When should Legionella infection be suspected?

Updated: Nov 13, 2018
  • Author: Mobeen H Rathore, MD, CPE, FAAP, FIDSA; Chief Editor: Russell W Steele, MD  more...
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For Legionnaires disease (LD), a high level of suspicion and prompt initiation of adequate antimicrobial therapy are critical to improve clinical outcomes. [33] In contrast, for Pontiac fever, treatment is symptomatic, and no antimicrobial therapy is recommended.

Therapy effective in patients with legionellosis should be considered for initial empirical treatment for severe community-acquired pneumonia (CAP) and for specific patients with nosocomial pneumonia. Support therapy in patients with shock and respiratory failure is administered as needed.

  • Situations suggesting Legionella disease

    • Gram stains of respiratory samples revealing many polymorphonuclear leukocytes with few or no organisms

    • Hyponatremia

    • Pneumonia with prominent extrapulmonary manifestations (eg, diarrhea, confusion, other neurologic symptoms)

    • Failure to respond to administration of beta-lactams, aminoglycoside antibiotics, or both

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