AAAAA
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Recent nursing home outbreak with 7 elderly nursing home residents died and 24 became acutely ill. All patients presented with low-grade fever, malaise, chills and non-specific illness, mild headache, myalagia, arthralgia, and some diarrhea. P.E. relative bradycardia, mental status change. CXR showed patchy brochopnemonia, leukocytosis and elevated AST. huponatremia and hypophosphatemia.
Currently the case is not in the hospital but now in the court with over 12 million dollars lawsuit against the nursing home owner.
If you are the attending physician , what would you do ?
7 people died and 12 million dollars lawsuit and more to come to sue YOU
What is the initial diagnostic test ?
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What is the diagnosis?
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What is the treatment ?
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What do you do afterwards ?
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| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
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Code word:
Fever with bradycardia
(normally it is fever with
tachycardia)
12 million dollars lawsuit
in your hand.
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| Jinx
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Posts: 316
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Legionnaires disease
The CDC laboratory criteria for diagnosis are:
Isolation of LDB from respiratory secretions, lung tissue, pleural fluid, or other normally sterile fluids,
Demonstration of a fourfold or greater rise in the reciprocal immunofluorescence antibody (IFA) titer to greater than or equal to 128 against Legionella pneumophila serogroup 1 between paired acute- and convalescent-phaseserum specimens,
Detection of L. pneumophila serogroup 1 in respiratory secretions, lung tissue, or pleural fluid by direct fluorescent antibody testing,
Demonstration of L. pneumophila serogroup 1 antigens in urine by radioimmunoassay or enzyme-linked immunosorbent assay
macrolides-azithromycin, erythromycin, and clarithromycin. are the primary treatment
the air/conditioning/water system needs to be examined for the bacteria and chlorinated
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| Jinx
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Infectious causes of relative bradycardia:
(1) Legionnaires' disease
(2) psittacosis
(3) Q fever
(4) typhoid fever
(5) typhus
(6) malaria
(7) babesiosis
(8) leptospirosis
(9) yellow fever
(10) dengue fever
(11) Rocky Mountain spotted fever
Noninfectious causes of relative bradycardia:
(1) beta-blockers
(2) CNS lesions
(3) malignant lymphoma
(4) factitious fever
(5) drug-related fever
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| AAAAA
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The simple test is urine for legionelle antigen but was not ordered and resulted in so many death !!
The air-filtration system on the roof ( the filter) was contaminated with legionelles and massive numbers of patient died and got sick but nothing was done !
Not even antibiotics were given !
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| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
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Elderly people will die and can die and they die
after pnemonia. Now you can understand why
we are in this Forum.
So many postings in other part complain WHY
we take the examination.
You have the responsibility to save life !
How much I ask you to order an urine test
for legionella and prescribe antibiotics for 5
days !
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