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Legionellosis in the Compromised Host

  • Chapter
Clinical Approach to Infection in the Compromised Host

Abstract

Six months after the outbreak of a mysterious pneumonia among conventioneers at the state American Legion meeting in Philadelphia during the summer of 1976, Joseph McDade and his colleagues at the Centers for Disease Control identified the causative organism, a fastidious gram-negative bacillus, and subsequently named Legionella pneumophila.1 Further epidemiologic investigation led to the discovery that this organism was also responsible for even earlier outbreaks of disease for which no cause had been found.2,3.

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References

  1. McDade, JE, Shepard CC, Fraser DW, et al: Legionnaires’ disease: Isolation of a bacterium and demonstration of its role in other respiratory disease. N Engl J Med 297: 1197–1203, 1977.

    PubMed  CAS  Google Scholar 

  2. Terranova W, Cohen ML, Fraser DW: 1974 outbreak of Legionnaires’ disease diagnosed in 1977: Clinical and epidemiological features. Lancet 2: 122–124, 1978.

    PubMed  CAS  Google Scholar 

  3. Thacker SB, Bennett JV, Tsai TF, et al: An outbreak in 1965 of severe respiratory illness caused by the Legionnaires’ disease bacterium. J Infect Dis 138: 512–519, 1978.

    PubMed  CAS  Google Scholar 

  4. Fang GD, Yu VL, Vickers RM: Disease due to the Legionellaceae (other than Legionella pneumophila): Historical, microbiological, clinical, and epidemiological review. Medicine (Baltimore) 68: 116–132, 1989.

    CAS  Google Scholar 

  5. Thacker WL, Benson RF, Schifman RB, et al: Legionella tucsonensis sp. nov. isolated from a renal transplant recipient. J Clin Microbiol 27: 1831–1834, 1989.

    PubMed  CAS  Google Scholar 

  6. Griffith ME, Lindquist DS, Benson RF, et al: First isolation of Legionella gormanii from human disease. J Clin Microbiol 26: 380–381, 1988.

    PubMed  CAS  Google Scholar 

  7. Wilkinson HW, Thacker WL, Benson RF, et al: Legionella birminghamensis sp. nov. isolated from a cardiac transplant recipient. J Clin Microbiol 25: 2120–2122, 1987.

    PubMed  CAS  Google Scholar 

  8. Thacker WL, Benson RF, Staneck JL, et al: Legionella cincinnatiensis sp. nov. isolated from a patient with pneumonia. J Clin Microbiol 26: 418–420, 1988.

    PubMed  CAS  Google Scholar 

  9. Benson RF, Thacker WL, Wilkinson HW, et al: Legionella pneumophila serogroup 14 isolated from patients with fatal pneumonia. J Clin Microbiol 26: 382, 1988.

    PubMed  CAS  Google Scholar 

  10. Benson RF, Thacker WL, Fang FC, et al: Legionella sainthelensi serogroup 2 isolated from patients with pneumonia. Res Microbiol 141: 453–463, 1990.

    PubMed  CAS  Google Scholar 

  11. Reingold AL, Thomason BM, Brake BJ, et al: Legionella pneumonia in the United States: The distribution of serogroups and species causing human illness. J Infect Dis 149: 819, 1984.

    PubMed  CAS  Google Scholar 

  12. Arnow PM, Chou T, Weil D, et al: Nosocomial Legionnaires’ disease caused by aerosolized tap water from respiratory devices. J Infect Dis 146: 460–467, 1982.

    PubMed  CAS  Google Scholar 

  13. Gump DW, Frank RO, Winn WJ, et al: Legionnaires’ disease in patients with associated serious disease. Ann Intern Med 90: 538–542, 1979.

    PubMed  CAS  Google Scholar 

  14. Haley CE, Cohen ML, Halter J, et al: Nosocomial Legionnaires’ disease: A continuing common-source epidemic at Wadsworth Medical Center. Ann Intern Med 90: 583–586, 1979.

    PubMed  CAS  Google Scholar 

  15. England AC 3rd, Fraser DW, Plikaytis BD, et al: Sporadic legionellosis in the United States: The first thousand cases. Ann Intern Med 94: 164–170, 1981.

    PubMed  Google Scholar 

  16. Girod JC, Reichman RC, Winn WJ, et al: Pneumonic and non-pneumonic forms of legionellosis: The result of a common-source exposure to Legionella pneumophila. Arch Intern Med 142: 545–547, 1982.

    PubMed  CAS  Google Scholar 

  17. Fraser DW: Legionnaires’ disease: Four summers’ harvest. Am J Med 68: 1–2, 1980.

    PubMed  CAS  Google Scholar 

  18. Goldberg DJ, Wrench JG, Collier PW, et al: Lochgoilhead fever: Outbreak of non-pneumonic legionellosis due to Legionella micdadei. Lancet 1: 316–318, 1989.

    PubMed  CAS  Google Scholar 

  19. Fields BS, Barbaree JM, Sanden GN, et al: Virulence of a Legionella anisa strain associated with Pontiac fever: An evaluation using protozoan, cell culture, and guinea pig models. Infect Immun 58: 3139–3142, 1990.

    PubMed  CAS  Google Scholar 

  20. Brenner DJ: Classification of the Legionellae. Semin Respir Infect 2: 190–205, 1987.

    PubMed  CAS  Google Scholar 

  21. Brenner DJ: Classification of the Legionellae. In Thornsberry C, Balows A, Feeley JC, et al (eds): Legionella: Proceedings of the 2nd International Symposium. American Society for Microbiology, Washington, DC, 1984, pp. 55–60.

    Google Scholar 

  22. Hebert GA, Callaway CS, Ewing EP: Comparison of Legionella pneumophila, L. micdadei, L. bozemanii, and L. dumoffi by transmission electron microscopy. J Clin Microbiol 19: 116–121, 1984.

    PubMed  CAS  Google Scholar 

  23. Gress FM, Myerowitz RL, Pasculle AW, et al: The ultrastructural morphologic features of Pittsburgh Pneumonia Agent. Am J Pathol 101: 63–69, 1980.

    PubMed  CAS  Google Scholar 

  24. Chandler FW, Roth IL, Callaway CS, et al: Flagella on Legionnaires’ disease bacteria: Ultrastructural observations. Ann Intern Med 93: 711–714, 1980.

    PubMed  CAS  Google Scholar 

  25. Orrison LH, Cherry WB, Tyndall RL, et al: Legionella oakridgensis: Unusual new species isolated from cooling tower water. Appl Environ Microbiol 45: 536–545, 1983.

    PubMed  CAS  Google Scholar 

  26. Chandler FW, Hicklin MD, Blackmon JA: Demonstration of the agent of Legionnaires’ disease in tissue. N Engl J Med 297: 1218–1220, 1977.

    PubMed  CAS  Google Scholar 

  27. Liu F, Wright DN: Gram stain in Legionnaires’ disease. Am J Med 77: 549–550, 1984.

    PubMed  CAS  Google Scholar 

  28. Isenberg HD: Microbiology of Legionnaires’ disease bacterium. Ann Intern Med 90: 502–505, 1979.

    PubMed  CAS  Google Scholar 

  29. Rogers BH, Donowitz GR, Walker GK, et al: Opportunistic pneumonia: A clinicopathological study of five cases caused by an unidentified acid-fast bacterium. N Engl J Med 301: 959–961, 1979.

    PubMed  CAS  Google Scholar 

  30. Myerowitz RL, Pasculle AW, Dowling JN, et al: Opportunistic lung infection due to “Pittsburgh Pneumonia Agent.” N Engl J Med 301: 953–958, 1979.

