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.
There are three major classes of antibiotics that are effective in treating legionellosis. These include the fluoroquinolones such as levofloxacin (Levaquin), and moxifloxacin (Avelox), the macrolides such as erythromycin,
azithromyocin (Zithromax), and clarithromycin (Biaxin), and the tetracyclines including doxycycline (Vibramycin).
A new class of antibiotics (glycylcyclines) are also effective. The choice of antibiotic is often dependent on the patient's clinical state, tolerance to the medication, and degree of certainty as to the diagnosis.
Zithromax and Levaquin are particularly effective because of decreased gastrointestinal irritation, higher potency, better penetration into tissue, and once-daily dosing.
In severe cases of Legionnaires' disease that seem more resistant to a single antibiotic, a second drug called rifampin
(Rifadin) may be added.
Pontiac fever requires no specific treatment.
How is Legionnaires' disease spread?
Outbreaks of legionellosis have occurred after people have
inhaled aerosols that come from a water source (for example, air-conditioning cooling towers, whirlpool spas, or showers) contaminated
with Legionella bacteria. People may be exposed to these aerosols in
homes, workplaces, hospitals, or public places. Infection cannot be
acquired from another person with legionellosis, and there is no
evidence of people becoming infected from auto air conditioners or
household window air-conditioning units.
Cases of Legionnaires' disease have increased throughout the United States, but
this most likely represents increased detection by better diagnostic tests. Some
would suggest that this increase may be due to global warming, though this seems
unlikely.
Hospital-acquired infections have occurred and are usually due to
contamination of the water supply. Two well-reported cases occurred in the 1980s
in Los Angeles, one at the Wadsworth VA hospital and the other at the City of
Hope. Guidelines have now been established for routine environmental testing for
Legionnaires' in several states in the United States and by the Veterans Affairs
health-care system.
With regard to travel-associated infection, this usually occurs in hotels
from contaminated water, most notably at the Legionnaires' convention in
Philadelphia. This disease has also been associated with travel on cruise ships.
Some data suggest an increase incidence of Legionnaires' in the elderly in
nursing homes linked to eating puréed food, probably also due to increased
aspiration in this population.
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.
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.
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.
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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