The treatment of Legionnaires’ disease
Abstract
The Legionellaceae family contains over 40 recognized species, but less than half of these cause disease in humans. The most frequently pathogenic species is Legionella pneumophila, of which there are 14 serogroups. L. pneumophilaaccounts for 90% (and serogroups 1- 6 for 85%) of all infections. Other important species include Legionella micdadei,Legionella bozemanii,Legionella dumoffii and Legionella longbeachae.The principal clinical illness is pneumonia (Legionnaires’ disease), although L. pneumophila has also been implicated in cases of endocarditis and myocarditis, and in haemodialysis infections. Treatment recommendations for Legionnaires’ disease are largely based on clinical experience of the first recognized outbreak in Philadelphia in 1976; in a retrospective review, patients treated with erythromycin or tetracycline had a 50% lower mortality rate compared with patients treated with β-lactams.1 Subsequently, erythromycin became the treatment ofchoice. More recently, a number of new antimicrobial agents have appeared, but formally assessing their comparative efficacy in treatment has proved difficult. No prospective controlled trials of therapy have been performed. Assessment of the efficacy and potential utility of antimicrobials against Legionellaspp. is based on four methods. First, in-vitro susceptibility testing can be performed to screen for active agents. Legionella spp. may be grown in either buffered yeast extract (BYE) broth or buffered charcoal- yeast…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 20 participants or records.
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