    PubMed  CAS  Google Scholar 

  31. Hoffman PS, Pine L, Bell S: Production of Superoxide and hydrogen peroxide in medium used to culture Legionella pneumophila. Appl Environ Microbiol 45: 784–791, 1983.

    PubMed  CAS  Google Scholar 

  32. Baine WB, Rasheed JK: Aromatic substrate specificity of browning by cultures of the Legionnaires’ disease bacterium. Ann Intern Med 90: 619–620, 1979.

    PubMed  CAS  Google Scholar 

  33. Hebert GA: Hippurate hydrolysis by Legionella pneumophila. J Clin Microbiol 13: 240–242, 1981.

    PubMed  CAS  Google Scholar 

  34. Moss CW, Dees SB: Cellular fatty acid composition of WIGA, a rickettsia-like agent similar to the Legionnaires disease bacterium. J Clin Microbiol 10: 390–391, 1979.

    PubMed  CAS  Google Scholar 

  35. Moss CW, Weaver RE, Dees SB, et al: Cellular fatty acid composition of isolates from Legionnaires disease. J Clin Microbiol 6: 140–143, 1977.

    PubMed  CAS  Google Scholar 

  36. Karr DE, Bibb WF, Moss CW: Isoprenoid quinones of the genus Legionella. J Clin Microbiol 15: 1044–1048, 1982.

    PubMed  CAS  Google Scholar 

  37. Hernandez FJ, Kirby BD, Stanley TM, et al: Legionnaires’ disease: Postmortem pathologic findings of 20 cases. Am J Clin Pathol 73: 488–495, 1980.

    PubMed  CAS  Google Scholar 

  38. Winn WC Jr, Myerowitz RL: The pathology of the Legionella pneumonias: A review of 74 cases and the literature. Hum Pathol 12: 401–422, 1981.

    PubMed  Google Scholar 

  39. Glavin FL, Winn WC Jr, Craighead JE: Ultrastructure of lung in Legionnaires’ disease: Observations of three biopsies done during the Vermont epidemic. Ann Intern Med 90: 555–559, 1979.

    PubMed  CAS  Google Scholar 

  40. Hicklin MD, Thomason BM, Chandler FW, et al: Pathogenesis of acute Legionnaires’ disease pneumonia. Am J Clin Pathol 73: 480–487, 1980.

    PubMed  CAS  Google Scholar 

  41. Evans CP, Winn WC Jr: Extrathoracic localization of Legionella pneumophila in Legionnaires’ pneumonia. Am J Clin Pathol 76: 813–815, 1981.

    PubMed  CAS  Google Scholar 

  42. Watts JC, Hicklin MD, Thomason BM, et al: Fatal pneumonia caused by Legionella pneumophila, serogroup 3: Demonstration of the bacilli in extrathoracic organs. Ann Intern Med 92: 186–188, 1980.

    PubMed  CAS  Google Scholar 

  43. Weisenburger DD, Helms CM, Renner ED: Sporadic Legionnaires’ disease: A pathologic study of 23 fatal cases. Arch Pathol Lab Med 105: 130–137, 1981.

    PubMed  CAS  Google Scholar 

  44. MacRae AD, Greaves PW, Platts P: Isolation of Legionella pneumophila from blood culture. Br Med J 2: 1189–1190, 1979.

    PubMed  CAS  Google Scholar 

  45. Rodgers FG: Isolation of Legionella pneumophila from blood [letter]. Lancet 1: 925, 1979.

    PubMed  CAS  Google Scholar 

  46. Edelstein PH, Meyer RD, Finegold SM: Isolation of Legionella pneumophila from blood. Lancet 1: 750–751, 1979.

    PubMed  CAS  Google Scholar 

  47. Kalweit WH, Winn WC Jr, Rocco TA Jr, et al: Hemodialysis fistula infections caused by Legionella pneumophila. Ann Intern Med 96: 173–175, 1982.

    PubMed  CAS  Google Scholar 

  48. Dorman SA, Hardin NJ, Winn WC Jr: Pyelonephritis associated with Legionella pneumophila, serogroup 4. Ann Intern Med 93: 835–837, 1980.

    PubMed  CAS  Google Scholar 

  49. Ampel NM, Ruben FL, Norden CW: Cutaneous abscess caused by Legionella micdadei. Ann Intern Med 102: 630–631, 1985.

    PubMed  CAS  Google Scholar 

  50. Arnow PM, Boyko EJ, Friedman EL: Perirectal abscess caused by Legionella pneumophila and mixed anaerobic bacteria. Ann Intern Med 98: 184–185, 1983.

    PubMed  CAS  Google Scholar 

  51. Mayock R, Skale B, Kohler RB: Legionella pneumophila pericarditis proved by culture of pericardial fluid. Am J Med 75: 534–536, 1983.

    PubMed  CAS  Google Scholar 

  52. McCabe RE, Baldwin JC, McGregor CA, et al: Prosthetic valve endocarditis caused by Legionella pneumophila. Ann Intern Med 100: 525–527, 1984.

    PubMed  CAS  Google Scholar 

  53. Schlanger G, Lutwick LI, Kurzman M, et al: Sinusitis caused by Legionella pneumophila in a patient with the acquired immune deficiency syndrome. Am J Med 77: 957–960, 1984.

    PubMed  CAS  Google Scholar 

  54. Johnson JD, Raff MJ, Van Arsdall JA: Neurologic manifestations of Legionnaires’ disease. Medicine (Baltimore) 63: 303–310, 1984.

    CAS  Google Scholar 

  55. Pendlebury WW, Perl DP, Winn WC Jr, et al: Neuropathologic evaluation of 40 confirmed cases of Legionella pneumonia. Neurology 33: 1340–1344, 1983.

    PubMed  CAS  Google Scholar 

  56. Riggs SA, Wray NP, Waddell CC, et al: Thrombotic throm-bocytopenic purpura complicating Legionnaires’ disease. Arch Intern Med 142: 2275–2280, 1982.

    PubMed  CAS  Google Scholar 

  57. Dowling JN, Kroboth FJ, Karpf M, et al: Pneumonia and multiple lung abscesses caused by dual infection with Legionella mic-dadei and Legionella pneumophila. Am Rev RespirDis 127: 121–125, 1983.

    CAS  Google Scholar 

  58. Strikas R, Seifert MR, Lentino JR: Autoimmune hemolytic anemia and Legionella pneumophila pneumonia. Ann Intern Med 99: 345, 1983.

    PubMed  CAS  Google Scholar 

  59. Knudsen F, Nielsen AH, Hansen KB: Legionella micdadei (Pittsburgh pneumonia agent) may cause non-pneumonic legionellosis [letter]. Lancet 1: 708, 1983.

    PubMed  CAS  Google Scholar 

  60. Hall SL, Wasserman M, Dahl L, et al: Acute renal failure secondary to myoglobinuria associated with Legionnaires’ disease. Chest 84: 633–635, 1983.

    PubMed  CAS  Google Scholar 

  61. Williams ME, Watanakunakorn C, Baird IM, et al: Legionnaires’ disease with acute renal failure. Am J Med Sci 279: 177–183, 1980.

    PubMed  CAS  Google Scholar 

  62. Saleh F, Rodichok LD, Satya-Murti S, et al: Legionnaires’ disease: Report of a case with unusual manifestations. Arch Intern Med 140: 1514–1516, 1980.

    PubMed  CAS  Google Scholar 

  63. Johnson W, Elliott JA, Helms CM, et al: A high molecular weight antigen in Legionnaires’ disease bacterium: Isolation and partial characterization. Ann Intern Med 90: 638–641, 1979.

