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Flashcard 7557190126860

Question
Hume dimostra che il principio di causalità
Answer
Non ha nessuna base oggettiva

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Flashcard 7557195369740

Question
Nella visione kantiana , pertanto , la scienza , globalmente considerata , risulta feconda in un duplice senso :
Answer
materia e forma

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#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Predominant symptoms include fever, cough, and shortness of breath [1-10]. Symptoms typically arise 2 to 10 days after exposure to contaminated water or soil. Fever and fatigue often precede the onset of cough. Rales and/or other signs of consolidation can be present on physical examination. Sputum may be difficult to obtain.
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f Legionella infection".) LEGIONNAIRES' DISEASE (LEGIONELLA PNEUMONIA) Clinical features — Pneumonia caused by Legionella is clinically and radiographically similar to other forms of pneumonia. <span>Predominant symptoms include fever, cough, and shortness of breath [1-10]. Symptoms typically arise 2 to 10 days after exposure to contaminated water or soil. Fever and fatigue often precede the onset of cough. Rales and/or other signs of consolidation can be present on physical examination. Sputum may be difficult to obtain. Radiographic findings are varied and nonspecific; however, the most common findings are patchy unilobar infiltrates, which can progress to consolidations [11-13]. Although no clinical f




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Pneumonia caused by Legionella is clinically and radiographically similar to other forms of pneumonia.
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"Microbiology, epidemiology, and pathogenesis of Legionella infection" and "Treatment and prevention of Legionella infection".) LEGIONNAIRES' DISEASE (LEGIONELLA PNEUMONIA) Clinical features — <span>Pneumonia caused by Legionella is clinically and radiographically similar to other forms of pneumonia. Predominant symptoms include fever, cough, and shortness of breath [1-10]. Symptoms typically arise 2 to 10 days after exposure to contaminated water or soil. Fever and fatigue often pr




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Radiographic findings are varied and nonspecific; however, the most common findings are patchy unilobar infiltrates, which can progress to consolidations [ 11-13].
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taminated water or soil. Fever and fatigue often precede the onset of cough. Rales and/or other signs of consolidation can be present on physical examination. Sputum may be difficult to obtain. <span>Radiographic findings are varied and nonspecific; however, the most common findings are patchy unilobar infiltrates, which can progress to consolidations [11-13]. Although no clinical features reliably distinguish Legionnaires' disease from other types of pneumonia, certain features may raise the index of suspicion [1-6,10,14-17]. These include:




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie

Although no clinical features reliably distinguish Legionnaires' disease from other types of pneumonia, certain features may raise the index of suspicion [1-6,10,14-17]. These include:

● Gastrointestinal symptoms such as nausea, vomiting, and diarrhea

● Hyponatremia

● Elevated hepatic transaminases

● C-reactive protein levels >100 mg/L

● Failure to respond to treatment for pneumonia with beta-lactam monotherapy

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um may be difficult to obtain. Radiographic findings are varied and nonspecific; however, the most common findings are patchy unilobar infiltrates, which can progress to consolidations [11-13]. <span>Although no clinical features reliably distinguish Legionnaires' disease from other types of pneumonia, certain features may raise the index of suspicion [1-6,10,14-17]. These include: ●Gastrointestinal symptoms such as nausea, vomiting, and diarrhea ●Hyponatremia ●Elevated hepatic transaminases ●C-reactive protein levels >100 mg/L ●Failure to respond to treatment for pneumonia with beta-lactam monotherapy Scoring systems combining these clinical and laboratory features have been developed, but none have been validated or proven to have adequate predictive value for diagnosis. A scoring s




