Legionnaires' disease mimicking swine influenza (H1N1) pneumonia during the "herald wave" of the pandemic
HEART & LUNG
Authors: Cunha, Burke A.; Klein, Natalie C.; Strollo, Stephanie; Syed, Uzma; Mickail, Nardeen; Laguerre, Marianne
Abstract
BACKGROUND: New York area hospitals were hit hard by the swine influenza (H1N1) pandemic in spring and summer 2009. During a pandemic, the initial cases may be difficult to recognize, but subsequent clinical diagnoses were relatively straightforward, given the high volume of cases and their typical clinical presentation. Swine influenza pneumonia presents as an influenza-like illness (ILI) with dry cough, fever > 102 degrees F and myalgias. A variety of other viral pneumonias, eg, cytomegalovirus, human parainfluenza virus 3 (HPIV 3), and adenovirus, as well as bacterial community-acquired pneumonias (CAPS) that may present with some of the clinical and laboratory features of H1N1 pneumonia. Most adults admitted to hospitals with ILIs during the pandemic had, in fact, definite or probable H1N1 pneumonia. The Infectious Disease Division at Winthrop-University Hospital developed a diagnostic weighted point score to identify probable H I NI cases in hospitalized adults with rapid negative influenza diagnostic tests (RIDTs). METHODS: We present a case of an elderly male who presented with an ILI and negative RIDTs during the H1N1 pandemic. He was admitted with a diagnosis of possible H1N1, and placed on influenza precautions and oseltamivir. Although the patient had features consistent with H1N1 pneumonia, Legionnaires' disease was included in the differential diagnosis because of his elevated serum ferritin levels. A Legionella urinary antigen test was positive for Legionella pneumophila (serogroups 01-06). RESULTS: The peak seasonal incidence of sporadic Legionnaires' disease occurs in the summer and fall. Even in the midst of a pandemic, clinicians should be on the alert for other infectious diseases that may mimic H1N1 pneumonia. In our experience, the best way to differentiate H1N1 from ILIs or other bacterial CAPs is through the Winthrop-University Hospital Infectious Disease Division's diagnostic weighted point score system for H1N1 pneumonia or its rapid simplified version, ie, the diagnostic swine influenza triad. Legionnaires' disease is the atypical CAP pathogen most likely to mimic H1N1 pneumonia. CONCLUSIONS: Based on this and other nine cases at our institution during the "herald wave" of pandemic, we conclude that Legionnaires' disease may mimic swine influenza (H1N1) pneumonia. (Heart Lung (R) 2010;39:242-248.)
Simultaneous transformation of a polynuclear complex and nitroxide in the reaction of the {Co-6(O)(2)PiV(10)} cluster with 2,4,4,5,5-pentamethyl-4,5-dihydro-1H-imidazolyl-(3-oxide)-1-oxyl
POLYHEDRON
Authors: Fursova, Elena; Kuznetsova, Olga; Ovcharenko, Victor; Romanenko, Galina; Ikorskii, Vladimir; Eremenko, Igor; Sidorov, Alexey
Abstract
The reaction of [Co-6(O)(2)Piv(10)Thf(3)H(2)O] center dot 1.5Thf, where Piv = (CH3)(3)CCO2- and Thf = tetrahydrofuran, with nitroxides 2,4,4,5,5-pentamethyl-4,5-dihydro- 1H-imidazole-3 -oxide-1-oxyl (NIT-Me) and/or 2,4,4,5,5-pentamethyl-4,5-dihydro-1H-imidazole-1-oxyl (Im-Me) leads to simultaneous transformation of both the polymetallic core and the nitroxides. New polynuclear complexes: [Co(9)Piv(12)(OH)(2)L-2(1)]center dot 0.5C(7)H(16), [Co(9)Piv(12)(OH)(2)L-2(1)]center dot C7H16, [Co(9)Piv(12)(OH)(2)L-2(1)] center dot 2C(7)H(16), [Co(8)Piv(8)(OH)(6)(HPiv)(4)(H2O)(2)L-2(4)], L-6[Co-6(O)(4)-Piv(9)(H2O)(2)]center dot 2HPiv, [Co(6)Piv(8)(HPiv)(2)L-2(5)], [Co(6)Piv(8)(HPiv)(2)L-2(5) center dot C(6)Piv(8)(HPiv)(2)L-2(5)][Co(10)Piv(14)(HPiv)(2)(L2L23)-L-2] center dot C7H16, and [C(10)Piv(14)(HPiv(14)(HPiv(2)L(2)(2)L(2)(3)] center dot C6H14 have been synthesized and characterized by X-ray crystallography; in these complexes, L-1-L-5 are modified molecules of the starting NIT-Me and/or Im-Me. (Graphics table) (c) 2006 Elsevier Ltd. All rights reserved.