    PubMed  CAS  Google Scholar 

  64. Wong KH, Moss CW, Hochstein DH, et al: “Endotoxicity” of the Legionnaires’ disease bacterium. Ann Intern Med 90: 624–627, 1979.

    PubMed  CAS  Google Scholar 

  65. Thorpe TC, Miller RD: Extracellular enzymes of Legionella pneumophila. Infect Immun 34: 632–635, 1981.

    Google Scholar 

  66. Thompson MR, Miller RD, Iglewski BH: In vitro production of an extracellular protease by Legionella pneumophila. Infect Immun 34: 299–302, 1981.

    PubMed  CAS  Google Scholar 

  67. Winn WC Jr, Chandler FW: Role of virulence factors in Le-gionella infections. Arch Pathol Lab Med 106: 105–107, 1982.

    PubMed  Google Scholar 

  68. Friedman M, Klein TW, Friedman H: Legionella pneumophila- induced suppression of macrophage spreading in vitro. Infect Immun 42: 421–423, 1983.

    PubMed  CAS  Google Scholar 

  69. Friedman RL, Lochner JE, Bigley RH, et al: The effects of Legionella pneumophila toxin on oxidative processes and bacterial killing of human polymorphonuclear leukocytes. J Infect Dis 146: 328–334, 1982.

    PubMed  CAS  Google Scholar 

  70. Davis GS, Winn WC Jr, Gump DW, et al: Legionnaires’ pneumonia after aerosol exposure in guinea pigs and rats. Am Rev RespirDis 126: 1050–1057, 1982.

    CAS  Google Scholar 

  71. Davis GS, Winn WC Jr, Gump DW, et al: The kinetics of early inflammatory events during experimental pneumonia due to Legionella pneumophila in guinea pigs. J Infect Dis 148: 823–835, 1983.

    PubMed  CAS  Google Scholar 

  72. Katz SM, Hashemi S: Electron microscopy examination of the inflammatory response to Legionella pneumophila in guinea pigs. Lab Invest 46: 24–32, 1982.

    PubMed  CAS  Google Scholar 

  73. Blander SJ, Horwitz MA: Vaccination with Legionella pneumophila membranes induces cell-mediated immunity and protective immunity in a guinea pig model of Legionnaires’ disease. J Clin Invest 87: 1054–1059, 1991.

    PubMed  CAS  Google Scholar 

  74. Dowling JN, Pasculle AW, Frola FN, et al: Infections caused by Legionella micdadei and Legionella pneumophila among renal transplant recipients. J Infect Dis 149: 703–713, 1984.

    PubMed  CAS  Google Scholar 

  75. Lin RY, DeCotis A, Krey PR: Legionnaires’ disease complicating steroid therapy in systemic lupus erythematosis. J Rheumatol 11: 375–376, 1984.

    PubMed  CAS  Google Scholar 

  76. Kugler JW, Armitage JO, Helms CM, et al: Nosocomial Legionnaires’ disease: Occurrence in bone marrow recipients. Am J Med 74: 281–288, 1983.

    PubMed  CAS  Google Scholar 

  77. Sheldon PA, Tight RR, Renner ED: Fatal Legionnaires’ disease coincident with initiation of immunosuppressive therapy. Arch Intern Med 145: 1138–1139, 1985.

    PubMed  CAS  Google Scholar 

  78. Saravolatz LD, Burch KH, Fisher E, et al: The compromised host and Legionnaires’ disease. Ann Intern Med 90: 533–537, 1979.

    PubMed  CAS  Google Scholar 

  79. Horbach I, Fehrenbach FJ: Legionellosis in heart transplant recipients. Infection 18: 361–363, 1990.

    PubMed  CAS  Google Scholar 

  80. Rudin JE, Wing EJ: A comparative study of Legionella micdadei and other nosocomial acquired pneumonia. Chest 86: 675–680, 1984.

    PubMed  CAS  Google Scholar 

  81. Widen R, Klein T, Friedman H: Enhanced susceptibility of cyclophosphamide-treated mice to infection with Legionella pneumophila. J Infect Dis 149: 1023–1024, 1984.

    PubMed  CAS  Google Scholar 

  82. Horwitz MA, Silverstein SC: Legionnaires’ disease bacterium (Legionella pneumophila) multiples intracelluarly in human monocytes. J Clin Invest 66: 441–450, 1980.

    PubMed  CAS  Google Scholar 

  83. Nash TW, Libby DM, Horwitz MA: Interaction between the Legionnaires’ disease bacterium (Legionella pneumophila) and human alveolar macrophages: Influence of antibody, lympho-kines, and hydrocortisone. J Clin Invest 74: 771–782, 1984.

    PubMed  CAS  Google Scholar 

  84. Horwitz MA, Silverstein SC: Interaction of the Legionnaires’ disease bacterium (Legionella pneumophila) with human phagocytes. I. L. pneumophila resists killing by polymorphonuclear leukocytes, antibody, and complement. J Exp Med 153: 386–397, 1981.

    CAS  Google Scholar 

  85. Horwitz MA, Silverstein SC: Interaction of the Legionnaires’ disease bacterium (Legionella pneumophila) with human phagocytes. II. Antibody promotes binding of L. pneumophila to monocytes but does not inhibit intracellular multiplication. J Exp Med 153: 398–406, 1981.

    PubMed  CAS  Google Scholar 

  86. Weinbaum DL, Benner RR, Dowling JN, et al: Interaction of Legionella micdadei with human monocytes. Infect Immun 46: 68–73, 1984.

    PubMed  CAS  Google Scholar 

  87. Weinbaum DL, Baily J, Benner RR, et al: The contribution of human neutrophils and serum to host defense against Legionella micdadei. J Infect Dis 148: 510–517, 1983.

    PubMed  CAS  Google Scholar 

  88. Horwitz MA: Phagocytosis of the Legionnaires’ disease bacterium (Legionella pneumophila) occurs by a novel mechanism: engulfment within a pseudopod coil. Cell 36: 27–33, 1984.

    PubMed  CAS  Google Scholar 

  89. Horwitz MA: Formation of a novel phagosome by the Legionnaires’ disease bacterium (Legionella pneumophila) in human monocytes. J Exp Med 158: 1319–1331, 1983.

    PubMed  CAS  Google Scholar 

  90. Horwitz MA: The Legionnaires’ disease bacterium (Legionella pneumophila) inhibits phagosome-lysosome fusion in human monocytes. J Exp Med 158: 2108–2126, 1983.

    PubMed  CAS  Google Scholar 

  91. Horwitz MA: Cell-mediated immunity in Legionnaires’ disease. J Clin Invest 71: 1686–1697, 1983.

    PubMed  CAS  Google Scholar 

  92. Nash TW, Libby DM, Horwitz MA: IFN-7-activated human alveolar macrophages inhibit the intracellular multiplication of Le-gionella pneumophila. J Immunol 140: 3978–3981, 1988.

    PubMed  CAS  Google Scholar 

  93. Byrd TF, Horwitz MA: Interferon gamma-activated human monocytes downregulate transferrin receptors and inhibit the intracellular multiplication of Legionella pneumophila by limiting the availability of iron. J Clin Invest 83: 1457–1465, 1989.

    PubMed  CAS  Google Scholar 

  94. Marra A, Horwitz MA, Shuman HA: The HI 60 model for the interaction of human macrophages with the Legionnaires’ disease bacterium. J Immunol 144: 2738–2744, 1990.

