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LegionellaAka: Legionella pneumophila, Legionella pneumonia, Legionnaire's Disease, Legionellosis

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  1. See Also
    1. Bacterial Pneumonia
  2. Pathophysiology
    1. Aerobic, intracellular, Gram Negative Rod
      1. Virulent organism
      2. More severe disease than other Atypical Pneumonia
    2. Transmission
      1. Optimal conditions for growth
        1. Temperature: 89 to 113 F water
        2. Stagnant water
      2. Waterborne
        1. Freshwater or moist soil near ponds
        2. Air conditioning
        3. Condensers
        4. Cooling towers
        5. Respiratory therapy equipment
        6. Showers or water faucets
        7. Whirlpools
    3. Incubation
      1. Two to ten days
  3. Risk Factors
    1. Tobacco Smoking
    2. Chronic Renal Failure
    3. Malignancy
    4. Immunosuppression
    5. Diabetes Mellitus
    6. Chronic Liver Disease
    7. Exposure to recent plumbing work
    8. Overnight stay outside the home
  4. Symptoms
    1. Prodrome for 12-48 hours
      1. Malaise
      2. Myalgia
      3. Headache
    2. Symptoms for 2-3 days
      1. Fever to 40.5 C persists for 8-10 days
      2. Gastrointestinal symptoms in 20-40% of cases
        1. Nausea or Vomiting
        2. Diarrhea
    3. Later Symptoms: Cough
      1. Minimal to no Sputum production
      2. Slightly blood tinged Sputum
  5. Signs
    1. Severe respiratory distress
    2. Confusion
    3. Disorientation
  6. Complications
    1. Respiratory failure (20-40% of cases)
    2. Extrapulmonary complications
      1. Myocarditis or Pericarditis
      2. Prosthetic valve endocarditis
      3. Glomerulonephritis
      4. Pancreatitis
      5. Peritonitis
  7. Radiology: Chest XRay
    1. Small Pleural Effusions
    2. Unilateral parenchymal infiltrates
      1. Round, fluffy opacities
      2. Spread contiguously to other lobes
      3. Progresses to dense consolidation
      4. Progresses to bilateral infiltrates
  8. Labs
    1. Complete Blood Count
      1. Leukocytosis
      2. Leukopenia
    2. Erythrocyte Sedimentation Rate
      1. Elevated markedly
    3. Liver Function Tests increased
    4. Sputum Exam
      1. Fluorescent Antibody studies of Sputum
      2. Legionella can not be seen on Gram Stain
  9. Diagnosis
    1. Legionella urine antigen testing
      1. High sensitivity and Specificity for serogroup 1
        1. Serogroup 1 (LP1) causes most U.S. cases
      2. Sputum Culture required to identify other serogroups
        1. Urine antigen and Sputum Culture all cases
      3. References
        1. Benin (2002) Clin Infect Dis 35:1039
    2. Sputum Culture on special medium
    3. Legionella Serologies
      1. Legionella fourfold titer rise to >= 1:128 or
      2. Legionella titer >= 1:256
  10. Management (Antibiotic course for 21 days)
    1. Azithromycin IV
    2. Levofloxacin IV
    3. Trovafloxacin IV
    4. Erythromycin IV
      1. Add Rifampin in immunocompromised or severe disease
  11. Course
    1. Response to antibiotics may not be seen for 4-5 days
    2. Up to 15% mortality in some studies
  12. References
    1. Gilbert (2001) Sanford Antimicrobial, p. 28
    2. Akbas (2001) Postgrad Med 109(5):135
    3. File (1998) Infect Dis Clin North Am 12(3):569
    4. Klein (1998) Semin Respir Infect 13(2):140
    5. Plouffe (2000) Clin Infect Dis 31:S35
    6. Tan (1999) Can Respir J 6:15A
    7. Waterer (2001) Am J Med 110(1):41

Legionellosis (C0023240)

Definition (MSH)Infections with bacteria of the genus LEGIONELLA.
Definition (CSP)gram negative bacterial infection by any species of Legionella including Legionnaire's disease, which is characterized by high fever, malaise, muscle aches, respiratory disorders and headache.
ConceptsDisease or Syndrome (T047)
MSHD007876
EnglishLegionella infection, Legionelloses, Legionellosis
Spanishinfeccion por Legionella, legionelosis
Parent ConceptsBacterial Infections (C0004623), Respiratory Tract Infections (C0035243), Gram-Negative Bacterial Infections (C0085423), Disease due to Gram-negative bacillus (C1319381)
SourcesCSP, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Legionnaires' Disease (C0023241)

Definition (MSH)An acute, sometimes fatal, pneumonia-like bacterial infection characterized by high fever, malaise, muscle aches, respiratory disorders and headache. It is named for an outbreak at the 1976 Philadelphia convention of the American Legion.
ConceptsDisease or Syndrome (T047)
ICD9482.84
MSHD007877
EnglishINFECT LEGIONELLA PNEUMOPHILA, Infection by Legionella pneumophilia, Legionella, Legionella pneumonia, LEGIONELLA PNEUMOPHILA INFECT, Legionella pneumophila Infection, Legionella pneumophila Infections, LEGIONNAIRE DIS, Legionnaire Disease, Legionnaire's Disease, LEGIONNAIRES DIS, Legionnaires disease, LEGIONNAIRES' DISEASE
Spanishenfermedad de los legionarios, infeccion por Legionella pneumophila, infeccion por Legionella pneumophilia, neumonia de los legionarios, neumonia por Legionella
Parent ConceptsPneumonia due to other specified bacteria (C0032286), Legionellosis (C0023240), Acute lower respiratory tract infection (C0238990), Bacterial lower respiratory infection (C0729520), Infectious disease of lung (C0876973), Ambiguous concept (C1274012), Pneumonia due to aerobic bacteria (C1443977)
SourcesCOSTAR, CSP, DXP, ICD9CM, LCH, MEDLINEPLUS, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Legionella pneumophila antigen (C0369588)

ConceptsImmunologic Factor (T129)
EnglishLegionella pneumophila, Legionella pneumophila Ag, Legionella pneumophila antigen
Spanishantigeno de Legionella pneumophila
Parent ConceptsAntigens, Bacterial (C0003321)
SourcesLNC, MTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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