Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

Information for Patients

View all Images (14)

Potentially life-threatening emergency
Legionellosis
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Legionellosis

Contributors: Neil Mendoza MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Legionellosis is caused by Legionella pneumophila, a small gram-negative bacillus found in aqueous environments.

Almost all cases of legionellosis are a result of inhalation of aerosolized bacteria contaminating warm man-made water bodies, such as water heaters, air conditioning equipment, cooling towers, warm-water baths, warm-water plumbing systems, and recirculating water systems. Contamination of such water systems in hospitals has led to nosocomial outbreaks of disease. Person-to-person transmission does not occur.

Legionellosis is believed to occur throughout the world. In the United States, about 9000 confirmed cases were reported each year in 2018 and 2019; the actual incidence is likely higher. The majority of patients were hospitalized for treatment. Most cases are sporadic. Less than one-fifth of all cases are associated with an outbreak, including health care-associated and travel accommodation-associated outbreaks.

Cigarette smoking, chronic heart and lung disease, male sex, diabetes mellitus, end-stage renal disease, cancer, and advanced age (older than 50 years) are some of the host factors that increase the risk for contracting legionellosis. Patients who are immunosuppressed are at a higher risk for infection with L pneumophila. Occupational exposures increase risk, such as hospital employment, work as a heating and air-conditioning technician, and building maintenance work. Social exposures include hot tub use.

The incubation period is generally between 2-10 days, but cases with incubation periods as long as one month have been reported. A prodromal illness consisting of headaches, myalgias, weakness, diarrhea, and abdominal pain may occur. These symptoms may suggest a viral illness and lead to a misdiagnosis. Cough, shortness of breath, pleuritic chest pain, and fever (in some cases, 40°C [104°F] or higher) may develop. Mental confusion may be present. Clinical examination findings are nonspecific and may include focal rales or signs of lung consolidation. The viral-like prodrome that does not progress to pneumonia is also referred to as Pontiac fever and is self-limited. Pontiac fever has been recognized only during outbreaks of legionellosis.

Nonspecific findings such as pulse-temperature dissociation, hyponatremia, abnormal liver enzymes, lymphocytopenia, thrombocytopenia, disseminated intravascular coagulation, elevated creatine kinase (CK), and elevated serum lactate dehydrogenase (LDH) have been described with legionellosis. These findings are insufficiently specific and sensitive to be of diagnostic value.

Rare cases of extrapulmonary disease have been described.

Codes

ICD10CM:
A48.1 – Legionnaires' disease

SNOMEDCT:
26726000 – Legionellosis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Subscription Required

References

Subscription Required

Last Reviewed:10/08/2024
Last Updated:10/13/2024
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Patient Information for Legionellosis
Print E-Mail Images (14)
Contributors: Medical staff writer
Premium Feature
VisualDx Patient Handouts
Available in the Elite package
  • Improve treatment compliance
  • Reduce after-hours questions
  • Increase patient engagement and satisfaction
  • Written in clear, easy-to-understand language. No confusing jargon.
  • Available in English and Spanish
  • Print out or email directly to your patient
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Legionellosis
A medical illustration showing key findings of Legionellosis : Cough, Diarrhea, Fever, Headache, Nausea, Pleuritic chest pain, Dyspnea, Myalgia
Imaging Studies image of Legionellosis - imageId=2954652. Click to open in gallery.  caption: 'Frontal chest x-ray with opacities in the bilateral lower lobes in this patient with Legionnaires' disease.'
Frontal chest x-ray with opacities in the bilateral lower lobes in this patient with Legionnaires' disease.
Copyright © 2024 VisualDx®. All rights reserved.