    PubMed  CAS  Google Scholar 

  95. Cianciotto NP, Eisenstein BI, Mody CH, et al: A mutation in the mip gene results in an attenuation of Legionella pneumophila virulence. J Infect Dis 162: 121–126, 1990.

    PubMed  CAS  Google Scholar 

  96. Edelstein PH: Nosocomial Legionnaires’ disease: A global perspective. J Hosp Infect 11(Supplement A): 182–188, 1988.

    Google Scholar 

  97. Ching WT, Meyer RD: Legionella infections. Infect Dis Clin North Am 1: 595–614, 1987.

    PubMed  CAS  Google Scholar 

  98. Reingold AL: Role of Legionellae in acute infections of the lower respiratory tract. Rev Infect Dis 10: 1018–1028, 1988.

    PubMed  CAS  Google Scholar 

  99. Muder RR, Yu VL, McClure JK, et al: Nosocomial Legionnaires’ disease uncovered in a prospective pneumonia study. JAMA 249: 3184–3188, 1983.

    PubMed  CAS  Google Scholar 

  100. Ruf B, Schürmann D, Horbach I, et al: The incidence of Le-gionella pneumonia: A 1-year prospective study in a large community hospital. Lung 167: 11–22, 1989.

    PubMed  CAS  Google Scholar 

  101. Torres A, Serra-Batlles J, Ferrer A, et al: Severe community-acquired pneumonia. Am Rev Respir Dis 144: 312–318, 1991.

    PubMed  CAS  Google Scholar 

  102. Falcö V, Fernandez de Sevilla T, Alegre J, et al: Legionella pneumophila: A cause of severe community-acquired pneumonia. Chest 100: 1007–1011, 1991.

    PubMed  Google Scholar 

  103. Bock BV, Kirby BD, Edlestein PH, et al: Legionnaires’ disease in renal-transplant recipients. Lancet 1: 410–413, 1978.

    PubMed  CAS  Google Scholar 

  104. Gombert ME, Josephson A, Goldstein EJC, et al: Cavitary Legionnaires’ pneumonia: Nosocomial infection in renal transplant recipients. Am J Surg 147: 402–405, 1984.

    PubMed  CAS  Google Scholar 

  105. Copeland J, Wieden M, Feinberg W, et al: Legionnaires’ disease following cardiac transplantation. Chest 79: 669–671, 1981.

    PubMed  CAS  Google Scholar 

  106. Kusne S, Dummer JS, Singh N, et al: Infections after liver transplantation: An analysis of 101 consecutive cases. Medicine (Baltimore) 67: 132–143, 1988.

    CAS  Google Scholar 

  107. Paya CV, Hermans PE, Washington JA 2d, et al: Incidence, distribution, and outcome of episodes of infection in 100 ortho-topic liver transplantations. Mayo Clin Proc 64: 555–564, 1989.

    PubMed  CAS  Google Scholar 

  108. Bangsborg JM, Jensen BN, Friis-Müller A, et al: Legionellosis in patients with HIV infection. Infection 18: 342–346, 1990.

    PubMed  CAS  Google Scholar 

  109. Fliermans CB, Cherry WB, Orrison LH, et al: Ecological distribution of Legionella pneumophila. Appl Environ Microbiol 41: 9–16, 1981.

    PubMed  CAS  Google Scholar 

  110. Tison DL, Pope DH, Cherry WB, et al: Growth of Legionella pneumophila in association with blue-green algae (cyanobac-teria). Appl Environ Microbiol 39: 456–459, 1980.

    PubMed  CAS  Google Scholar 

  111. Tyndall RL, Domingue EL: Cocultivation of Legionella pneumophila and free-living amoebae. Appl Environ Microbiol 44: 954–959, 1982.

    PubMed  CAS  Google Scholar 

  112. Holden EP, Winkler HH, Wood DO, et al: Intracellular growth of Legionella pneumophila within Acanthamoeba castellanii Neff. Infect Immun 45: 18–24, 1984.

    PubMed  CAS  Google Scholar 

  113. Fields BS, Shotts EB Jr, Feeley JC, et al: Proliferation of Legionella pneumophila as an intracellular parasite of the ciliated protozoan Tetrahymena pyriformis. Appl Environ Microbiol 47: 467–471, 1984.

    PubMed  CAS  Google Scholar 

  114. Breiman RF, Fields BS, Sanden GN, et al: Association of showeruse with Legionnaires’ disease: Possible role of amoebae. JAMA 263: 2924–2926, 1990.

    PubMed  CAS  Google Scholar 

  115. Muder RR, Yu VI, Woo AH: Mode of transmission of Legionella pneumophila: A critical review. Arch Intern Med 146: 1607–1612, 1986.

    PubMed  CAS  Google Scholar 

  116. Tobin JO, Beare J, Dunnill MS, et al: Legionnaires’ disease in a transplant unit: Isolation of the causative agent from shower baths. Lancet 2: 118–121, 1980.

    PubMed  CAS  Google Scholar 

  117. Cordes LG, Wiesenthal AM, Gorman GW, et al: Isolation of Legionella pneumophila from hospital shower heads. Ann Intern Med 94: 195–197, 1981.

    PubMed  CAS  Google Scholar 

  118. Stout J, Yu VL, Vickers RM, et al: Ubiquitousness of Legionella pneumophila in the water supply of a hospital with endemic Legionnaires’ disease. N Engl J Med 306: 466–468, 1982.

    PubMed  CAS  Google Scholar 

  119. Helms CM, Massanari RM, Wenzel RP, et al: Legionnaires’ disease associated with a hospital water system: A five-year progress report on continuous hyperchlorination. JAMA 259: 2423–2427, 1988.

    PubMed  CAS  Google Scholar 

  120. Hanrahan JP, Morse DL, Scharf VB, et al: A community hospital outbreak of legionellosis: Transmission by potable hot water. Am J Epidemiol 125: 639–649, 1987.

    PubMed  CAS  Google Scholar 

  121. Stout JE, Yu VL, Muraca P: Legionnaires’ disease acquired within the homes of two patients: Link to the home water supply. JAMA 257: 1215–1217, 1987.

    PubMed  CAS  Google Scholar 

  122. Stout JE, Yu VL, Muraca P, et al: Potable water as a cause of sporadic cases of community-acquired Legionnaire’s disease. N Engl J Med 326: 151–155, 1992.

    PubMed  CAS  Google Scholar 

  123. Lowry PW, Blankenship RJ, Gridley W, et al: A cluster of Le-gionella sternal-wound infections due to postoperative topical exposure to contaminated tap water. N Engl J Med 324: 109–113, 1991.

    PubMed  CAS  Google Scholar 

  124. Farrell ID, Barker JE, Miles EP, et al: A field study of the survival of Legionella pneumophila in a hospital hot-water system. Epidemiol Infect 104: 381–387, 1990.

    PubMed  CAS  Google Scholar 

  125. Wadowsky RM, Yee RB, Mezmar L, et al: Hot water systems as sources of Legionella pneumophila in hospital and nonhospital plumbing fixtures. Appl Environ Microbiol 43: 1104–1110, 1982.

    PubMed  CAS  Google Scholar 

  126. Colbourne JS, Pratt DJ, Smith MG, et al: Water fittings as sources of Legionella pneumophila in a hospital plumbing system. Lancet 1: 210–213, 1984.

    PubMed  CAS  Google Scholar 

  127. Vickers RM, Yu VL, Hanna SS, et al: Determinants of Le-gionella pneumophila contamination of water distribution systems: 15-Hospital prospective study. Infect Control 8: 357–363, 1987.

