Management of Legionella in the intensive care setting

In August 2009, during the swine flu pandemic, a 55-year-old male presented to the Emergency Department (ED) with shortness-of-breath and chest pain. He had experienced diarrhoea and vomiting during the 3 weeks preceding admission, and so had sought the advice of his General Practitioner (GP) who had prescribed a course of oseltamivir (Tamiflu). Despite this, his symptoms had worsened, and on arrival in the ED he was found to be tachypnoeic, tachycardic, feverish, anuric and in type I respiratory failure with a compensated metabolic acidosis. He subsequently became hypotensive, and so was transferred to the Intensive Care Unit (ICU) for supportive treatment of three organ failures. Investigation revealed that he was suffering from Legionnaires disease. This required a prolonged inpatient stay owing to both disease and treatment related complications.