Devi, a 28 year female, has diarrhoea, confusion, high grade fever with bilateral pneumonitis. The diagnosis is :
Answer is A (Legionella): Pneumonia in association with clinical clues in the form of high grade fever, confusion and diarrhea suggests a diagnosis of Legionnaire's pneumonia Legionnaire's disease : Legionnaires disease presents as an 'atypical pneumoniaQ where a gram stained smear of sputum does not show organisms (Caused by Legionella). Legionella Legionella is a gram negative Q,motile Q,non-encapsulated bacilli Q,classified under a miscellaneous group Man to Man transmission does not occur with Legionella. Q. No animal reservoirs occur. Q Disease is limited to humans. Q Legionella survive and multiply inside free living amoeba and protozoa, distributed in natural reservoirs such as stagnant waters Q,mud and hot spring. Human infection is typically acquired by inhalation of aerosols, which form the only source of infection.2 Smoking and immunocompromised status.are known risk factors. The disease occurs with unusual frequency among patients with hairy cell leukemia but not among patients with other types of leukemia Common Risk factors for Legionnaires disease Advancing age Immunocompromised patients: - Transplant recipients, HIV, Glucocoicoid recipients - Hairy cell leukaemia (monocyte deficiency and dysfunction) Chronic lung disease Smokers Diabetes mellitus (Javetz) Presents as mild cough slightly productive sputum, sometimes streaked with blood, along with high fever and nonspecific symptoms such as malaise, fatigue, anorexia & headache. Think about the diagnosis as Legionaire's disease whenever the question talks about a pneumonia like picture along with any of the these : Occurrence of illness in immunocompromised e,smokers Q or those with chronic lung disease Q,or Occurance of illness in an environment where potable water supply is known to be contaminated with Legionella Onset of symptoms within 10 days of discharge from a hospital (1.P. 2 to 10 day), or High fever, Q or Gastrointestinal difficulties like diarrhea, Q or Neurological abnormalities like confusion or altered Sensorium, Q or Numerous neutrophils but no organisms revealed by gram staining of respiratory secretions, or Hyponatremia Q is more common in Legionnaire's, than in any other form of pneumonia, or Failure to respond to p-lactam drugs e (penicillin or cephalosporins) and aminoglycosids antibiotics.
Legionella
Neisseria meningitis
Streptococcus pneumoniae
H. influenza