    PubMed  CAS  Google Scholar 

  128. Garbe PL, Davis BJ, Weisfeld JS, et al: Nosocomial Legionnaires’ disease: Epidemiologie demonstration of cooling towers as a source. JAMA 254: 521–524, 1985.

    PubMed  CAS  Google Scholar 

  129. Dondero TJ Jr, Rendtorff RC, Mallison GF, et al: An outbreak of Legionnaires’ disease associated with a contaminated air-conditioning cooling tower. N Engl J Med 302: 365–370, 1980.

    PubMed  Google Scholar 

  130. Addiss DG, Davis JP, Wand PJ, et al: Two cases of community-acquired Legionnaires’ disease: Evidence for association with a cooling tower. J Infect Dis 159: 572–575, 1989.

    PubMed  CAS  Google Scholar 

  131. O’Mahony MC, Stanwell-Smith RE, Tillett HE, et al: The Stafford outbreak of Legionnaires’ disease. Epidemiol Infect 104: 361–380, 1990.

    PubMed  Google Scholar 

  132. Breiman RF, Cozen W, Fields BS, et al: Role of air sampling in investigation of an outbreak of Legionnaires’ disease associated with exposure to aerosols from an evaporative condenser. J Infect Dis 161: 1257–1261, 1990.

    PubMed  CAS  Google Scholar 

  133. CDC: Legionnaires’ disease outbreak associated with a grocery store mist machine-Louisiana, 1989. Morb Mortal Wkly Rep 39: 108–110, 1990.

    Google Scholar 

  134. Vogt RL, Hudson PJ, Orciari L, et al: Legionnaires’ disease and a whirlpool spa [letter]. Ann Intern Med 107: 596, 1987.

    PubMed  CAS  Google Scholar 

  135. Zuravleff JJ, Yu VL, Shonnard JW, et al: Legionella pneumophila contamination of a hospital humidifier: Demonstration of aerosol transmission and subsequent subclinicai infection in exposed guinea pigs. Am Rev Respir Dis 128: 657–661, 1983.

    PubMed  CAS  Google Scholar 

  136. Mastro TD, Fields BS, Breiman RF, et al: Nosocomial Legionnaires’ disease and use of medication nebulizers. J Infect Dis 163: 667–671, 1991.

    PubMed  CAS  Google Scholar 

  137. Woo AH, Yu VL, Goetz A: Potential in-hospital modes of transmission of Legionella pneumophila: Demonstration experiments for dissemination by showers, humidifiers, and rinsing of ventilation bag apparatus. Am J Med 80: 567–573, 1986.

    PubMed  CAS  Google Scholar 

  138. Anonymous: Trouble in the potting shed. Lancet 336: 151-152, 1990.

    Google Scholar 

  139. Redd SC, Lin FYC, Fields BS, et al: A rural outbreak of Legionnaires’ disease linked to visiting a retail store. Am J Public Health 80: 431–434, 1990.

    PubMed  CAS  Google Scholar 

  140. Timbury MC, Donaldson JR, McCartney AC, et al: How to deal with a hospital outbreak of Legionnaires’ disease. J Hosp Infect 11(Supplement A): 189–195, 1988.

    PubMed  Google Scholar 

  141. Goetz A, Yu VL: Screening for nosocomial legionellosis by culture of the water supply and targeting of high-risk patients for specialized laboratory testing [editorial]. Am J Infect Control 19: 63–66, 1991.

    PubMed  CAS  Google Scholar 

  142. Stout JE, Joly J, Para M, et al: Comparison of molecular methods for subtyping patients and epidemiologically linked environmental isolates of Legionella pneumophila. J Infect Dis 157: 486–495, 1988.

    PubMed  CAS  Google Scholar 

  143. Pfaller M, Hollis R, Johnson W, et al: The application of molecular and immunologic techniques to study the epidemiology of Legionella pneumophila serogroup 1. Diagn Microbiol Infect Dis 12: 295–302, 1989.

    PubMed  CAS  Google Scholar 

  144. Dournon E, Bibb WF, Rajagopalan P, et al: Monoclonal antibody reactivity as a virulence marker for Legionella pneumophila serogroup 1 strains. J Infect Dis 157: 496–501, 1988.

    PubMed  CAS  Google Scholar 

  145. Joly JR, Winn WC: Correlation of subtypes of Legionella pneumophila defined by monclonal antibodies with epidemiological classification of cases and environmental sources. J Infect Dis 150: 667–671, 1984.

    PubMed  CAS  Google Scholar 

  146. Muraca PW, Yu VL, Goetz A: Disinfection of water distribution systems for Legionella: A review of application procedures and methodologies. Infect Control Hosp Epidemiol 11: 79–88, 1990.

    PubMed  CAS  Google Scholar 

  147. Snyder MB, Siwicki M, Wireman J, et al: Reduction in Legionella pneumophila through heat flushing followed by continuous supplemental chlorination of hospital hot water. J Infect Dis 162: 127–132, 1990.

    PubMed  CAS  Google Scholar 

  148. Dennis PJ, Taylor JA, Fitzgeorge RB, et al: Legionella pneumophila in water plumbing systems. Lancet 1: 949–957, 1982.

    PubMed  CAS  Google Scholar 

  149. Tobin JO, Swann RA, Bartlett CL: Isolation of Legionella pneumophila from water systems: Methods and preliminary results. Br Med J (Clin Res) 282: 515–517, 1981.

    CAS  Google Scholar 

  150. Redd SC, Cohen ML: Legionella in water: What should be done? [editorial]. JAMA 257: 1221–1222, 1987.

    PubMed  CAS  Google Scholar 

  151. Winn WJ. The problem of environmental Legionella. Infect Control 6: 139–140, 1985.

    PubMed  Google Scholar 

  152. Katz SM, Habib WA, Hammel JM, et al: Lack of airborne spread of infection by Legionella pneumophila among guinea pigs. Infect Immun 38: 620–622, 1982.

    PubMed  CAS  Google Scholar 

  153. Yu VL, Zuravleff JJ, Gavlik L, et al: Lack of evidence for person-to-person transmission of Legionnaires’ disease. J Infect Dis 147: 362, 1983.

    PubMed  CAS  Google Scholar 

  154. Vereerstraeten P, Stolear J-C, Schoutens-Serruys E, et al: Erythromycin prophylaxis for Legionnaire’s disease in immu nosuppressed patients in a contaminated hospital environment. Transplantation 41: 52–54, 1986.

    PubMed  CAS  Google Scholar 

  155. Tsai TF, Finn DR, Plikaytis BD, et al: Legionnaires’ disease: Clinical features of the epidemic in Philadelphia. Ann Intern Med 90: 509–517, 1979.

    PubMed  CAS  Google Scholar 

  156. Broome CV, Goings SA, Thacker SB, et al: The Vermont epidemic of Legionnaires’ disease. Ann Intern Med 90: 573–577, 1979.

    PubMed  CAS  Google Scholar 

  157. Helms CM, Viner JP, Sturm RH, et al: Comparative features of pneumococcal, mycoplasmal, and Legionnaires’ disease pneumonias. Ann Intern Med 90: 543–547, 1979.

    PubMed  CAS  Google Scholar 

  158. Yu VL, Kroboth FJ, Shonnard J, et al: Legionnaires’ disease: New clinical perspective from a prospective pneumonia study. Am J Med 73: 357–361, 1982.

    PubMed  CAS  Google Scholar 

  159. Kirby BD, Snyder KM, Meyer RD, et al: Legionnaires’ disease: Report of sixty-five nosocomially acquired cases and review of the literature. Medicine (Baltimore) 59: 188–205, 1980.

