Could it be Legionella?

Aust Fam Physician. 2008 Oct;37(10):812-5

Authors: Darby J, Buising K

BACKGROUND: Community acquired pneumonia is a common condition presenting to general practitioners and emergency departments across Australia. Legionella is one of many pathogens responsible for community acquired pneumonia. Cases of Legionella may occur sporadically or as part of an outbreak. OBJECTIVE: This article describes the clinical manifestations of Legionella infection and provides clinicians with an approach to its diagnosis and management. DISCUSSION: Legionella infection is typically associated with community acquired pneumonia, which can be severe. Features pointing to Legionella as a cause of pneumonia include the presence of gastrointestinal symptoms, especially diarrhoea; neurological symptoms, especially confusion; fever up to 40 degrees C; hyponatraemia; and hepatic dysfunction. However, none of these is required to make the diagnosis. Sometimes nonrespiratory symptoms can predominate. Diagnosis requires the use of special tests specific for Legionella, the most clinically useful being urinary antigen tests and serology. Recommended treatments include macrolide therapy or doxycycline.

PMID: 19002299 [PubMed - indexed for MEDLINE]

Rational investigation of upper abdominal pain.

Aust Fam Physician. 2008 Aug;37(8):602-7

Authors: Grimpen F, Pavli P

BACKGROUND: Upper abdominal pain is a common problem with an extraordinary diversity of possible causes. Many patients have no structural disease, and making the correct diagnosis can be a challenge. The roles of endoscopy, testing for Helicobacter pylori, and imaging techniques have been debated widely and continue to be a matter for discussion. OBJECTIVE: This article details the value of various investigations in the setting of specific presentations of upper abdominal pain. DISCUSSION: Functional dyspepsia is a common cause of upper abdominal pain but the diagnosis should only be made after consideration of more serious pathology. The various organic causes of upper abdominal pain and the appropriate investigations are discussed. Early endoscopy is advisable in the presence of alarm symptoms and in patients over 55 years of age.

PMID: 18704205 [PubMed - indexed for MEDLINE]