Active Ingredient: Azithromycin
Systematic testing of samples with suspected prosthetic infection by molecular biology techniques was essential. Legionella micdadei should be added to the list of microorganisms causing prosthetic joint infection.
Among these infections, Aspergillus is a common cause of fatal pneumonia.
Owing to the precarious clinical condition of many patients who acquire invasive mold infections, clinicians often treat them on the basis of radiographic findings, such as the halo sign. However, in patients who do not respond to treatment or who have uncommon presentations, bronchoscopy or lung biopsy looking for other pathogens should be considered.
This study describes two cases in which the radiographic halo signs characteristic of Aspergillus were in fact due to Legionella jordanis, a pathogen that has been culture proven only in two patients previously both of whom had underlying lung pathology and diagnosed by serologic evidence in several other patients.
In immunocompromised patients, Legionella can present as a cavitary lesion.
These cases illustrate the importance of obtaining tissue cultures to differentiate among the wide variety of pathogens present in this patient population. The patient had no prior history of cardiothoracic intervention or congenital valvular process.
A transesophageal echocardiogram showed a vegetation on the aortic valve.
Blood culture and bronchoalveolar lavage returned positive for L. The patient was treated with levofloxacin for 6 weeks total after a second set of blood cultures were negative.
The patient survived a complicated hospital course and was discharged to a rehabilitation facility. Serial CT scans obtained from five sporadic cases of Legionella pneumophila pneumonia were retrospectively reviewed.
Chest CT was analyzed with regard to frequency and appearance of CT patterns of pulmonary abnormalities. Consolidation and ground-glass opacities, with or without an air bronchogram, were the most common abnormalities detected in CT scans during follow-up patients with L.
Two patterns were observed: subpleural and peribronchovascular.
The subpleural pattern was seen in four patients and the peribronchovascular pattern in one. Interlobular septal thickening was seen in one patient.