Legionella Pneumophila

Index:

Introduction………………………………………………………..……………………………....Pág. 3

Pathology.................................………………………………….…….......................Pág. 4

Radiographic Evidence...............................….……………..……………...…....….Pág. 7

Conclusion ………………………………………………......…..….…………………………....Pág. 9

Bibliography……………………………….………………………..….…………..………….....Pág. 10

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 INTRODUCTION

This approach intend to be a simple demonstration of what the Radiological findings

should look like, concerning the area of interest, in order to provide immediate
information about the acquired pictures, if they fit in the expected quality standards, and
possess enough diagnostic quality in order to decide if they are acceptable to be sent
into PACS or repeated.

The underlying principle of this study is not to be extensively thorough in what pertains
to this matter, but, instead, highlight the main landmarks that will outline it and provide
some quick identifiable references.

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 PATHOLOGY

Legionella Pneumophila

It is an aerobic Gram Negative bacterium, characterized by having a red-discolouring

lipopolysaccharide capsule when subjected to Gram stain. It is known by having several
other strains, however this study regards to Pneumophilia strain, from which result
Pathologies normally associated with the respiratory tract, but not only, and of which
the most common is Pneumonia.

Bacteria’s Habitat

This bacterium finds its preferred habitat in biofilm accumulated in aquatic

environments or in water circulation ducts that protect it from the action of other
inhibiting bacteria such as amoebae and protozoa and allow them to multiply.

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Even so, in non-stagnant or reservoir water environments, Legionella is not present in
worrying values as its concentration is extremely low and the risk of contamination is
extremely reduced since the ideal temperature for bacterial multiplication is between
77ºF and 113ºF.

Spreading and Contagion

As this is not a contagious disease caused by interpersonal contact, it is transmitted

through the aspiration of particles of contaminated water, so that the concern should be
directed to environments that favour the formation of these droplets such as showers,
sprinklers, saunas, spas ... that is, environments that can fog water.

Risk Acessement

Although it may seem daunting, due to the proximity and abundance of the media that
promote the proliferation and spread of bacteria, legionella Pneumophila induce disease
is a very rare disease, a recent study estimates that the exposure rate is 10 cases per
million people and outbreaks occur only when water quality control is neglected.

Still, there are risk groups associated with the spread of the bacteria, which can easily be
infected and hence a concern in preventing, diagnosing and fighting the disease,
namely:

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• Age group over 55 years old

• Excessive Alcohol Consumption

• Smoking

• COPD

• Immunosuppressed Individuals

• Diabetic Patients

The therapy

Since Pneumonia is the pathology most directly associated with Legionella, being a
respiratory infection, therapy indicates the use of antibiotics and the success rate is
higher the sooner therapy is started.

In simpler cases, the therapy can be carried out by the patient himself at home, by oral
administration of the antibiotic; in more severe clinical situations, the drug should be
administered parenterally, in a hospital setting.

Legionella can also cause a much more benign pathology, known as Pontiac's disease,
which behaves like a common flu, does not develop pneumonia, is hospitalization rare
and spontaneously cured in 100% of cases.

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 RADIOGRAPHIC EVIDENCE

Picture 1 - Anterior Posterior Projection

Central Radius, perpendicular, pointed to

the midpoint of D7.

Absence of chest rotation, both lungs being

visible from their apices to the costophrenic
angles with some scapular overlapping.

Air-filled trachea from D1, visible hilar

opacity as well as cardiac shadow and
overlap of mediastinal structures

Chest X Ray at the time of patient’s admission,

where thickening of the right pulmonary
parenchyma evolving to the base of the lung
can be seen.

Picture 2 - Posterior Anterior Exposure

Central Radius perpendicular and pointed at

the midpoint of D7.

Absence of chest rotation, both lungs being

visible from the apices to the costophrenic
angles.

Some clavicle overlap in lung apex, scapular

overlap in costal grid and increased cardiac
shadow can be observed

Chest X Ray acquired during hospitalization,

where an increase of parenchyma’s diffuse
opacification can be observed

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 Picture 3 - Anterior Posterior Exposure

Central Radius perpendicular, pointed at

the midpoint of D7.

Absence of rotation and no scapular

overlap, both lungs being visible from their
apices to costophrenic angles.

Air-filled trachea from D1, visible hilar

opacity as well as cardiac shadow and
overlap of mediastinal structures

Chest examination on the third day after

hospitalization showing a reduction in the size and
diffusion of parenchyma’s opacification as well as
opacification’s volume.

Picture 4 - Anterior Posterior Exposure

Central Radius perpendicular, pointed at

the midpoint of D7.

Absence of rotation and no scapular

overlap, both lungs being visible from their
apices to the costophrenic angles.

Air-filled trachea from D1, visible hilar

opacity as well as cardiac shadow and
overlap of mediastinal structures

Chest X Ray seven days after patient’s admission,

showing almost complete remission of infection with
normal parenchyma’s morphology

By observing the pictures, the pathology’s improvement can be testified.

In Pic. 1 we observe the initial state of the infection, In Pic. 2 there’s a illness evolution
that almost completely covers the right lung, falling into remission after a successful
therapy put in place, In Pic. 3 is already showed a considerable improvement and in
Pic. 4 an almost complete parenchyma’s normality.

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 CONCLUSION

With the certainty that the scope of a Diagnostic Radiographer’s competencies does not
include medical diagnostics and, therefore, a more complex approach to this matter
would become more suitable for an Academic publication, only justifiable in it’s
appropriate environment, It’s a legitimate assumption that the present study have
changed my perspective as an Healthcare Professional, whose main purpose is to
provide clinical supportive evidence, in what regards the determination of a patient’s
health condition.

The knowledge obtained through the consulted publications have indeed provided me
with useful elements from which, not just me, but several others, will beneficiate as the
need to share them arise while performing my duties, particularly in an A&E suite,
where the job demanding, sometimes, brings us to work all by ourselves in a quick
pace.

Being always ready to pursue new goals and accept new challenges, I look forward the
opportunity to use this recently acquired information, in order to improve my
competencies and to perform my duties in a better and more efficient manner, always
regarding the ones who trust in my professional skills to provide them with the help
they seek: The Patients.

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 BIBLIOGRAPHY

1. http://www.mdsaude.com/2014/11/legionelose-doenca-legionario.html

2. http://www.123helpme.com/view.asp?id=44791

3. http://www.mdsaude.com/2009/02/quais-sao-os-sintomas-da-
pneumonia.html

4. http://www.mdsaude.com/2014/02/pneumonia-e-tuberculose.html

5. http://www.who.int/water_sanitation_health/emerging/legionella.pdf

6. http://www.legionellatesting.com/pdf/Paper.pdf

7. BONTRAGER, Kenneth L. Textbook of Radiographic Positioning and

Related Anatomy 6th ed. MOSBY-ELSEVIER

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