LEGIONELLA - World Health Organization
LEGIONELLA - World Health Organization
LEGIONELLA - World Health Organization
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1.1.1 Legionnaires’ disease<br />
Symptoms<br />
Legionnaires’ disease lacks characteristic symptoms or signs — there is no typical syndrome,<br />
and not everyone exposed to the organism will develop symptoms of the disease (Yu et al.,<br />
1982; Macfarlane et al., 1984; Granados et al., 1989; Roig et al., 1991; Sopena et al., 1998;<br />
Ruiz et al., 1999; Gupta, Imperiale & Sarosi, 2001). However, several clinical signs are classically<br />
associated with Legionnaires’ disease rather than with other causes of pneumonia. Table 1.1<br />
(below) lists the most common symptoms of Legionnaires’ disease and Pontiac fever.<br />
Table . Ma n character st cs of Leg onna res’ d sease and Pont ac fever<br />
Character st c Leg onna res’ d sease Pont ac fever<br />
Incubation period 2–10 days, rarely up to 20 days 5 hrs–3 days (most<br />
commonly 24–48 hrs)<br />
Duration Weeks 2–5 days<br />
Case–fatality rate Variable depending on susceptibility; in hospital<br />
patients, can reach 40–80%<br />
No deaths<br />
Attack rate 0.1–5% of the general population<br />
0.4–14% in hospitals<br />
Up to 95%<br />
Symptoms • Often non-specific<br />
• Influenza-like illness<br />
• Loss of strength (asthenia)<br />
(moderate to severe<br />
• High fever<br />
influenza)<br />
• Headache<br />
• Nonproductive, dry cough<br />
• Sometimes expectoration blood-streaked<br />
• Chills<br />
• Muscle pain<br />
• Difficulty in breathing, chest pain<br />
• Diarrhoea (25–50% of cases)<br />
• Loss of strength<br />
(asthenia), tiredness<br />
• High fever and chills<br />
• Muscle pain<br />
(myalgia)<br />
• Headache<br />
• Joint pain<br />
(arthralgia)<br />
• Vomiting, nausea (10–30% of cases)<br />
• Central nervous system manifestations, such<br />
as confusion and delirium (50% of cases)<br />
• Renal failure<br />
• Diarrhoea<br />
• Nausea, vomiting<br />
(in a small proportion<br />
of people)<br />
• Hyponatraemia (serum sodium 700 units/ml (dyspnoea) and<br />
• Failure to respond to beta-lactam antibiotics<br />
or aminoglycosides<br />
• Gram stain of respiratory specimens with<br />
numerous neutrophils and no visible organisms<br />
dry cough<br />
Sources: Woodhead & Macfarlane, 1987; Stout & Yu, 1997; Yu, 2000; Akbas & Yu, 2001; Mülazimoglu & Yu, 2001<br />
<strong>LEGIONELLA</strong> AND THE PREVENTION OF LEGIONELLOSIS
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