Indiana University Infectious Diseases Fellowship
14 Feb,
12 tweets, 6 min read
#idboardreview 50 M from Australia works at wastewater treatment facility presents w/ fever, cough, dyspnea wbc10k, Na130, Tbili7, Alk270, AST75,ALT110 , LLL consolidation. diagnosis? #meded #idmedEd #idtwitter 
#Legionella #longbeachae far less common species in US despite its discovery in Long Beach, California (<5% of legionellosis). L #longbeachae is endemic in Australia & New Zealand
#Legionnaires disease: CAP but more GI sx (N, V, D, abd pain), neurological sx (HA, seizure, FND, obtundation) & labs (low sodium/phosphorus, inc CPK, inc LFTs, inc inflammatory markers, myoglobinurea, microscopic hematuria & relative lymphopenia)
clinical manifestations & treatment of L. longbeachae do not differ from that of L. pneumophila
#Legionella pneumophila transmitted via water sources but
L #longbeachae via soil particularly gardening soil, compost, potting soils; warning labels are included on commercial potting soil in some endemic regions.
L #longbeachae via soil particularly gardening soil, compost, potting soils; warning labels are included on commercial potting soil in some endemic regions.
R.f #legionella #longbeachae eating or drinking after gardening without hand hygiene, hanging flower pots that drip water, facial contact with compost and potting soils
-other classic r.f. COPD, smoker, old age, immunocompromised state
-other classic r.f. COPD, smoker, old age, immunocompromised state
#Legionella spp. are fastidious, requiring specialized media such as buffered charcoal yeast extract agar (BCYE), which includes iron and l-cysteine, both required for growth.
Tx #legionella levofloxacin or azithromycin. #longbeachae is often resistant to teteracycline
since urine antigen tests only detects L. pneumophila serotype 1 #longbeachae is missed so pcr is preferred but depends on adequate sputum sample. culture is gold standard but may take 3-5 d
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