eMedicine Specialties > Emergency Medicine > Infectious Diseases

Legionnaires Disease: Follow-up

Author: Frank C Smeeks lll, MD, Chief Medical Officer, Frye Regional Medical Center
Contributor Information and Disclosures

Updated: Jun 1, 2009

Follow-up

Further Inpatient Care

  • Hospital admission is indicated in almost all patients.
  • ICU admission should be based on clinical judgment of current severity of illness, presence of comorbid disease, general health of the patient, and availability of adequate patient monitoring.
  • Consultation with a pulmonologist or infectious disease specialist is strongly recommended.

Further Outpatient Care

  • Close follow-up with a pulmonologist or infectious disease specialist is recommended following discharge.

Transfer

  • Transfer may be indicated for patients presenting to facilities without adequate ICU facilities, pulmonary consultants, or infectious disease specialists.

Deterrence/Prevention

  • Heating water to 60-70 degrees Centigrade may help prevent water contamination.
  • Ultraviolet light or copper silver ionization is bactericidal.
  • Sources of infection including nosocomial sources must be evaluated (environmental culture and screening). Potable water supplies, water storage, and plumbing should be disinfected. 

Complications

  • Dehydration, septic shock
  • Hyponatremia due to SIADH
  • Respiratory insufficiency, hypoxic respiratory failure
  • Endocarditis
  • Gastrointestinal symptoms - Diarrhea, vomiting, anorexia
  • DIC
  • Renal failure
  • Multiple organ failure
  • Coma
  • Death in 10% of treated nonimmunocompromised patients and in as many as 80% of untreated immunocompromised patients
  • Bacteremia or abscess formation in immunocompromised patients

Prognosis

  • Recovery is variable.
  • Some patients experience rapid improvement, while others have a much more protracted course despite treatment.
  • The mortality rate approaches 50% with nosocomial infections.
  • Data concerning the overall prognosis of patients are unreliable because of the high rate of serious comorbid diseases.
  • Prognosis depends on the early administration of active antibiotics.

Patient Education

  • Altering modifiable risk factors is beneficial.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the disease in the absence of upper respiratory symptoms
  • Failure to hospitalize patients suspected of having Legionnaires disease, especially those with comorbid diseases
  • Failure to consider the diagnosis in patients with altered mental status, fever, and normal CSF studies
  • Failure to initiate antibiotic therapy
  • Failure to monitor for rhabdomyolysis

Special Concerns

  • Pregnancy: Avoid tetracyclines.
  • Pediatric: Fortunately, Legionnaires disease is unusual in this group.
  • Geriatric: Aggressive therapy may be indicated due to the higher mortality rate.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the medical review of this article by Joseph U Becker, MD.

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Scott Savage, DO, to the development and writing of this article.



More on Legionnaires Disease

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

  1. CDC. Summary of notifiable diseases, United States 1995. MMWR Morb Mortal Wkly Rep. Oct 25 1996;44(53):1-87. [Medline].

  2. [Guideline] Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. Mar 1 2007;44 Suppl 2:S27-72. [Medline].

  3. Amsden GW. Treatment of Legionnaires' disease. Drugs. 2005;65(5):605-14. [Medline].

  4. Blanquer J, Blanquer R, Borras R, et al. Aetiology of community acquired pneumonia in Valencia, Spain: a multicentre prospective study. Thorax. Jul 1991;46(7):508-11. [Medline].

  5. CDC. Legionnaires disease associated with a whirlpool spa display--Virginia, September-October, 1996. MMWR Morb Mortal Wkly Rep. Jan 31 1997;46(4):83-6. [Medline].

  6. Cunna B. Legionnaire's disease - Case studies in infectious disease. Emerg Med. 1992;24:227-234.

  7. Falco V, Fernandez de Sevilla T, Alegre J, Ferrer A, Martinez Vazquez JM. Legionella pneumophila. A cause of severe community-acquired pneumonia. Chest. Oct 1991;100(4):1007-11. [Medline].

  8. Lane G, Ferrari A, Dreher HM. Legionnaire's disease: a current update. Medsurg Nurs. Dec 2004;13(6):409-14. [Medline].

  9. Marrie TJ, Haldane EV, Noble MA, Faulkner RS, Martin RS, Lee SH. Causes of atypical pneumonia: results of a 1-year prospective study. Can Med Assoc J. Nov 15 1981;125(10):1118-23. [Medline].

  10. Marston BJ, Lipman HB, Breiman RF. Surveillance for Legionnaires' disease. Risk factors for morbidity and mortality. Arch Intern Med. Nov 14 1994;154(21):2417-22. [Medline].

  11. Palmer L. Legionella pneumonia - Cardiopulmonary problems in the office. Emerg Med. 1992;24:84-94.

  12. Reingold AL. Role of legionellae in acute infections of the lower respiratory tract. Rev Infect Dis. Sep-Oct 1988;10(5):1018-28. [Medline].

  13. Shah A, Check F, Baskin S, Reyman T, Menard R. Legionnaires' disease and acute renal failure: case report and review. Clin Infect Dis. Jan 1992;14(1):204-7. [Medline].

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Further Reading

Other resources

Legionellosis Resource Center

Clinical guidelines

Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007 Mar 1;44 Suppl 2:S27-72. [335 references] PubMed

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Keywords

Legionnaires disease, Legionnaires' disease, Legionella pneumophila, L pneumophila, atypical pneumonia, pulmonary infection, Pontiac fever, community-acquired bacterial pneumonia, CAP

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Contributor Information and Disclosures

Author

Frank C Smeeks lll, MD, Chief Medical Officer, Frye Regional Medical Center
Frank C Smeeks lll, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Eric M Kardon, MD, FACEP, Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jeter (Jay) Pritchard Taylor III, MD, Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist
Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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