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Mortality, even in tertiary care centers, ranges from about 1 to 10 percent [4,20,21]. Mortality after admission to ICU may be over 30 percent with some patients requiring extracorporeal membrane oxygenation [22]
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ad moderate/severe pneumonia (Pneumonia Severity Index IV to V) and 18 percent required intensive care unit (ICU) admission [20]. In other case series, ICU admission was required in 44 percent. <span>Mortality, even in tertiary care centers, ranges from about 1 to 10 percent [4,20,21]. Mortality after admission to ICU may be over 30 percent with some patients requiring extracorporeal membrane oxygenation [22]. Local complications are uncommon but include empyema and lung abscess. Extrapulmonary complications are rare. (See 'Extrapulmonary Legionella disease' below.) Clinical features of Legi




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Clinical features of Legionnaires' disease do not appear to vary with the infecting species or serotypes. In a case series evaluating over 100 patients with Legionnaires' disease, signs and symptoms of Legionella longbeachae pneumonia were largely similar to those of Legionella pneumophila pneumonia [4].
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rporeal membrane oxygenation [22]. Local complications are uncommon but include empyema and lung abscess. Extrapulmonary complications are rare. (See 'Extrapulmonary Legionella disease' below.) <span>Clinical features of Legionnaires' disease do not appear to vary with the infecting species or serotypes. In a case series evaluating over 100 patients with Legionnaires' disease, signs and symptoms of Legionella longbeachae pneumonia were largely similar to those of Legionella pneumophila pneumonia [4]. Key differences between these species are epidemiologic. L. pneumophila is found worldwide and typically acquired from contaminated water sources in late summer and early fall. By contr




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Patient risk factors include older age, smoking, and chronic lung, cardiovascular, or renal disease [23-26]. Immunocompromise, particularly impaired cell-mediated immunity, increases both the likelihood of infection and poorer outcome [27-29].
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e to soil or potting mix in areas where the incidence of L. longbeachae is high. (See "Microbiology, epidemiology, and pathogenesis of Legionella infection", section on 'Geographic variation'.) <span>Patient risk factors include older age, smoking, and chronic lung, cardiovascular, or renal disease [23-26]. Immunocompromise, particularly impaired cell-mediated immunity, increases both the likelihood of infection and poorer outcome [27-29]. Failure to respond to beta-lactam monotherapy in a patient with pneumonia should also raise suspicion for Legionella infection. Concern may also be raised when the course of a viral inf




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Failure to respond to beta-lactam monotherapy in a patient with pneumonia should also raise suspicion for Legionella infection. Concern may also be raised when the course of a viral infection follows an unexpected course.
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nd chronic lung, cardiovascular, or renal disease [23-26]. Immunocompromise, particularly impaired cell-mediated immunity, increases both the likelihood of infection and poorer outcome [27-29]. <span>Failure to respond to beta-lactam monotherapy in a patient with pneumonia should also raise suspicion for Legionella infection. Concern may also be raised when the course of a viral infection follows an unexpected course. Fatal cases of coinfection with severe acute respiratory syndrome coronavirus 2 have been reported but these are rare and the association is unclear [30]. (See "Microbiology, epidemiolo




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
Although certain clinical features (eg, altered mental status, gastrointestinal symptoms, and hyponatremia) might raise suspicion for Legionella infection, no individual symptom or sign or combination is pathognomic. Laboratory testing is necessary for diagnosis.
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coronavirus 2 have been reported but these are rare and the association is unclear [30]. (See "Microbiology, epidemiology, and pathogenesis of Legionella infection", section on 'Risk factors'.) <span>Although certain clinical features (eg, altered mental status, gastrointestinal symptoms, and hyponatremia) might raise suspicion for Legionella infection, no individual symptom or sign or combination is pathognomic. Laboratory testing is necessary for diagnosis. Whom to test — Because early diagnosis and administration of appropriate antimicrobial therapy is associated with improved outcomes in patients with Legionnaires' disease [31,32], we ta




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie

Because early diagnosis and administration of appropriate antimicrobial therapy is associated with improved outcomes in patients with Legionnaires' disease [31,32], we take an inclusive approach to diagnosis and generally test the following patients:

● All patients with moderate to severe CAP or patients with CAP who require hospitalization

