Legionnaire's Disease

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Itayi Charasika from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description[edit | edit source]

Legionnaire’s Disease is a deadly severe form of pneumonia. It is the cause of nosocomial pneumonia. This disease can be fatal. Legionnaire’s disease is a lung infection. It is a disease caused by a bacteria, known as Legionella. This disease is often screened for whenever a person is diagnosed with pneumonia because of the close resemblance Legionnaire’s has to pneumonia. Legionnaire’s disease is commonly from inhaling the bacteria.


The bacteria, Legionella, in Legionnaire’s disease can also lead to Pontiac Fever, which is like a milder version of Legionnaire’s disease. Pontiac Fever resembles the flu. If a person is diagnosed with both illnesses, then the term is Legionellosis. Unlike Legionnaire’s disease, Pontiac Fever usually clears on it own1.


History of Disease: Legionnaire’s disease first came about in 1967 when a group of people in Philadelphia, attending an American Legion convention meeting became exposed to this disease.

Prevalence[edit | edit source]

add text here

Characteristics/Clinical Presentation[edit | edit source]

add text here

Associated Co-morbidities[edit | edit source]

People at risk:

  •  Smokers (esp. Middle-aged/older adults who smoke cigarettes)
  •  Chronic lung disease
  •  Advanced age
  • Alcohol abuse
  • Surgery
  • Recent travel with an overnight stay outside of the home
  • Exposure to whirlpool spas
  • Recent repairs or maintenance work on domestic plumb
  •  Immune system compromised by

     - DM
     - Renal Failure
     - Cancer (esp. hematological or pulmonary malignancy)
     - AIDS

Medications[edit | edit source]

  • Erythromycin (the drug of choice for prolonged period) - given early
  • Rifampin is also a benefit

Newer Effective Therapeutic Options Include Antibiotics (Macrolides)4:

  • Clarithromycin
  • Azithromycin
  •  Fluoroquinolones

Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]

Legionnaire’s disease is diagnosed by growing bacteria on a special medium and silver staining. The bacteria is identified in the sputum and the Legionella antigen is seen in the urine4.


What diagnostic tests can confirm Legionnaires' disease? (http://www.cdc.gov/legionella/faq.htm9)

Etiology/Causes[edit | edit source]

Legionnaire’s disease is the cause of nosocomial pneumonia4.

 
Common places that allow Legionella transmission10:
1. Potable (drinking) water systems
2. Whirlpool spas
3. Cooling towers
Conditions for Legionella transmission10:
1. Heat
2. Stasis
3. Aerosolization

Systemic Involvement[edit | edit source]

  • Gastrointestinal symptoms include nausea, vomiting, diarrhea, and anorexia.
  • Neurologic symptoms include headache, lethargy, altered mental status, and rarely, focal symptoms.
  • Musculoskeletal symptoms include arthralgias and myalgias.
  • Nonpulmonary symptoms are prominent early in the disease.

Medical Management (current best evidence)[edit | edit source]

For patients with Pontiac fever: it is a self-limited illness that does not benefit from antibiotic treatment. Complete recovery usually occurs within 1 week10.

Physical Therapy Management (current best evidence)[edit | edit source]

  •  Screening Questions:

    - Have you traveled recently? (Patient could have traveled-associated Legionnaire’s disease (http://www.cdc.gov/legionella/faq.htm9)


What does the diagnosis of Legionnaire’s disease include? Two clinical syndromes:


  • Patient Care

   - Respiratory Therapists/PTs: O2 therapy, repositioning, postural drainage, suctioning4

  • Monitor

    - Chest wall expansion, depth/pattern of ventilations, cough, chest pain, restlessness, & hypoxemia4

  • Signs of Shock

    - ↓ blood pressure, tachycardia w/weak thread pulse, diaphoresis, clamy skin, & cold4

  •  Patient Education

     - Pulmonary hygiene, deep breathing and coughing exercises, chest physiotherapy, postural drainage, disposal of solid tissues to prevent disease transmission4

Alternative/Holistic Management (current best evidence)[edit | edit source]

add text here

Differential Diagnosis[edit | edit source]

S/S:

  • Fevers, chills, dry or productive cough, fatigue, anorexia, headache, myalgia, diarrhea, muscle aches, & gastrointestinal symptoms4

Case Reports/ Case Studies[edit | edit source]

add links to case studies here (case studies should be added on new pages using the case study template)

Resources
[edit | edit source]

1.http://www.cdc.gov/legionella/patient_facts.htm 2. http://www.osha.gov/SLTC/legionnairesdisease/index.html 3. OSHA eTool: http://www.osha.gov/dts/osta/otm/legionnaires/index.html 4. Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company. Phildelphia. Edition 19. 2001. Pg.121 5. Atypical Presentation of Legionnaire’s Disease: A Case Report and Review. Sophie Kay1, DO, Christopher Grantham2, MD, Michelle Dahdouh3, MD. http://newyorkmedicaljournal.org/index.php/articles/atypical_presentation_of_legionnaires_disease_a_case_report_and_review 6. Legionnaires Disease: A Case Study. By Melinda Cramer, RN, BSN. From School of Nursing, University of Pennsylvania, Philadelphia, Pa. American Journal of Critical Care. 2003;12: 234-238. http://ajcc.aacnjournals.org/content/12/3/234.full 7. Severe Legionnaires disease complicated by multi-organ dysfunction in a previously healthy patient: a case report. Kays Kassha1, Issam Abuanza2, Samer A Hadi3 and Roy Hilton2. http://casesjournal.com/content/2/1/9151 8. Legionnaires' Disease with Facial Nerve Palsy. Case Reports in Medicine. Volume 2011 (2011), Article ID 916859, 4 pgs. Shailesh R. Basani, Salwa Mohamed Ahmed, and Eyassu Habte-Gabr. Received 20 September 2010; Accepted 16 January 2011. http://www.hindawi.com/journals/crim/2011/916859/ 9. http://www.cdc.gov/legionella/faq.htm
10. http://www.cdc.gov/legionella/top10.htm

Recent Related Research (from Pubmed)[edit | edit source]

see tutorial on Adding PubMed Feed

Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10 


References[edit | edit source]

see adding references tutorial.


Retrieved from "https://www.physio-pedia.com/index.php?title=Legionnaire%27s_Disease&oldid=31973"