Legionnaires Disease in Emergency Medicine Treatment & Management

  • Author: Frank C Smeeks lll, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 31, 2011
 

Prehospital Care

  • Oxygen therapy is the mainstay of prehospital therapy.
  • Intravenous (IV) access and fluid therapy may be indicated for dehydration or septic shock.
  • Restraints may be required for patients with altered mental status. Seizure precautions may be indicated.
  • Differentiating Legionnaires disease with multiple rigors and altered mental status from a seizure disorder may be possible only through a clinical examination.
Next

Emergency Department Care

  • Control the airway as indicated clinically. Support ventilation and oxygenation.
  • Rehydrate the patient as indicated, especially in shock or diarrheal disease.
  • Antipyretics may be used, as indicated.
  • Cardiac monitoring may be required if chest pain, hypotension, bradycardia, or other indicators are present.
  • Obtain laboratory specimens (respiratory culture and urine antigen testing), CXR, CT scan, and CSF, as indicated.
  • Begin empiric antibiotic therapy as noted below. (Also see the CDC's Legionella Resource Center and Infectious Diseases Society of America's clinical guideline.[2] )
Previous
Next

Consultations

  • Because of the protean presentation of this disease, many different consultations may be indicated.
  • General internists, pulmonologists, critical care specialists, cardiologists, gastroenterologists, neurologists, infectious disease specialists, nephrologists, oncologists, and general surgeons may be required at one time or another.
Previous
Proceed to Medication
 
 
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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; 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.

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 

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

References

  1. CDC. Summary of notifiable diseases, United States 2008. MMWR Morb Mortal Wkly Rep. June 25 2010;57(54):1-94.

  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]. [Full Text].

  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].

 
Previous
Next
 
This electron micrograph depicts an amoeba, Hartmannella vermiformis (orange), as it entraps a Legionella pneumophila bacterium (green) with an extended pseudopod. After it is ingested, the Legionella pneumophila bacterium can survive as a symbiont within what then becomes its protozoan host. The amoeba then becomes what is referred to as a "Trojan horse," for by harboring the pathogenic bacteria, the amoeba can afford them protection, and in fact, in times of adverse environmental conditions, are able to metamorphose into a cystic-stage enabling it, and its symbiotic resident pathogens to withstand such environmental stresses. Image courtesy of the Centers for Disease Control and Prevention and Dr. Barry S Fields.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.