LEGIONNAIRES DISEASE

Legionella pneumophila- gram-negative aerobic freshwater bacterium.

Widely distributed in soil & water.

Exists in nature as a protozoan parasite, often seen within fresh water biofilms.

Primarily causes pneumonia, flulike illness & gastrointestinal symptoms.

Legionella colonizes commercial water systems (apartment buildings, hotels, hospitals, air conditioning cooling towers).

One of the three most common causes of community acquired pneumonia (CAP), and the most common atypical pneumonia.

In lungs- Legionella infects alveolar macrophages.

Transmitted by breathing contaminated water droplets or aspiration of contaminated water.

Community outbreaks- associated with whirlpools, fountains, spas, and aboard cruise ships.

Legionnaires disease- Risk factors

& more common in

Cigarettes smoker,

Chronic lung disease,

Immunocompromised- HIV; diabetes; organ transplant recipients; corticosteroid use.

Impaired cellular immunity (Legionella are intracellular pathogens),

Male gender,

Alcohol abuse,

Antimicrobials use in last 3 months

Advanced age, etc.

LEGIONNAIRES DISEASE- Symptoms & signs:

Cough typically dry (scanty sputum), fever/chills, dyspnoea, watery diarrhoea, pleuritic chest pain, headache, myalgia, arthralgia, nausea and vomiting, neuropsychiatric menifestations- encephalopathy, confusion, disorientation, hallucinations, insomnia, and seizure, depression, etc.

Relative bradycardia,

Temperature ≥102°F & low pulse rate <100 beats/min.

Signs of consolidation rales, pectoriloquy, egophony, tactile fremitus.

LEGIONNAIRES DISEASE- COMPLICATIONS:

Dehydration, Hyponatremia, Respiratory insufficiency, Bacteremia, lung abscess, Cellulitis, Sinusitis, Endocarditis, Pancreatitis, Pyelonephritis, Perirectal abscess, Renal failure, Disseminated intravascular coagulation, Encephalitis, Pericarditis, Multiple organ dysfunction syndrome (MODS), Coma, Death more in immunocompromised.

LEGIONNAIRES DISEASE- Investigation:

Testing sputum samples (from lower respiratory secretions) using polymerase chain reaction (PCR) detects ~100% of all Legionella species.

Culture for Legionella species 80–90% sensitivity (uses special media buffered charcoal yeast extract [BCYE] agar), result time delays of up to 7 days.

Serologic testing such as urinary antigen test (UAT) detects serogroup 1 (which causes ~80% of disease).

UAT specific (95–100%) but of less sensitive.

Hyponatremia, Hypophosphatemia, Lymphopenia, Mild elevated liver enzymes, elevated LDH, elevated creatine kinase, Microscopic haematuria, Highly elevated C-reactive protein (CRP) (>30), Highly elevated ferritin (≥2 times normal),

Chest X-ray shows unilateral lower lobe patchy alveolar infiltrate with consolidation, Cavitation and abscess (more common in immunocompromised) & Pleural effusion.

LEGIONNAIRES DISEASE- Treatment:

Levofloxacin 750 mg orally or IV once daily or

Azithromycin 500 mg orally or IV once daily

Clarithromycin 500 mg orally twice daily

Duration of therapy 10-14 days, & 21 days for immunocompromised or patients with severe disease.

Second Line

Doxycycline 100 mg IV or PO q12h for 14 days.

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