● Any patient with CAP or nosocomial pneumonia who has a known or possible exposure to Legionella (eg, during an outbreak)

● Immunocompromised patients (who are at higher risk for Legionella infection and severe disease)

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oms, and hyponatremia) might raise suspicion for Legionella infection, no individual symptom or sign or combination is pathognomic. Laboratory testing is necessary for diagnosis. Whom to test — <span>Because early diagnosis and administration of appropriate antimicrobial therapy is associated with improved outcomes in patients with Legionnaires' disease [31,32], we take an inclusive approach to diagnosis and generally test the following patients: ●All patients with moderate to severe CAP or patients with CAP who require hospitalization ●Any patient with CAP or nosocomial pneumonia who has a known or possible exposure to Legionella (eg, during an outbreak) ●Immunocompromised patients (who are at higher risk for Legionella infection and severe disease) Our approach is largely consistent with recommendations from the Infectious Diseases Society of America (IDSA), the American Thoracic Society (ATS), the British Thoracic Society (BTS),




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
In addition, IDSA/ATS and BTS guidelines recommend testing for patients with nonsevere CAP who have specific risk factors or epidemiologic exposures [33,35-38].
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onal Institute for Health and Care Excellence (NICE) [33-35]. Each organization recommends testing for Legionella infection in all patients with severe CAP or those who require hospitalization. <span>In addition, IDSA/ATS and BTS guidelines recommend testing for patients with nonsevere CAP who have specific risk factors or epidemiologic exposures [33,35-38]. Approach to testing — The main testing options for Legionella infection include nucleic acid detection (eg, polymerase chain reaction [PCR]), urine antigen tests, and culture (table 1).




#Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
  • When testing for Legionella in patients with pneumonia, we prefer to use PCR on a lower respiratory tract sample (eg, sputum or bronchoalveolar lavage specimen) because PCR has high diagnostic accuracy and detects all Legionella species and serogroups.
  • If PCR is not available or if sputum cannot be obtained, urine antigen testing is an acceptable alternative, especially in regions such as the United States where the prevalence of L. pneumophila serogroup 1 is high. The main advantages of the urinary antigen test are its rapid turnaround time and high specificity.
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    35-38]. Approach to testing — The main testing options for Legionella infection include nucleic acid detection (eg, polymerase chain reaction [PCR]), urine antigen tests, and culture (table 1). <span>When testing for Legionella in patients with pneumonia, we prefer to use PCR on a lower respiratory tract sample (eg, sputum or bronchoalveolar lavage specimen) because PCR has high diagnostic accuracy and detects all Legionella species and serogroups. If PCR is not available or if sputum cannot be obtained, urine antigen testing is an acceptable alternative, especially in regions such as the United States where the prevalence of L. pneumophila serogroup 1 is high. The main advantages of the urinary antigen test are its rapid turnaround time and high specificity. Because the urinary antigen test only detects L. pneumophila serotype 1, we generally send PCR or culture on a lower respiratory tract sample when urine antigen assays are negative and




    #Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
    The major limitation of PCR is the inability to obtain adequate sputum samples from patients with Legionnaires' disease. For some patients, inducing sputum for testing may enhance diagnostic yield [44]
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    nella species and serotypes. The diagnostic accuracy of PCR appears to be high and exceeds that of culture but is difficult to determine because there is no reliable reference standard [39-43]. <span>The major limitation of PCR is the inability to obtain adequate sputum samples from patients with Legionnaires' disease. For some patients, inducing sputum for testing may enhance diagnostic yield [44]. Testing for upper respiratory samples by PCR is also an alternative; however, the sensitivity is low [44]. Metagenomic next generation sequencing of blood other bodily fluids is under




