eMedicine Specialties > Infectious Diseases > Lower Respiratory Tract Infections

Legionnaires Disease: Follow-up

Author: Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Coauthor(s): Lynn E Sullivan, MD, Assistant Professor of Medicine, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Feb 5, 2008

Follow-up

Further Inpatient Care

  • Patients with mild-to-moderate pneumonia are admitted to the hospital for parenteral antibiotics and supportive measures. Patients deemed to have a severe pneumonia may require ICU admission for closer monitoring. Quickly initiate empiric antibiotic treatment and obtain a diagnostic workup.

Further Outpatient Care

  • In milder cases, patients can be treated in the outpatient setting with oral antibiotics.
  • For patients who are hospitalized and treated with intravenous antibiotics, start oral antibiotics while in the hospital and observe for continued response. Continue oral antibiotics on an outpatient basis for 14-21 days, depending on the severity of the presenting illness. Patients should receive close follow-up care to ensure complete resolution of their respiratory symptoms.

Inpatient & Outpatient Medications

  • Patients should complete the full course of their antibiotics, whether the treatment is initiated in the outpatient setting or in the hospital.

Deterrence/Prevention

  • Prevention and control of nosocomial legionellosis
    • Legionellae should be sought in hospitalized patients with an increased risk for infection and subsequent death.
    • If one definite case or 2 possible cases of nosocomial legionnaires disease (LD) occur among inpatients, initiate an investigation for a hospital source.
    • Routinely maintain cooling towers and use only sterile water for filling and rinsing of nebulization devices.
    • Improve the design and maintenance of cooling towers and plumbing systems.
  • Disinfection
    • Superheating water to 70-80°C, with flushing of distal sites
    • Installation of copper-silver ionization units, which produce metallic ions that disrupt the bacterial cell wall, thus resulting in lysis and cell death: This method provides sustained protection and is very effective at eradicating legionellae.
    • Use of ultraviolet light, which kills legionellae by damaging cellular DNA: This system is effective when disinfecting localized areas; however, because it provides no sustained protection, adjunctive treatments must be used.
    • Hyperchlorination of water is no longer recommended because legionellae are fairly chlorine resistant, and chlorine decomposes at higher water temperatures found in hot water systems being treated.

Complications

  • Decreased pulmonary function
  • Abscess formation (in the lungs or at extrapulmonary sites)
  • Pulmonary fibrosis or scarring
  • Fulminant respiratory failure
  • Death

Prognosis

  • Progressive respiratory failure is the most common cause of death in patients with Legionella pneumonia. The mortality rate depends on the comorbid conditions of the patient, as well as the choice and timeliness of antibiotics administration. The site of acquisition (eg, nosocomial, community-acquired) may also affect the outcome.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize L pneumophila as an important cause of CAP could lead to suboptimal treatment with inappropriate antibacterial agents and could result in unnecessary patient morbidity and mortality.
 


More on Legionnaires Disease

Overview: Legionnaires Disease
Differential Diagnoses & Workup: Legionnaires Disease
Treatment & Medication: Legionnaires Disease
Follow-up: Legionnaires Disease
References
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References

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Further Reading

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Keywords

legionnaire disease, LD, Legionella pneumonia, Legionella pneumophila, L pneumophila, legionellosis, legionnaires disease, Pontiac fever, nosocomial pneumonia, community-acquired pneumonia, Legionella micdadei, L micdadei, Legionella bozemanii, L bozemanii, Legionella dumoffii, L dumoffii, Legionella longbeachae, L longbeachae, Pittsburgh pneumonia agent

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Contributor Information and Disclosures

Author

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Lynn E Sullivan, MD, Assistant Professor of Medicine, Yale University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Fred A Lopez, MD, Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine
Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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