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The illness will respond to amoxicillin
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One would also expect liver function test abnormalities
This illness never presents with gastrointestinal symptoms
The same pathogen may cause epiglottitis in children
If the disease progresses to sepsis, it will cause black lesions on the skin
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The clinical presentation of legionella can be very similar to other organisms, but may also have gastrointestinal symptoms, hyponatremia, and LFT abnormalities. Exposure to a contaminated water source that is aerosolized is a risk factor. Along with mycoplasma and chlamydia, legionella forms the third most common pathogen implicated in atypical pneumonias. Legionella pneumonia is common in transplant patients, patients with renal failure, COPD, and smokers, but less common in healthy adults and children. The urinary antigen assay is very sensitive and the antigen may persist in the urine for weeks even after treatment has begun. Patients may have LFT abnormalities and GI symptoms. Treatment should include a quinolone or macrolide, such as erythromycin. The illness does not respond to amoxicillin. Transmission occurs through aerosolization of a contaminated water source. Watkins and Lemonovich discuss diagnosis and management of community-acquired pneumonia in adults. Cough, fever, and pleuritic chest pain are the essential clinical features. For outpatients with comorbidities or who have used antibiotics within the previous three months, a respiratory fluoroquinolone (levofloxacin, gemifloxacin, or moxifloxacin), or an oral beta-lactam antibiotic plus a macrolide should be used. Inpatients not admitted to an intensive care unit should receive a respiratory fluoroquinolone, or a beta-lactam antibiotic plus a macrolide. Thibodeau and Viera discuss atypical pathogens in community acquired pneumonia such as mycoplasma, chlamydia, and legionella. Antibiotic treatment is empiric and includes coverage for both typical and atypical organisms. Doxycycline, a fluoroquinolone with enhanced activity against Streptococcus pneumoniae, or a macrolide is appropriate for outpatient treatment of immunocompetent adult patients. Hospitalized adults should be treated with cefotaxime or ceftriaxone plus a macrolide, or with a fluoroquinolone alone. Illustration A depicts the black lesions seen in pseudomonal sepsis. Incorrect Answers: Answer 1: Legionella responds poorly to amoxicillin Answer 3: Legionella often also presents with gastrointestinal symptoms. Answer 4: Haemophilus influenzae is the most common cause of epiglottitis in children. Answer 5: Black lesions on the skin are indicative of pseudomonal sepsis.
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