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Canadian Journal of Infectious Diseases
Volume 3 (1992), Issue 5, Pages 253-260
http://dx.doi.org/10.1155/1992/582736
Review

Nosocomial Legionnaires’ Disease: Clinical and Radiographic Patterns

Thomas J Marrie,1,2 David Haldane,1,2 and Gregory Bezanson1,2

1Departments of Medicine and Microbiology, Dalhousie University, Halifax, Nova Scotia, Canada
2Victoria General Hospital, Halifax, Nova Scotia, Canada

Received 6 May 1991; Accepted 9 August 1991

Copyright © 1992 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

From 1981 to 1991, 55 patients (33 males, 22 females, mean age 58.6 years) with nosocomial Legionnaires’ disease were studied. The mortality rate was 64%. One-half of the patients developed nosocomial Legionnaires’ disease within three weeks of admission. A surprising clinical feature was the low rate of findings of consolidation on physical examination, despite the fact that 52% of patients had this finding on chest radiograph. More than one-half of patients had pre-existing lung disease, rendering a radiographic diagnosis of pneumonia due to Legionella pneumophila impossible in 16% of cases despite microbiological confirmation. Nineteen per cent of patients who had blood cultures done had a pathogen other than L pneumophila isolated, suggesting dual infection in at least some of the patients. When the clinical and radiographic findings were combined it was noted that 40% of patients had one of three patterns suggestive of nosocomial Legionnaires’ disease: rapidly progressive pneumonia, lobar opacity and multiple peripheral opacities. However, in 60% of patients there were no distinctive features.