Medicus, Vol. 14 No. 1_ARI, 2005.
Review article
Legionnaires' Disease: A Practical Approach to Diagnostics and Treatment
Ilija Kuzman
Ivan Puljiz
Abstract
Legionellae regularly colonise water supply
systems and devices, and people are infected through the
inhalation of a contaminated water aerosol. Legionnaires'
disease affects all age groups and more often elderly
people, particularly those with chronic cardiac, pulmonary
and renal diseases. Immunocompromised patients are at
especially high risk. Legionella is responsible for 2 to 15% of
pneumonias in the general population. There are no reliable
clinical, laboratory or radiological indicators that could
with certainty differentiate legionnaires' disease from other
pneumonias. Consequently, clinical doubts should be always
confi rmed with special laboratory tests (culture, detection
of antigen in respiratory secretion or urine, serologic tests,
molecular diagnostics). Legionella urinary antigen test is
especially convenient and reliable in clinical practice.
The appropriate antibiotic should be administered in the
treatment of legionnaires' disease as early as possible.
However, L. pneumophila, as many other causes of pneumonia,
is rarely diagnosed at the onset of the disease when the
antimicrobial treatment is initiated. Since legionellae have
been relatively frequently reported as causative agents of
pneumonia, it is advisable and rational to use legionellaeffi
cient antibiotics in the empirical treatment of pneumonia,
and particularly of atypical pneumonias. New macrolides,
and especially azithromycin, exhibit better activity in vitro
and in the experimental model than erythromycin, which is
traditionally recommended for the treatment of legionnaires'
disease. Fluoroquinolones, doxycycline and rifampicin have
been also successfully used. A delayed administration of
an effi cient antibiotic results in a bad prognosis. Therefore,
all patients with a more severe clinical picture or severe
accompanying chronic diseases and compromised immunity
require an antibiotic effi cient against legionella during the
onset of the treatment. Our clinical experience shows that
a timely treatment of legionella with azithromycin has been
successful and crucial for the outcome of the disease.
Keywords
legionnaires' disease; Legionella pneumophila; macrolides; fluoroquinolones
Hrčak ID:
18822
URI
Publication date:
26.1.2005.
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