Wednesday, 10 January 2018

Treatments For Legionnaires Disease, Diagnosis And Risks

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Legionnaires' disease takes its name from the first recognized outbreak, which occurred during a convention of the American Legion in Philadelphia, in July 1976. The bacteria spread through the air conditioning system. The first person died on 27 July, 3 days after the convention ended. During the following week, over 130 people, mostly male, were admitted to the hospital, and 25 of them died. They had all been to the same conference, and they had all stayed at the same hotel. In January 1977, the cause was identified as a previously unknown bacterium, which was then named Legionella . Legionnaires' disease is also known as legionellosis.
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Complications
Legionnaires' disease can lead to a number of life-threatening complications, including:


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  • Respiratory failure : This occurs when the lungs are no longer able to provide the body with enough oxygen or can't remove enough carbon dioxide from the blood.
  • Septic shock : This occurs when a severe, sudden drop in blood pressure reduces blood flow to vital organs, especially to the kidneys and brain. The heart tries to compensate by increasing the volume of blood pumped, but the extra workload eventually weakens the heart and reduces blood flow even further.
  • Acute kidney failure : This is the sudden loss of your kidneys' ability to perform their main function — filtering waste material from your blood. When your kidneys fail, dangerous levels of fluid and waste accumulate in your body.

When not treated effectively and promptly, legionnaires' disease may be fatal, especially if your immune system is weakened by disease or medications.

Diagnosis
Laboratory tests may include a modest increase in white blood cells, mild abnormalities in liver function studies, a low sodium in the blood, and even some decreased function of the kidneys. Nevertheless, these features can also be seen with a variety of different types of pneumonia. Chest X-rays often demonstrate abnormal densities (areas of that lungs that on the X-ray film appear whiter). However, it is difficult to distinguish Legionnaires' disease from other types of pneumonia by symptoms and chest X-ray alone. Additional specific tests are required for diagnosis.
A physician will consider the signs and symptoms, and ask whether the patient has recently spent time in a large building, such as a hotel or hospital.
Tests that can help to detect the disease include:
◾A urine test to detect antigens, the special proteins produced by the immune system to fight the Legionella bacteria
◾Blood tests
◾Imaging scans to check the state of the kidneys and lungs
A lumbar puncture, or spinal tap, can reveal whether the disease has affected the brain.

Treatments For Legionnaires Disease
There are three major classes of antibiotics that are effective in treating a Legionella infection. These include the fluoroquinolones such as
levofloxacin ( Levaquin), and moxifloxacin ( Avelox), the macrolides such as erythromycin, azithromyocin ( Zithromax ), and clarithromycin ( Biaxin), and the tetracyclines including
doxycycline ( Vibramycin). A new class of antibiotics (glycylcyclines) are also effective. The choice of antibiotic is often dependent on the patient's clinical state, tolerance to the medication, and a health care professional's degree of certainty as to the diagnosis. Zithromax and Levaquin are particularly effective because of decreased gastrointestinal irritation, higher potency, better penetration into tissue, and once-daily dosing. In severe cases of Legionnaires' disease that seem more resistant to a single antibiotic, a second drug called rifampin ( Rifadin) may be added.


Legionnaires’ disease is usually more serious in elderly people who have weakened immune systems or other medical conditions. If you’re elderly, you have a higher risk of developing complications and you may need to stay in the hospital for an extended period.



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Author: Richard Smith