[Severe legionellosis after abuse of anti-inflammatory drugs--diagnostic and intensive care aspects based on a case report].
Legionella infections are getting increasingly important as causes of severe pneumonias or of acute respiratory insufficiency. Consumptive or immunosuppressive underlying diseases such as diabetes mellitus, cardiac insufficiency, alcohol-induced liver damage, malignant tumours or drug-induced immunosuppression after organ transplantation, are among the risk factors. Diagnosis is based on direct identification of the pathogen from body secretions by means of direct immunofluorescence. The serological immunoresponse often takes place long after outbreak of the disease or fails entirely to appear and is therefore only suitable for retrospective confirmation. Therapy of choice is an intravenous administration of erythromycin. There are now increasing pointers to the efficiency of fluoroquinolone antibiotics, such as ciprofloxacin. We report on the course of a severe case of legionnaire's disease with multiple organ failure occurring in a patient after bone marrow depression induced by anti-inflammatory drugs. Treatment erythromycin resulted in a marked cholestasis, so that antibiotic treatment was changed to ciprofloxacin. This therapy as well as the supportive intensive-care treatment eventually led to the patient's complete recovery. Based on the case report, fundamental aspects of diagnostics, antibiotic treatment, intensive-care treatment and prognosis of severe cases of legionellosis are discussed.
Bein
T
T
Klinik für Anästhesiologie, Klinikum der Universität Regenburg.
Ehret
W
W
Metz
C
C
Hobbhahn
J
J
Taeger
K
K
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001853:Bone Marrow / Q000187:drug effects / Q000276:immunology; D002939:Ciprofloxacin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003422:Critical Care; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects; D004177:Dipyrone / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects; D007877:Legionnaires' Disease / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology; D008111:Liver Function Tests; D017116:Low Back Pain / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000188:drug therapy / Q000276:immunology; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D002939:Ciprofloxacin; D004177:Dipyrone
Schwere Legionellose nach Antiphlogistika-Abusus--diagnostische und intensivtherapeutische Aspekte anhand einer Kasuistik.