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      Unusual Bacterial Infections and the Pleura

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          Abstract

          Rickettsiosis, Q fever, tularemia, and anthrax are all bacterial diseases that can affect the pleura. Rocky Mountain Spotted Fever (RMSF) and Mediterranean Spotted Fever (MSF) are caused by Rickettsia rickettsii and Rickettsia conorii, respectively. Pleural fluid from a patient with MSF had a neutrophil-predominant exudate. Coxiella burnetii is the causative agent of Q fever. Of the two cases described in the literature, one was an exudate with a marked eosinophilia while the other case was a transudate due to a constrictive pericarditis. Francisella tularensis is the causative agent of tularemia. Pleural fluid from three tularemia patients showed a lymphocyte predominant exudate. Bacillus anthracis is the causative agent of anthrax. Cases of inhalational anthrax from a recent bioterrorist attack evidenced the presence of a serosanguineous exudative pleural effusion. These four bacterial microorganisms should be suspected in patients presenting with a clinical history, exposure to known risk factors and an unexplained pleural effusion.

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          Anthrax as a biological weapon, 2002: updated recommendations for management.

          Thomas V. Inglesby, Tara O'Toole, Donald Henderson … (2002)
          To review and update consensus-based recommendations for medical and public health professionals following a Bacillus anthracis attack against a civilian population. The working group included 23 experts from academic medical centers, research organizations, and governmental, military, public health, and emergency management institutions and agencies. MEDLINE databases were searched from January 1966 to January 2002, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Reference review identified work published before 1966. Participants identified unpublished sources. The first draft synthesized the gathered information. Written comments were incorporated into subsequent drafts. The final statement incorporated all relevant evidence from the search along with consensus recommendations. Specific recommendations include diagnosis of anthrax infection, indications for vaccination, therapy, postexposure prophylaxis, decontamination of the environment, and suggested research. This revised consensus statement presents new information based on the analysis of the anthrax attacks of 2001, including developments in the investigation of the anthrax attacks of 2001; important symptoms, signs, and laboratory studies; new diagnostic clues that may help future recognition of this disease; current anthrax vaccine information; updated antibiotic therapeutic considerations; and judgments about environmental surveillance and decontamination.
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            Rocky Mountain spotted fever.

            Filipe Dantas-Torres (2007)
            Rocky Mountain spotted fever (RMSF) is a life-threatening disease caused by Rickettsia rickettsii, an obligately intracellular bacterium that is spread to human beings by ticks. More than a century after its first clinical description, this disease is still among the most virulent human infections identified, being potentially fatal even in previously healthy young people. The diagnosis of RMSF is based on the patient's history and a physical examination, and often presents a dilemma for clinicians because of the non-specific presentation of the disease in its early course. Early empirical treatment is essential to prevent severe complications or a fatal outcome, and treatment should be initiated even in unconfirmed cases. Because there is no vaccine available against RMSF, avoidance of tick-infested areas is still the best way to prevent the infection.
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              The atypical pneumonias: clinical diagnosis and importance

              B.A. Cunha (2006)
              The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three non-zoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella. These atypical agents, unlike the typical pathogens, often cause extrapulmonary manifestations. Atypical CAPs are systemic infectious diseases with a pulmonary component and may be differentiated clinically from typical CAPs by the pattern of extrapulmonary organ involvement which is characteristic for each atypical CAP. Zoonotic pneumonias may be eliminated from diagnostic consideration with a negative contact history. The commonest clinical problem is to differentiate legionnaire's disease from typical CAP as well as from C. pneumoniae or M. pneumonia infection. Legionella is the most important atypical pathogen in terms of severity. It may be clinically differentiated from typical CAP and other atypical pathogens by the use of a weighted point system of syndromic diagnosis based on the characteristic pattern of extrapulmonary features. Because legionnaire's disease often presents as severe CAP, a presumptive diagnosis of Legionella should prompt specific testing and empirical anti-Legionella therapy such as the Winthrop-University Hospital Infectious Disease Division's weighted point score system. Most atypical pathogens are difficult or dangerous to isolate and a definitive laboratory diagnosis is usually based on indirect, i.e., direct flourescent antibody (DFA), indirect flourescent antibody (IFA). Atypical CAP is virtually always monomicrobial; increased IFA IgG tests indicate past exposure and not concurrent infection. Anti-Legionella antibiotics include macrolides, doxycycline, rifampin, quinolones, and telithromycin. The drugs with the highest level of anti-Legionella activity are quinolones and telithromycin. Therapy is usually continued for 2 weeks if potent anti-Legionella drugs are used. In adults, M. pneumoniae and C. pneumoniae my exacerbate or cause asthma. The importance of the atypical pneumonias is not related to their frequency (~15% of CAPs), but to difficulties in their diagnosis, and their nonresponsiveness to β-lactam therapy. Because of the potential role of C. pneumoniae in coronary artery disease and multiple sclerosis (MS), and the role of M. pneumoniae and C. pneumoniae in causing or exacerbating asthma, atypical CAPs also have public health importance.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Respir Med J
                Journal ID (iso-abbrev): Open Respir Med J
                Journal ID (publisher-id): TORMJ
                Title: The Open Respiratory Medicine Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-3064
                Publication date (Electronic): 6 September 2012
                Publication date Collection: 2012
                Volume: 6
                Pages: 75-81
                Affiliations
                Division of Pulmonary and Critical Care, Medical University of South Carolina, USA
                Author notes
                [* ]Address correspondence to this author at the Division of Pulmonary and Critical Care, Medical University of South Carolina, 96 Jonathan Lucas St. Suite 812-CSBMSC 630, Charleston, SC 29425, USA; Tel: 843-792-7199; E-mail: kummerfe@ 123456musc.edu
                Article
                Publisher ID: TORMJ-6-75
                DOI: 10.2174/1874306401206010075
                PMC ID: 3439802
                PubMed ID: 22977649
                SO-VID: 481e1867-049b-4ac6-a00e-0b02fe4eefe0
                Copyright © © Kummerfeldt et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 26 May 2012
                Date revision received : 7 August 2012
                Date accepted : 14 August 2012
                Categories
                Subject: Article

                ScienceOpen disciplines: Respiratory medicine
                Keywords: rickettsia,anthrax,q fever,tularemia,pleural disease.
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: rickettsia, anthrax, q fever, tularemia, pleural disease.

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