engleski

Clinical and epidemiological characteristics of Legionnaires` disease in our patient

Introduction: Legionella pneumophila is implicated in 2-6% of community-acquired pneumonia (CAP) cases. Legionella can be a major cause of lethal pneumonia, with mortality rates of 5-25% among immunocompetent hosts and substantially higher rates among immunosuppressed hosts. The aim of our study was to analyse clinical and epidemiological characteristics of Legionnaires' Disease (LD) in our hospitalized patients. Patients and methods: We retrospectively studied patients with LD hospitalized at the University Hospital for Infectious Diseases in Zagreb, during the four years period from January 1, 2000 through December 31, 2003. LD was confirmed serologically by enzyme-linked immunosorbent assay (ELISA) and/or by specific Legionella antigen in urine. Results were analyzed with descriptive statistics. Results: A total of 60 patients were studied. The majority of patients were males (53/60), mean age 49 years, range 26-85. The localities of the presumed Legionella pneumophila exposed LD patients were mostly in Zagreb area (45/60). More than half of LD cases occurred between June and October (35/60). In all cases the presentation was sporadic. One third of patients had one or more co-morbid illnesses. Half of the patients were smokers. The most common symptoms were fever (60/60), cough (42/60) and headache (38/60). Accelerated erythrocyte sedimentation rate (ESR) and increased level of C-reactive protein (CRP) had all patients. Leukocytosis was recorded in 42/60 patients. Two patients presented with acute renal failure. More than half of the patients (36/60) with LD had increased level of aminotransferases and 14/60 had hyponatriaemia (Sodium <130 mmol/L). Abnormal ECG findings had 35/60, and four patients had myocarditis. The radiological manifestations of pneumonia were interstitial in 29/60, and alveolar in 25/60, localized mostly unilaterally (44/60). Pleural effusion was recorded in nearly one third of patients (18/60). Patients were grouped into five risk classes according to the Pneumonia Severity Index (PSI). There were 41 patients in low-risk class (I to III), and 19 in high-risk class (IV and V). Mechanical ventilation was used in seven patients. Four patients developed ARDS, and one patient died. Conclusion: On the average, we annually hospitalized 15 patients with LD which occurred as sporadic cases. The clinical symptoms of the LD closely resembled those of other atypical agent, while laboratory findings were unremarkably different from pneumococcal pneumonia. One third of patients belonged to high-risk class. The mortality rates were low.

Legionnaires` disease

nije evidentirano