Clinical+Aspects

====Symptoms of legionnaires disease of appear 2-14 days after exposure to the bacteria. More than 50 Legionella species are described but //Legionella pneumophila// is the cause of more than 95% of all legionnaires diseases and can be fatal. Mortalilty of patients with pneumonia may exceed 30 % for the elderly //(Krojgaard, Louise H 2011) why italic? why the difference in size? //====

====As the infection increases the symptoms may also increase. Further symptoms may include the following; coughing with a yellow/green mucus production, chest pain, shallow breathing, shortness of breath, fever, chills, fatigue after short periods of physical activity, sinus infections and in some cases asthma may also occur //( Reischl U et al, 2002 ).// this is a paper about diagnostic methods! ==== ====legionnaires disease displays two clinical syndromes depending on? ; Legionnaires disease and Pontiac fever, this together is known as legionellosis. ====

====The Pontiac fever is what causes the flu like symptoms which were mentioned above //(Guyard C et al, 2010).//When Pontiac fever is displayed then the patient has mild forms of legionellosis. Legionnaires disease causes pneumonia in severe cases of legionellosis, whereas Pontiac fever doesn’t cause pneumonia, which shows the patient in this case has severe forms of Legionnaires disease. This paragraph could and should be shortened as it contains repetitions. ==== Pleural effusion is when vast amounts of fluid collect in the pleural space, this impairs the ability of the lungs to expand and move, restricting breathing. Does pleural diffusion happen? When why?explain ==== As this fluid amount increases, the ability to breath of the patient decreases further. There is also an additional risk that this fluid can become infected leading to emphysema. Emphysema is when this infected fluid causes the build-up of pus //(Kawanami, t et al, 2011) //. This build up of pus leads to the symptoms worsening; increased chest pain, dry cough, increased fever and weight loss. ====

====There are two types of pleural effusion;Transudate pleural effusions and exudate pleural effusions. Transudate pleural is caused by fluid which has leaked from blood vessels into the pleural space //(Cianciotto, N, 2001)//. Exudate pleural effusions are caused by inflammation of the pleura, drug reactions, blocked blood vessels, amongst other causes leading to restrictions in breathing. ====

The diagram above displays the abnormal quantity of pleural fluid between the surfaces of the lungs and chest cavity.
====Severe symptoms of pneumonia also include cyanosis. Cyanosis is when the skin of patient with progressed cases of pneumonia turns to a blue/purple colour //(Declercka, p et al, 2009)//. This is caused by a lack of oxygen in the blood. These symptoms will show in both adults and children but children will display and increased shortness in breath. Other severe symptoms also include confusion. As you discussion is heavily concentrated on pleural diffusion you should make clearer the link to infection ====


 * ====Nicholas P. Cianciotto. (2001). Pathogenicity of Legionella pneumophila. International Journal of Medical Microbiology. 291 (5), 331-343. ====
 * ====Priscilla Declercka, Jonas Behetsa, Anca Margineanub, Vincent van Hoefa, Brenda De Keersmaeckera, Frans Olleviera. (2009). Replication of Legionellapneumophila in biofilms of water distribution pipes. Microbiological Research. 164 (6), 593-603 ====
 * ====<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Toshinori Kawanami, Kazuhiro Yatera, Kazumasa Fukuda, Kei Yamasaki, Masamizu Kunimoto, Shuya Nagata, Chinastu Nishida, Hiroshi Ishimoto, Midori Ogawa, Hatsumi Taniguchi and Hiroshi Mukae. (2011). Diagnosis of Fulmianat Pneumonia Causes by Legionella pneumophila Serogroup 8 with the Sequence Analysis of the 16s rRNA Gene. Tohoku J. Exp. Med. ====
 * ====<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Guyard C, Low DE. (2010). Legionella infections and travel associated legionellosis.. Travel Med Infect Dis.. 9 (4), 176-86. ====
 * ====<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Louise H Krojgaard, Karen A Krogfelt, Hans-Jorgen Albrechtsen, Soren A Uldum. (2011). Detection of Legionella by quantitative-Polymerase Chain Reaction (qPCR) for monitoring and risk assessment. BMC Microbiology. ====
 * ====<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Udo Reischl, Hans-Jörg Linde, Norbert Lehn, Olfert Landt,Kevin Barratt and Nele Wellinghausen. (2002). Direct Detection and Differentiation of Legionella spp. and Legionella pneumophila in Clinical Specimens by Dual-Color Real-Time PCR and Melting Curve Analysis. Journal of Clinical Mircobiology. 40 (11), 3814-3817. ====

Some relevant facts were reported but need to be discussed and put into context with the infection. Incorrect use of referencing protocol