    #Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
    The sensitivity of urine antigen tests ranges from approximately 70 to 80 percent and the specificity approaches 100 percent in patients with Legionnaires' disease caused by L. pneumophila serotype 1 [39,46,47].
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    e sensitivity and specificity is yet to be determined [45]. Urine Legionella antigen testing — The Legionella urinary antigen test is a commonly used alternative test for Legionnaires' disease. <span>The sensitivity of urine antigen tests ranges from approximately 70 to 80 percent and the specificity approaches 100 percent in patients with Legionnaires' disease caused by L. pneumophila serotype 1 [39,46,47]. Legionella antigens can be detected in urine as early as one day after symptom onset and persist for days to weeks. The turnaround time for the assay is a few hours. Lateral flow device




    #Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
    Legionella antigens can be detected in urine as early as one day after symptom onset and persist for days to weeks. The turnaround time for the assay is a few hours. Lateral flow devices are simple can be used in most clinical laboratories [48].
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    urine antigen tests ranges from approximately 70 to 80 percent and the specificity approaches 100 percent in patients with Legionnaires' disease caused by L. pneumophila serotype 1 [39,46,47]. <span>Legionella antigens can be detected in urine as early as one day after symptom onset and persist for days to weeks. The turnaround time for the assay is a few hours. Lateral flow devices are simple can be used in most clinical laboratories [48]. The major disadvantage of the assay is that it only detects L. pneumophila serotype 1. While L. pneumophila serotype 1 causes over 80 percent of reported cases of Legionnaires' disease




    #Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
    The major disadvantage of the assay is that it only detects L. pneumophila serotype 1. While L. pneumophila serotype 1 causes over 80 percent of reported cases of Legionnaires' disease in most regions of the world, L. longbeachae is common in some regions, such as Australia and New Zealand, which limits the utility of the assay [49]. Other urinary antigen systems that detect a broader range of species are under are under investigation [50]
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    y as one day after symptom onset and persist for days to weeks. The turnaround time for the assay is a few hours. Lateral flow devices are simple can be used in most clinical laboratories [48]. <span>The major disadvantage of the assay is that it only detects L. pneumophila serotype 1. While L. pneumophila serotype 1 causes over 80 percent of reported cases of Legionnaires' disease in most regions of the world, L. longbeachae is common in some regions, such as Australia and New Zealand, which limits the utility of the assay [49]. Other urinary antigen systems that detect a broader range of species are under are under investigation [50]. Culture — Culture on special media is considered the gold standard for diagnosis of Legionella infections. Culture can be performed on nearly any sample type and results are typically




    #Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
    Culture — Culture on special media is considered the gold standard for diagnosis of Legionella infections. Culture can be performed on nearly any sample type and results are typically obtained in approximately three to five days.
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    ions, such as Australia and New Zealand, which limits the utility of the assay [49]. Other urinary antigen systems that detect a broader range of species are under are under investigation [50]. <span>Culture — Culture on special media is considered the gold standard for diagnosis of Legionella infections. Culture can be performed on nearly any sample type and results are typically obtained in approximately three to five days. For Legionnaires' disease, the sensitivity of sputum cultures is variable with a reported range of <10 to 80 percent [39,46,51]. The specificity of culture nears 100 percent as colon




    #Clinical #Clinique #Legionella #Legionellose #Maladies-infectieuses-et-tropicales #Manifestation #Pneumonia #Pneumonie
    For Legionnaires' disease, the sensitivity of sputum cultures is variable with a reported range of <10 to 80 percent [39,46,51]. The specificity of culture nears 100 percent as colonization with Legionella species does not occur.
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    s considered the gold standard for diagnosis of Legionella infections. Culture can be performed on nearly any sample type and results are typically obtained in approximately three to five days. <span>For Legionnaires' disease, the sensitivity of sputum cultures is variable with a reported range of <10 to 80 percent [39,46,51]. The specificity of culture nears 100 percent as colonization with Legionella species does not occur. A major limitation of sputum culture is that only about one-half of patients with Legionnaires' disease produce sputum [2-6]. As with other types of pneumonia, induced sputum and bronch