Correct!
5. Any of the above
Correct!
5. Any of the above
Her chest x-ray shows worsening of her right lower lobe consolidation and a thoracic CT scan showed near complete consolidation of her upper right upper lobe with extension into the right middle and lower lobes. The cause of her pneumonia is unclear and it is not definitely clear how to proceed. Any of the options would probably be acceptable depending on local expertise and clinical judgment. Repeat bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was offered to the patient. However, she was feeling slightly better and wanted to wait a few more days. Later that day the bronchoalveolar lavage polymerase chain reaction and culture both returned positive for Legionella. She was continued on her levofloxacin and made an uneventful recovery.
The mortality of Legionella is 16 to 30% but less than 10% with appropriate treatment (4). Azithromycin and levofloxacin both are both effective treatments. There are no comparative studies but some suggest possible benefit from combined treatment. The duration of therapy is usually 10 to 14 days in immunocompetent patients and 21 days in immunosuppressed suppressed patients.
The urinary antigen for Legionella has a sensitivity of 80% and specificity close to 100%. The test is specific only for serogroup 1. However, the majority of Legionella in community-acquired pneumonia is serogroup 1.
Several signs and symptoms may be present in immuncompetent patients with community-acquired pneumonia suggesting Legionella (Table 2)
Table 2. Signs and symptoms suggesting Legionella pneumonia.
References