Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
How is the diagnosis of Legionnaires' disease made?
Laboratory tests may include a modest increase in white blood cells, mild abnormalities in liver function studies, a low sodium in the blood, and even some decreased function of the kidneys.
Nevertheless, these features can also be seen with a variety of different types of pneumonia. Chest X-rays often demonstrate abnormal densities (areas of that lungs that on the X-ray film appear whiter). However, it is difficult to distinguish Legionnaires' disease from other types of pneumonia by symptoms and chest X-ray alone. Additional specific tests are required for diagnosis.
These other tests are specialized and are not routinely performed on people with fever or pneumonia. Several types of tests are available. The most useful test uses a urine sample to detect identifiable proteins of the Legionnaires' bacterium (Legionella antigens). This test has the disadvantage of only testing for
Legionella pneumophila serogroup 1 (this is the organism responsible for 90% of the cases). Additionally, detecting the bacteria in a culture of the sputum may be helpful. Lastly, tests that compare antibody levels of
Legionella in two blood samples obtained three to six weeks apart showing a fourfold rise in the antibodies in the blood against the bacterium can be confirmatory after the disease is gone.
Because these tests complement each other, a positive result from
each test when Legionnaires' disease is suspected increases the
probability of confirming the diagnosis. However, because none of the
laboratory tests is 100% sensitive, the diagnosis of legionellosis is
not excluded even if one or more of the tests is negative. Of the
available tests, the most specific is culture isolation of the
bacterium from secretions from the respiratory tract.
Who develops Legionnaires' disease?
People of any age can develop Legionnaires' disease, but the illness
most often affects middle-aged and older people, particularly those
who smoke cigarettes or have chronic lung disease, as these individuals have a greater likelihood of developing any respiratory illness.
People at an increased risk for Legionnaires' disease also
include people whose immune systems are suppressed by diseases such
as cancer, kidney failure requiring dialysis, diabetes, or AIDS.
Those who take medications that suppress the immune system are also
at risk including those chronically on steroids.
Pontiac fever most commonly occurs in people who are otherwise
healthy.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Acute respiratory distress syndrome (ARDS) is a lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. Causes of ARDS include: pneumonia, aspiration, severe blow to the chest, sepsis, severe injury with shock, drug overdose, and/or inflamed pancreas. Treatment for ARDS include extra oxygen, and/or medication.
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