    CAS  Google Scholar 

  160. Kirby BD, Snyder KM, Meyer RD, et al: Legionnaires’ disease: Clinical features of 24 cases. Ann Intern Med 89: 297–309, 1978.

    PubMed  CAS  Google Scholar 

  161. Kroboth FJ, Yu VL, Reddy SC, et al: Clinicoradiographic correlation with the extent of Legionnaire disease. Am J Roentgenol 141: 263–268, 1983.

    CAS  Google Scholar 

  162. Kirby BD, Peck H, Meyer RD: Radiographic features of Legionnaires’ disease. Chest 76: 562–565, 1979.

    PubMed  CAS  Google Scholar 

  163. Fairbank JT, Mamourian AC, Dietrich PA, et al: The chest radiograph in Legionnaires’ disease: Further observations. Radiology 147: 33–34, 1983.

    PubMed  CAS  Google Scholar 

  164. Edelstein PH, Meyer RD, Finegold SM: Long-term followup of two patients with pulmonary cavitation caused by Legionella pneumophila. Am Rev Respir Dis 124: 90–93, 1981.

    PubMed  CAS  Google Scholar 

  165. Lake KB, Van Dyke JJ, Gerberg E, et al: Legionnaires’ disease and pulmonary cavitation. Arch Intern Med 139: 485–486, 1979.

    PubMed  CAS  Google Scholar 

  166. Lewin S, Brettman LR, Goldstein EJ, et al: Legionnaires’ disease: A cause of severe abscess-forming pneumonia. Am J Med 67: 339–342, 1979.

    PubMed  CAS  Google Scholar 

  167. Dietrich PA, Johnson RD, Fairbank JT, et al: The chest radiograph in Legionnaires’ disease. Radiology 127: 577–582, 1978.

    PubMed  CAS  Google Scholar 

  168. Pope TL Jr, Armstrong P, Thompson R, et al: Pittsburgh pneumonia agent: Chest film manifestations. Am J Roentgenol 138: 237–241, 1982.

    Google Scholar 

  169. Muder RR, Reddy SC, Yu VL, et al: Pneumonia caused by Pittsburgh pneumonia agent: Radiologie manifestations. Radiology 150: 633–637, 1984.

    PubMed  CAS  Google Scholar 

  170. Bernardini DL, Lerrick KS, Hoffman K, et al: Neurogenic bladder: New clinical finding in Legionnaires’ disease. Am J Med 78: 1045–1046, 1985.

    PubMed  CAS  Google Scholar 

  171. Posner MR, Caudill MA, Brass R, et al: Legionnaires’ disease associated with rhabdomyolysis and myoglobinuria. Arch Intern Med 140: 848–850, 1980.

    PubMed  CAS  Google Scholar 

  172. Allen TP, Fried JS, Wiegmann TB, et al: Legionnaires’ disease associated with rash and renal failure. Arch Intern Med 145: 729–730, 1985.

    PubMed  CAS  Google Scholar 

  173. Wegmüller E, Weidmann P, Hess T, et al: Rapidly progressive glomerulonephritis accompanying Legionnaires’ disease. Arch Intern Med 145: 1711–1713, 1985.

    PubMed  Google Scholar 

  174. Marshall W, Foster RS Jr, Winn W: Legionnaires’ disease in renal transplant patients. Am J Surg 141: 423–429, 1981.

    PubMed  CAS  Google Scholar 

  175. Warner CL, Fayad PB, Heffner RR Jr: Legionella myositis. Neurology 41: 750–752, 1991.

    PubMed  CAS  Google Scholar 

  176. Nelson DP, Rensimer ER, Raffin TA: Legionella pneumophila pericarditis without pneumonia. Arch Intern Med 145: 926, 1985.

    PubMed  CAS  Google Scholar 

  177. Tompkins LS, Roessler BJ, Redd SC, et al: Legionella prostheticvalve endocarditis. N Engl J Med 318: 530–535, 1988.

    PubMed  CAS  Google Scholar 

  178. Sharrar RG, Friedman HM, Miller WT, et al: Summertime pneumonias in Philadelphia in 1976: An epidemiologic study. Ann Intern Med 90: 577–580, 1979.

    PubMed  CAS  Google Scholar 

  179. Baptiste-Desruisseaux D, Duperval R, Marcoux JA: Legionnaires’ disease in the immunocompromised host: Usefulness of Gram’s stain. Can Med Assoc J 133: 117–118, 1985.

    PubMed  CAS  Google Scholar 

  180. Fraser DW, Tsai TR, Orenstein W, et al: Legionnaires’ disease: Description of an epidemic of pneumonia. N Engl J Med 297: 1189–1197, 1977.

    PubMed  CAS  Google Scholar 

  181. Meyer RD, Edelstein PH, Kirby BD, et al: Legionnaires’ disease: Unusual clinical and laboratory features. Ann Intern Med 93: 240–243, 1980.

    PubMed  CAS  Google Scholar 

  182. Edelstein PH, Meyer RD, Finegold SM: Laboratory diagnosis of Legionnaires’ disease. Am Rev Respir Dis 121: 317–327, 1980.

    PubMed  CAS  Google Scholar 

  183. Nunn C, Chereshsky A, Pearce JL: Atypical pneumonia caused by dual infection with Legionella pneumophila and Mycoplasma pneumoniae. N Z Med J 103: 512–513, 1990.

    PubMed  CAS  Google Scholar 

  184. Muder RR, Yu VL, Vickers RM, et al: Simultaneous infection with Legionella pneumophila and Pittsburgh pneumonia agent: Clinical features and epidemiologic implications. Am J Med 74: 609–614, 1983.

    PubMed  CAS  Google Scholar 

  185. Broome CV, Cherry WB, Winn WC Jr, et al: Rapid diagnosis of Legionnaires’ disease by direct immunofluorescent staining. Ann Intern Med 90: 1–4, 1979.

    PubMed  CAS  Google Scholar 

  186. Zuravleff JJ, Yu VL, Shonnard JW, et al: Diagnosis of Legionnaires’ disease: An update of laboratory methods with new emphasis on isolation by culture. JAMA 250: 1981–1985, 1983.

    PubMed  CAS  Google Scholar 

  187. Buesching WJ, Brust RA, Ayers LW: Enhanced primary isolation of Legionella pneumophila from clinical specimens by low-pH treatment. J Clin Microbiol 17: 1153–1155, 1983.

    PubMed  CAS  Google Scholar 

  188. Edelstein PH, McKinney RM, Meyer RD, et al: Immunologic diagnosis of Legionnaires’ disease: Cross-reactions with anareobic and microaerophilic organisms and infections caused by them. J Infect Dis 141: 652–655, 1980.

    PubMed  CAS  Google Scholar 

  189. Johnson DA, Wagner KF, Blanks J, et al: False-positive direct fluorescent antibody testing for Legionella [letter]. JAMA 253: 40–41, 1985.

    PubMed  CAS  Google Scholar 

  190. Ristagno RL, Saravolatz LD: A pseudoepidemic of Legionella infections. Chest 88: 466–467, 1985.

    PubMed  CAS  Google Scholar 

  191. Edelstein PH: Improved semiselective medium for isolation of Legionella pneumophila from contaminated clinical and environmental specimens. J Clin Microbiol 14: 298–303, 1981.

    PubMed  CAS  Google Scholar 

  192. Pasculle AW, Feeley JC, Gibson RJ, et al: Pittsburgh pneumonia agent: Direct isolation from human lung tissue. J Infect Dis 141: 727–732, 1980.

