likely to present as severe pneumonia, it is important to presumptively diagnose Legionnaires’ disease clinically so that coverage against Legionella spp. is included in the initial empiric antimicrobial therapy.We described a case of respiratory failure secondary to Legionnaires’ disease. An extensive review of the literature about the clinical aspects of Legionnaires’ disease is presented. Introduction Legionella is a common cause of atypical community-acquired pneumonia in both immunosuppresed and immunocompetent patients, requiring intensive care unit admission in many cases. Legionella pneumophila causes approximately 90% of all legionellosis and between 70% - 90% of Legionnaires ’ disease is caused by Legionella pneumophila serogroup 1 (1). Legionnaires’ disease can develop into life-threatening pneumonia that might cause significant morbidity and mortality if not diagnosed and treated correctly. Clinical features do not differentiate Legionella infection from other types of pneumonia, although several clinical and nonspecific laboratory findings may suggest the diagnosis (2). Case Report An 85-year-old man was admitted to the hospital for generalized weakness, fever and confusion for 2 days. His past medical history was remarkable for hypertension, chronic obstructive pulmonary disease, atrial fibrillation, benign prostatic hypertrophy, degenerative joint disease and gastroesophageal reflux disease. His family denied any recent travel, exposure to bodies of water or contact with ill people.Vital signs on admission were: blood pressure of 195/93 mmHg, heart rate of 109 beats/minute, respiratory rate of 34 breaths/minute and temperature of 103.8oF. Oxygen saturation was 84% breathing room air that improved to 94% while receiving oxygen at 3 liters/minute by nasal canula. Physical examination showed a well-nourished white male, confused and tachypneic. Auscultation of the heart and lungs showed irregularly irregular rhythm and bilateral rales, respectively. Neurological examination showed no focal deficits. There was no cyanosis or clubbing.Initial complete blood cell count results showed a white blood cell count of 24,600/mm3 [4,000 – 11, 000], a hemoglobin level of 14.8 g/dl [11 – 16] and a platelet count of 215,000/mm3 [160 – 400]. Relevant serum chemistry results included a sodium level of 143 mEq/L [135 – 145], a bicarbonate level of 19 mEq/L [24 – 30] and a creatinine level of 1.1 mg/dl [0.6 – 1.3]. Aspartate aminotransferase level was 303 units/L [10 – 37], an alanine aminotransferase level was 165 units/L [5 – 37], an alkaline phosphatase level was 426 units/L [56 - 155], a total bilirrubin level was 1.5 mg/dl [0.2 – 1.1] and a lactate dehydrogenase level was 581 units/L [60 – 200]. Phosphate level was decreased to 1.9 mg/dl [2.5 – 4.2] and a creatine kinase level was 601 units/L [38 – 174]. Arterial blood gas result showed a pH of 7.49 [7.35 – 7.45], a pCO2 of 26 mmHg [35 – 45] and a pO2 of 120 mmHg [85 – 100], with the patient breathing oxygen at 3 liters/minute by nasal canula. Chest radiography demonstrated a right middle lung density (Figure 1), and intravenous ceftriaxone (1 g Q24h) was initiated for possible pneumonia.
机译：非典型的社区获得性肺炎病原体，例如军团菌，会引起全身性肺炎感染。由于军团菌感染很可能表现为严重的肺炎，因此重要的是，临床上推测性诊断军团菌病很重要，这样才能覆盖军团菌。最初的经验性抗微生物治疗已包括在内。我们描述了一例退伍军人病继发性呼吸衰竭的病例。介绍了有关退伍军人病临床方面文献的详尽综述。简介退伍军人病菌是免疫抑制和有免疫能力的患者中非典型性社区获得性肺炎的常见原因，在许多情况下需要重症监护病房。嗜肺军团菌约占所有军团菌病的90％，其中70％-90％的退伍军人病是由嗜肺军团菌血清群1（1）引起的。军团病可能发展为威胁生命的肺炎，如果不正确诊断和治疗，可能会导致大量发病和死亡。尽管没有几个临床和非特异性实验室检查结果可能提示诊断，但临床特征并未将军团杆菌感染与其他类型的肺炎区分开。病例报告一名85岁的男子因全身无力，发烧和精神混乱入院2天。他过去的病史对高血压，慢性阻塞性肺疾病，心房纤颤，良性前列腺肥大，退行性关节病和胃食管反流病有显着影响。他的家人否认最近有任何旅行，接触水域或与病人接触，入院时的生命体征为：血压195/93 mmHg，心律109次/分钟，呼吸率34次/分钟，体温103.8oF。氧饱和度为84％呼吸室内空气，经鼻导管以3升/分钟的速度接受氧气的同时，室内空气的氧气饱和度提高到94％。体格检查显示，白人男性营养丰富，精神错乱，呼吸急促。心脏和肺的听诊分别显示不规则的不规则节律和双侧罗音。神经系统检查未发现病灶缺陷。没有发osis或棍状。最初的全血细胞计数结果显示白血球计数为24,600 / mm3 [4,000 – 11，000]，血红蛋白水平为14.8 g / dl [11 – 16]，血小板计数为215,000 / mm3 [160 – 400]。相关的血清化学结果包括钠水平为143 mEq / L [135 – 145]，碳酸氢盐水平为19 mEq / L [24 – 30]和肌酐水平为1.1 mg / dl [0.6 – 1.3]。天门冬氨酸氨基转移酶水平为303单位/ L [10 – 37]，丙氨酸氨基转移酶水平为165单位/ L [5 – 37]，碱性磷酸酶水平为426单位/ L [56-155]，总胆红素水平为1.5毫克/分升[0.2 – 1.1]和乳酸脱氢酶水平为581单位/升[60 – 200]。磷酸盐水平降至1.9 mg / dl [2.5 – 4.2]，肌酸激酶水平为601单位/升[38 – 174]。动脉血气结果显示pH为7.49 [7.35 – 7.45]，pCO2为26 mmHg [35 – 45]和pO2为120 mmHg [85 – 100]，患者通过鼻导管以3升/分钟的速度呼吸氧气。胸部X光片显示右中肺密度（图1），并开始静脉注射头孢曲松（1 g Q24h）以治疗可能的肺炎。

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