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[Legionellosis as a polyvalent disease picture]
1St. Vincenz Krankenhaus, Innere Abteilung, Menden.
Abstract:
This article reports on the course of four cases of legionellosis confirmed by a positive fluorescence titre of 1:128. The dramatic course was characterized by severe pneumonia in only a single case. Common features of all four patients were alcohol abuse, cholestatic hepatitis, progressive azotaemia and leukocytosis above 30 x 10(9)/l, or an ESR above 110 (Westergren). In view of the doubtful prognosis of the disease, the care-providing physician should bot wait for a significant increase in titres before starting treatment with tetracyclines or erythromycins.
Insights
Early treatment for legionellosis is crucial. This study highlights key symptoms like cholestatic hepatitis and high white blood cell counts, urging physicians to start antibiotics like tetracyclines or erythromycins promptly, even before definitive diagnostic confirmation.
Area of Science:
- Infectious Diseases
- Hepatology
- Nephrology
Background:
- Legionellosis is a severe bacterial infection often presenting with pneumonia.
- Diagnosis can be delayed, impacting patient outcomes.
- Identifying key clinical indicators is vital for timely intervention.
Purpose of the Study:
- To report on the clinical course of four confirmed legionellosis cases.
- To identify common clinical features and laboratory findings.
- To emphasize the importance of early treatment initiation.
Main Methods:
- Case series reporting on four patients with confirmed legionellosis.
- Analysis of clinical presentation, laboratory results, and disease progression.
- Fluorescence immunoassay for Legionella antibody detection.
Main Results:
- Severe pneumonia occurred in only one of the four cases.
- Common features included alcohol abuse, cholestatic hepatitis, and progressive azotaemia.
- Marked leukocytosis (>30 x 10(9)/l) or elevated ESR (>110 mm/hr) were observed.
Conclusions:
- Legionellosis can present with varied severity, not always severe pneumonia.
- Clinical indicators such as cholestatic hepatitis and azotaemia warrant consideration for legionellosis.
- Physicians should initiate antibiotic treatment (tetracyclines or erythromycins) promptly, without awaiting significant titer increases, due to the uncertain prognosis.