    PubMed  CAS  Google Scholar 

  193. Vickers RM, Brown A, Garrity GM: Dye-containing buffered charcoal-yeast extract medium for differentiation of members of the family Legionellaceae. J Clin Microbiol 13: 380–382, 1981.

    PubMed  CAS  Google Scholar 

  194. Kohorst WR, Schonfeld SA, Macklin JE, et al: Rapid diagnosis of Legionnaires’ disease by bronchoalveolar lavage. Chest 84: 186–190, 1983.

    PubMed  CAS  Google Scholar 

  195. Bartlett JG: The technique of transtracheal aspirate: When and how to use TTA to diagnose severe pneumonia. J Crit Illness 1: 43–49, 1986.

    Google Scholar 

  196. Wing EJ, Schafer FJ, Pasculle AW: The use of tracheal and pulmonary aspiration to diagnose Legionella micdadei pneumonia. J Clin Microbiol 13: 380–382, 1982.

    Google Scholar 

  197. Rihs JD, Yu VL, Zuravleff JJ, et al: Isolation of Legionella pneumophila from blood with the BACTEC system: A prospective study yielding positive results. J Clin Microbiol 22: 422–424, 1985.

    PubMed  CAS  Google Scholar 

  198. Reinhardt JF, Nakahama C, Edelstein PH: Comparison of blood culture methods for recovery of Legionella pneumophila from the blood of guinea pigs with experimental infection. J Clin Microbiol 25: 719–721, 1987.

    PubMed  CAS  Google Scholar 

  199. Chester B, Poulos EG, Demaray MJ, et al: Isolation of Legionella pneumophila serogroup 1 from blood with nonsupplemented blood culture bodies. J Clin Microbiol 17: 195–197, 1983.

    PubMed  CAS  Google Scholar 

  200. Wilkinson HW: Serodiagnosis of legionellosis: Legionella pneumophila, L. bozemanii, L. micdadei, and L. gormanii as indirect immunofluorescence antigens. In Schlessinger D (ed): Microbiology 1981. American Society for Microbiology, Washington, DC, 1981, pp. 165–168.

    Google Scholar 

  201. Sathapatayavongs B, Kohler RB, Wheat LJ, et al: Rapid diagnosis of Legionnaires’ disease by latex agglutination. Am Rev Respir Dis 127: 559–562, 1983.

    PubMed  CAS  Google Scholar 

  202. Sedgwick AK, Tilton RC: Identification of Legionella pneumophila by latex agglutination. J Clin Microbiol 17: 365–368, 1983.

    PubMed  CAS  Google Scholar 

  203. Kohler RB, Zimmerman SE, Wilson E, et al: Rapid radioimmunoassay diagnosis of Legionnaires’ disease. Ann Intern Med 94: 601–605, 1981.

    PubMed  CAS  Google Scholar 

  204. Brindle RJ: Nosocomial Legionnaires’ disease—advances in diagnosis and typing. J Hosp Infect 11(Suppl A): 196–200, 1988.

    PubMed  Google Scholar 

  205. Sampson JS, Wilkinson HW, Tsang VCW, et al: Kinetic-dependent enzyme-linked immunosorbent assay for detection of antibodies to Legionella pneumophila. J Clin Microbiol 18: 1340–1344, 1983.

    PubMed  CAS  Google Scholar 

  206. Wilkinson HW, Crude DD, Broome CV: Validation of Legionella pneumophila indirect immunofluorescence assay with epidemic sera. J Clin Microbiol 13: 139–146, 1981.

    PubMed  CAS  Google Scholar 

  207. Wilkinson HW, Reingold AL, Brake BJ, et al: Reactivity of serum from patients with suspected legionellosis against 29 antigens of Legionellaceae and Legionella-like organisms by indirect immunofluorescence assay. J Infect Dis 147: 23–31, 1983.

    PubMed  CAS  Google Scholar 

  208. Gray JJ, Ward KN, Warren RE, et al: Serological cross-reaction between Legionella pneumophila and Citrobacter freundii in indirect immunofluorescence and rapid microagglutination tests. J Clin Microbiol 29: 200–201, 1991.

    PubMed  CAS  Google Scholar 

  209. Katz SM, Holsclaw DS Jr: Serum antibodies to Legionella pneumophila in patients with cystic fibrosis. JAMA 248: 2284–2288, 1982.

    PubMed  CAS  Google Scholar 

  210. Kohler RB, Winn WC Jr, Wheat LJ: Onset and duration of urinary antigen excretion in Legionnaires’ disease. J Clin Microbiol 20: 605–607, 1984.

    PubMed  CAS  Google Scholar 

  211. Ruf B, Schürmann D, Horbach I, et al: Prevalence and diagnosis of Legionella pneumonia: A 3-year prospective study with emphasis on application of urinary antigen detection. J Infect Dis 162: 1341–1348, 1990.

    PubMed  CAS  Google Scholar 

  212. Wilkinson HW, Sampson JS, Plikaytis BB: Evaluation of a commercial gene probe for identification of Legionella cultures. J Clin Microbiol 23: 217–220, 1984.

    Google Scholar 

  213. Edelstein PH: Evaluation of the Gen-Probe DNA probe for the detection of legionellae in culture. J Clin Microbiol 23: 481–484, 1986.

    PubMed  CAS  Google Scholar 

  214. Laussucq S, Schuster D, Alexander WJ, et al: False-positive DNA probe test for Legionella species associated with a cluster of respiratory illnesses. J Clin Microbiol 26: 1442–1444, 1988.

    PubMed  CAS  Google Scholar 

  215. Fain JS, Bryan RN, Cheng L, et al: Rapid diagnosis of Legionella infection by a nonisotopic in situ hybridization method. Am J Clin Pathol 95: 719–724, 1991.

    PubMed  CAS  Google Scholar 

  216. Wing EJ, Schafer FJ, Pasculle AW: Successful treatment of Legionella micdadei (Pittsburgh Pneumonia Agent) pneumonia with erythromycin. Am J Med 71: 836–840, 1981.

    PubMed  CAS  Google Scholar 

  217. Rudin JE, Evans TL, Wing EJ: Failure of erythromycin in treatment of Legionella micdadei pneumonia. Am J Med 76: 318–320, 1984.

    PubMed  CAS  Google Scholar 

  218. Unertl KE, Lenhart FP, Forst H, et al: Brief report: Ciprofloxacin in the treatment of legionellosis in critically ill patients including those cases unresponsive to erythromycin. Am J Med 87(Supplement 5A): 128S–130S, 1989.

    PubMed  CAS  Google Scholar 

  219. Dournon E, Mayaud C, Wolff M, et al: Comparison of the activity of three antibiotic regimens in severe Legionnaires’ disease. J Antimicrob Chemother 26(Supplement B): 129–139, 1990.

    PubMed  Google Scholar 

  220. Hooper TL, Gould FK, Swinburn CR, et al: Ciprofloxacin: A preferred treatment for Legionella infections in patients receiving cyclosporin A [letter]. J Antimicrob Chemother 22: 952–953, 1988.

    PubMed  CAS  Google Scholar 

  221. Kurz RW, Graninger W, Egger TP, et al: Failure of treatment of Legionella pneumonia with ciprofloxacin [letter]. J Antimicrob Chemother 22: 389–391, 1988.

    PubMed  CAS  Google Scholar 

  222. Fraser DW, Wachsmuth I, Bopp C, et al: Antibiotic treatment of guinea-pigs infected with agent of Legionnaires’ disease. Lancet 1: 175–178, 1978.

