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- This disease was named for the
first medically recorded epidemic outbreak at a convention
of Legionnaires in 1976 in Philadelphia, in which 34 deaths
occurred. It is caused by the atypical bacterium
Legionella pneumophilia . It is actually one of the four most common causes of community-acquired Pneumonia. It is acquired by breathing contaminated aerosol droplets.
- It occurs much more commonly in smokers, those with chronic lung disease, or those who are immuno-compromised (e.g., cancer).
- Outbreaks have been associated with contaminated water sources, such as communal lakes, rivers, ponds; cooling towers used in public air conditioning systems and industrial settings; and infected showerheads and faucets.
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- Cough
- Phlegm often colored
- Chest pain on deep breath and/or cough
- High fever
- Person feels and looks very ill
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- Lung exam may reveal diffuse or localized crackles
- Laboratory:
- Special cultures are required (does not show up on gram stain)
- Serum titers and direct fluorescent antibody stains are less reliable but sometimes helpful
- Chest X-Ray classically shows a diffuse reticulonodular pattern
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- Erythromycin intravenously followed by oral Erythromycin for total 14-21 days is still the treatment of choice. But alternatives such as Levofloxacin (Levaquin)Levaquin) or Clarithromycin (Biaxin)Biaxin) are probably equally effective, with fever gastrointestinal side effects
- In immunocompromised patients, rifampin is usually added to one of the above drugs, and treatment is for 21 days.
- Tetracycline and trimethoprim/sulfamethoxazole also appear effective, but there is less documentation for their use.
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