[A clinical study of fulminant Legionnaires' disease]

Seven cases of fulminant Legionnaires' disease treated at Kitasato University Hospital between 1985 and 1992 were reviewed. These patients were male with a mean age of 55.9 years (range, 37-67 yrs), and five were heavy alcohol drinkers. All seven patients required mechanical ventilation. Four patients recovered (group 1) and three expired due to respiratory failure (group 2). The mean interval from initial symptoms to the development of respiratory failure was 8.8 days in group 1 and 6.0 days in group 2, except in the one patient with lung cancer (case 6). The progression of pneumonia was more rapid in group 2. The mean intervals from admission to administration of erythromycin were 1.5 days and 3.5 days, respectively, in groups 1 and 2. In group 1, pulmonary infiltrates and respiratory insufficiency worsened for the first few days after erythromycin administration but improved thereafter. The average duration of ventilatory care in group 1 was 13.3 days. The administration of rifampicin combined with erythromycin may be useful for the treatment of fulminant Legionnaires' disease. When fulminant pneumonia is encountered in a middle-aged or elderly male alcoholic, Legionnaires' disease should be suspected and erythromycin administration with rifampicin should be initiated as early as possible.