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Alternative namesLegionella pneumonia; Pontiac fever
DefinitionLegionnaire's disease is an acute respiratory infection caused by the bacterium Legionella pneumophila , which can cause a broad spectrum of disease from mild cough and fever to a serious pneumonia .
Causes, incidence, and risk factorsThe bacteria that cause Legionnaire's disease have been found in water delivery systems and can survive in the warm, moist, air conditioning systems of large buildings including hospitals. The infection is transmitted through the respiratory system. Person-to-person spread has not been proved.
From the onset of symptoms, the condition typically worsens during the first 4 to 6 days, with improvement starting in another 4 to 5 days. Most infection occurs in middle-aged or older people, although it has been reported in children. Typically, the disease is less severe in children.
Risk factors include cigarette smoking; underlying diseases such as renal failure , cancer, diabetes, or chronic obstructive pulmonary disease ; people with suppressed immune systems from chemotherapy, steroid medications, or diseases such as cancer and leukemia; alcoholism; being middle-aged or elderly, and in people on a ventilator for extended periods.
Signs and tests
The goal of treatment is to eliminate the infection with antibiotics. Treatment is started as soon as Legionnaire's disease is suspected, without waiting for confirmation by culture results.
The antibiotic commonly used is quinolone (ciprofloxacin, levofloxacin, moxifloxacin, or gatifloxacin) or a macrolide (azithromycin, clarithromycin, or erythromycin).
Supportive treatment includes hospitalization for fluid and electrolyte replacement and oxygen administration by mask or by mechanical ventilation, if the respiratory system becomes severely compromised by the infection.
Expectations (prognosis)The overall death rate for those with pneumonia is about 15%, and the death rate increases in those with underlying diseases. The mortality for patients who develop Legionnaire's disease while hospitalized is close to 50%, especially when antibiotics are started late.
Some complications include respiratory failure requiring use of a respirator.
Calling your health care providerCall your health care provider if breathing difficulties develop.
PreventionActive surveillance of infections that were acquired within a hospital can lead to the treatment of contaminated water delivery systems. Detection and treatment of sources outside hospitals usually occurs during or after an epidemic has happened.
Update Date: 8/11/2003Daniel Levy, M.D., Ph.D., Infectious Diseases, Greater Baltimore Medical Center, Baltimore, MD. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT