Abstract
From 1981 to 1991, 55 patients (33 males, 22 females, mean age 58.6 years) with nosocomial Legionnaires' disease were studied. The mortality rate was 64%. One-half of the patients developed nosocomial Legionnaires' disease within three weeks of admission. A surprising clinical feature was the low rate of findings of consolidation on physical examination, despite the fact that 52% of patients had this finding on chest radiograph. More than one-half of patients had pre-existing lung disease, rendering a radiographic diagnosis of pneumonia due to Legionella pneumophila impossible in 16% of cases despite microbiological confirmation. Nineteen per cent of patients who had blood cultures done had a pathogen other than L pneumophila isolated, suggesting dual infection in at least some of the patients. When the clinical and radiographic findings were combined it was noted that 40% of patients had one of three patterns suggestive of nosocomial Legionnaires' disease: rapidly progressive pneumonia, lobar opacity and multiple peripheral opacities. However, in 60% of patients there were no distinctive features.
Highlights
RESUME: De 1981 a 1991. 55 patients (33 de sexe masculin ct 22 de sexe feminin: moyenne cl'a
Korvick and co-·workers (19) reviewed 16 reports of nosocomial legionellosis published from 1965 lo 1983
Korvick and Yu (20) in another report noted that surgical patients represent 23 to 50% of all patients with nosocomial Legionnaires· disease
Summary
Fifty-five patients (33 males and 22 females; mean age 58.6 years) had nosocomial Lecrionnaires· disease diagnosed from 1981 to June 1990. Thirty-eigh t of the iso late were L pneumophiLa serogroup l. Of note is U1e large number of patien ts wh o were receiving corticosteroid therapy- 69o/o. An additional 16o/o received orne oU1er form ofln1munosuppressive therapy.1\ven ty-nine per cent had a malignan cy and 60o/o required assisted ventilation. 1\venty-eight per cent of those who had blood cultures done had a pailiogen isolated. TABlE 3 Results of blood cultures in 55 patients with nosocomial legionnaires' disease. TABlE 4 Results of sputum cultures and special stains for pathogens other than legionellaceae in 55 patients with nosocomial l egionnaires' disease. TABlE 5 APACHE score* a nd mortality in 5 1 patients with noso comial l egionnaires' disease
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