    PubMed  CAS  Google Scholar 

  223. Plouffe JF, Para MF, Bollin GE: Sulfamethoxazole-trimethoprim treatment of guinea pigs infected with Legionella pneumophila. J Infect Dis 150: 780–782, 1978.

    Google Scholar 

  224. Winn WCJ, Davis GS, Gump DW, et al: Legionnaires’ pneumonia after intratracheal inoculation of guinea pigs and rats. Lab Invest 47: 568–578, 1982.

    PubMed  Google Scholar 

  225. Edelstein PH, Calarco K, Yasui VK: Antimicrobial therapy of experimentally induced Legionnaires’ disease in guinea pigs. Am Rev Respir Dis 130: 849–856, 1984.

    PubMed  CAS  Google Scholar 

  226. Edelstein PH: Rifampin resistance of Legionella pneumophila is not increased during therapy for experimental Legionnaires disease: Study of rifampin resistance using a guinea pig model of Legionnaires disease. Antimicrob Agents Chemother 35: 5–9, 1991.

    PubMed  CAS  Google Scholar 

  227. Saito A, Koga H, Shigeno H, et al: The antimicrobial activity of ciprofloxacin against Legionella species and the treatment of experimental Legionella pneumonia in guinea pigs. J Antimicrob Chemother 18: 251–260, 1986.

    PubMed  CAS  Google Scholar 

  228. Edelstein PH, Edelstein MAC, Weidenfeld J, et al: In vitro activity of sparfloxacin (Cl-978; At-4140) for clinical Legionella isolates, pharmacokinetics in guinea pigs, and use to treat guinea pigs with L. pneumophila pneumonia. Antimicrob Agents Chemother 34: 2122–2127, 1990.

    PubMed  CAS  Google Scholar 

  229. Fitzgeorge RB, Featherstone AS, Bakerville A: Efficacy of azithromycin in the treatment of guinea pigs infected with Legionella pneumophila by aerosol. J Antimicrob Chemother 25(Suppl A): 101–108, 1990.

    PubMed  CAS  Google Scholar 

  230. Thornsberry C, Baker CN, Kirven LA: In vitro activity of antimicrobial agents on Legionnaires disease bacterium. Antimicrob Agents Chemother 13: 78–80, 1978.

    PubMed  CAS  Google Scholar 

  231. Edelstein PH, Edelstein MA: In vitro activity of azithromycin against clinical isolates of Legionella species. Antimicrob Agents Chemother 35: 180–181, 1991.

    PubMed  CAS  Google Scholar 

  232. Felmingham D, Robbins MJ, Sanghrajka M, et al: The in vitro activity of some 14-, 15-and 16-membered macrolides against Staphylococcus spp. Legionella spp., Mycoplasma spp. and Ureaplasma urealyticum. Drugs Exp Clin Res 17: 91–99, 1991.

    CAS  Google Scholar 

  233. Edelstein PW, Meyer RD: Susceptibility of Legionella pneumophila to twenty antimicrobial agents. Antimicrob Agents Chemother 18: 403–408, 1980.

    PubMed  CAS  Google Scholar 

  234. Pasculle AW, Dowling JN, Weyant RS, et al: Susceptibility of Pittsburgh pneumonia agent (Legionella micdadei) and other newly recognized members of the genus Legionella to nineteen antimicrobial agents. Antimicrob Agents Chemother 20: 793–799, 1981.

    PubMed  CAS  Google Scholar 

  235. Dowling JN, Weyant RS, Pasculle AW: Bacterial activity of antibiotics against Legionella micdadei (Pittsburgh pneumonia agent). Antimicrob Agents Chemother 22: 272–276, 1982.

    PubMed  CAS  Google Scholar 

  236. Edelstein PH, Gaudet EA, Edelstein MAC: In vitro activity of lomefloxacin (NY-198 or SC47111), ciprofloxacin, and erythromycin against 100 clinical Legionella strains. Diagn Microbiol Infect Dis 12: 93S–95S, 1989.

    PubMed  CAS  Google Scholar 

  237. Johnson JD, Hand WL, Francis JB, et al: Antibiotic uptake by alveolar macrophages. J Lab Clin Med 95: 429–439, 1980.

    PubMed  CAS  Google Scholar 

  238. Yoshida S-I, Mizuguchi Y: Antibiotic susceptibility of Legionella pneumophila Philadelphia-1 in cultured guinea-pig peritoneal macrophages. J Gen Microbiol 130: 901–906, 1984.

    PubMed  CAS  Google Scholar 

  239. Horwitz MA, Silverstein SC: Intracellular multiplication of Legionnaires’ disease bacteria (Legionella pneumophila) in human monocytes is reversibly inhibited by erythromycin and rifampin. J Clin Invest 71: 15–26, 1983.

    PubMed  CAS  Google Scholar 

  240. Gibson DH, Fitzgeorge RB: Persistence in serum and lungs of guinea pigs of erythromycin, gentamicin, chloramphenicol and rifampicin and their in-vitro activities against Legionella pneumophila. J Antimicrob Chemother 12: 235–244, 1983.

    PubMed  CAS  Google Scholar 

  241. Karmody CS, Weinstein L: Reversible sensorineural hearing loss with erythromycin lactobionate. Ann Otol Rhin Laryng 86: 9–11, 1977.

    CAS  Google Scholar 

  242. Martell R, Heinrichs D, Stiller CR, et al: The effects of erythromycin in patients treated with cyclosporine. Ann Intern Med 104: 660–661, 1986.

    PubMed  CAS  Google Scholar 

  243. Jensen CW, Flechner SM, Van Buren CT, et al: Exacerbation of cyclosporine toxicity by concomitant administration of erythromycin. Transplantation 43: 263–270, 1987.

    PubMed  CAS  Google Scholar 

  244. Langhoff E, Madsen S: Rapid metabolism of cyclosporine and prednisone in kidney transplant patients receiving tuberculostatic treatment. Lancet 2: 1031, 1983.

    PubMed  CAS  Google Scholar 

  245. Sanders KL, Walker DH, Lee TJ: Relapse of Legionnaires’ disease in a renal transplant recipient. Arch Intern Med 140: 833–834, 1980.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Section of Infectious Diseases, Veterans Administration Medical Center, University of Arizona Health Sciences Center, Tucson, Arizona, 85724, USA

    Neil M. Ampel

  2. Montefiore University Hospital, and Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 15213, USA

    Edward J. Wing

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Editors and Affiliations

  1. Massachusetts General Hospital, Boston, Massachusetts, USA

    Robert H. Rubin M.D. (Chief of Transplantation Infectious Disease, Director of the Center for Experimental Pharmacology and Therapeutics) (Chief of Transplantation Infectious Disease, Director of the Center for Experimental Pharmacology and Therapeutics)

  2. Division of Health Sciences and Technology, Harvard University-Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

    Robert H. Rubin M.D. (Chief of Transplantation Infectious Disease, Director of the Center for Experimental Pharmacology and Therapeutics) (Chief of Transplantation Infectious Disease, Director of the Center for Experimental Pharmacology and Therapeutics)

  3. Pacific California Medical Center, San Francisco, California, USA

    Lowell S. Young M.D. (Director of Kuzell Institute for Arthritis and Infectious Diseases, Chief of Division of Infectious Diseases) (Director of Kuzell Institute for Arthritis and Infectious Diseases, Chief of Division of Infectious Diseases)

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Ampel, N.M., Wing, E.J. (1994). Legionellosis in the Compromised Host. In: Rubin, R.H., Young, L.S. (eds) Clinical Approach to Infection in the Compromised Host. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-2490-8_11

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