Legionellosis natural history, complications and prognosis: Difference between revisions
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{{Legionellosis}} | {{Legionellosis}} | ||
{{CMG}} | {{CMG}} {{AE}} {{YD}}; {{SSK}} | ||
==Overview== | ==Overview== | ||
In Legionnaires' disease, the majority of exposed patients do not develop any symptoms. Patients who develop clinical manifestations usually report [[pneumonia]]-like symptoms that worsen at 4 to 6 days following onset of symptoms and eventually resolve by day 5 to 10 of symptom-onset. Approximately 1% to 35% of individuals progress to develop Legionnaires'-related complications and death. Complications of Legionnaires' disease include [[empyema]], lung failure, [[acute kidney injury]], [[endocarditis]], [[neurological]] disease, [[septic shock]], and multi-organ failure. The prognosis is generally good for healthy patients, but patients with co-morbidities are at higher risk of developing complications and death. In contrast, [[Pontiac fever]] has a high attack rate but is associated with mild [[flu]]-like symptoms that resolve within 1 to 2 days and is almost always self-limited without any complications. | |||
==Natural History== | ==Natural History== | ||
===Legionnaires' Disease=== | ===Legionnaires' Disease=== | ||
*The majority of patients do not develop any symptoms (low attack rate). Patients who demonstrate clinical manifestations (approximately 5% to 10%) usually have other co-morbidities (see [[Legionellosis risk factors| ''Risk Factors'']]. | *The majority of exposed patients do not develop any symptoms (low attack rate). Patients who demonstrate clinical manifestations (approximately 5% to 10%) usually have other co-morbidities (see [[Legionellosis risk factors|''Risk Factors'']]). | ||
* Infected individuals usually start to develop symptoms 5-7 following transmission (range: 2 days to 19 days).<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | * Infected individuals usually start to develop symptoms 5-7 following transmission (range: 2 days to 19 days).<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | ||
*Patients report worsening of symptoms of pneumonia (fever, cough, chest pain, dyspnea) at 4 to 6 days following onset of symptoms.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | *Patients report worsening of symptoms of [[pneumonia]] ([[fever]], [[cough]], [[chest pain]], [[dyspnea]]) at 4 to 6 days following onset of symptoms.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | ||
*The majority of patients report resolution 10 days after symptom onset. | *The majority of patients report resolution 10 days after symptom onset. | ||
*Approximately 1% to | *Approximately 1% to 35% of individuals progress to develop Legionnaires'-related complications and death. | ||
===Pontiac Fever=== | ===Pontiac Fever=== | ||
*Unlike Legionnaires's disease, the attack rate of Pontiac fever is high, and as many as 90% to 95% of exposed individuals will develop symptoms.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | *Unlike Legionnaires's disease, the attack rate of [[Pontiac fever]] is high, and as many as 90% to 95% of exposed individuals will develop symptoms.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | ||
*Pontiac fever is characterized by | *Pontiac fever is characterized by mild [[flu]]-like symptoms with a short illness duration (typically 1-2 days). | ||
*Symptoms of Pontiac fever typically last for a total of 2 to 5 days.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | *Symptoms of [[Pontiac fever]] typically last for a total of 2 to 5 days.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | ||
*Development of Pontiac fever-related complications is very rare. | *Development of [[Pontiac fever]]-related complications is very rare. | ||
==Complications== | ==Complications== | ||
Complications may develop among patients who develop Legionnaires' disease. Complications may include:<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | Complications may develop among patients who develop Legionnaires' disease. Complications may include:<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | ||
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* [[Lung failure]] | * [[Lung failure]] | ||
* [[Acute kidney injury]] | * [[Acute kidney injury]] | ||
* [[Endocarditis]] | |||
* [[Peripheral neuropathy]] | * [[Peripheral neuropathy]] | ||
* [[Sepsis|Severe sepsis]], [[septic shock]], and [[multiorgan failure]] | * [[Sepsis|Severe sepsis]], [[septic shock]], and [[multiorgan failure]] | ||
In contrast, Pontiac fever is not usually associated with any complications. | In contrast, [[Pontiac fever]] is not usually associated with any complications. | ||
==Prognosis== | ==Prognosis== | ||
* Without treatment, Legionnaires' disease is associated with a case-fatality rate | * Without treatment, Legionnaires' disease is associated with a case-fatality rate that may be as high as 35%.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref> | ||
* Individuals with significant co-morbidities (e.g. renal failure, advanced COPD) are at higher risk of legionellosis-related death. | * Individuals with significant co-morbidities (e.g. renal failure, advanced [[COPD]]) are at higher risk of legionellosis-related death. | ||
* A substantially higher proportion of fatal cases occur during [[nosocomial]] outbreaks. | * A substantially higher proportion of fatal cases occur during [[nosocomial]] outbreaks. | ||
* [[Pontiac fever]] has an excellent prognosis and is almost always a self-limited disease. | * [[Pontiac fever]] has an excellent prognosis and is almost always a self-limited disease. | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Medical disasters]] | [[Category:Medical disasters]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 18:09, 18 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.
Overview
In Legionnaires' disease, the majority of exposed patients do not develop any symptoms. Patients who develop clinical manifestations usually report pneumonia-like symptoms that worsen at 4 to 6 days following onset of symptoms and eventually resolve by day 5 to 10 of symptom-onset. Approximately 1% to 35% of individuals progress to develop Legionnaires'-related complications and death. Complications of Legionnaires' disease include empyema, lung failure, acute kidney injury, endocarditis, neurological disease, septic shock, and multi-organ failure. The prognosis is generally good for healthy patients, but patients with co-morbidities are at higher risk of developing complications and death. In contrast, Pontiac fever has a high attack rate but is associated with mild flu-like symptoms that resolve within 1 to 2 days and is almost always self-limited without any complications.
Natural History
Legionnaires' Disease
- The majority of exposed patients do not develop any symptoms (low attack rate). Patients who demonstrate clinical manifestations (approximately 5% to 10%) usually have other co-morbidities (see Risk Factors).
- Infected individuals usually start to develop symptoms 5-7 following transmission (range: 2 days to 19 days).[1]
- Patients report worsening of symptoms of pneumonia (fever, cough, chest pain, dyspnea) at 4 to 6 days following onset of symptoms.[1]
- The majority of patients report resolution 10 days after symptom onset.
- Approximately 1% to 35% of individuals progress to develop Legionnaires'-related complications and death.
Pontiac Fever
- Unlike Legionnaires's disease, the attack rate of Pontiac fever is high, and as many as 90% to 95% of exposed individuals will develop symptoms.[1]
- Pontiac fever is characterized by mild flu-like symptoms with a short illness duration (typically 1-2 days).
- Symptoms of Pontiac fever typically last for a total of 2 to 5 days.[1]
- Development of Pontiac fever-related complications is very rare.
Complications
Complications may develop among patients who develop Legionnaires' disease. Complications may include:[1]
- Empyema
- Emphysema
- Lung failure
- Acute kidney injury
- Endocarditis
- Peripheral neuropathy
- Severe sepsis, septic shock, and multiorgan failure
In contrast, Pontiac fever is not usually associated with any complications.
Prognosis
- Without treatment, Legionnaires' disease is associated with a case-fatality rate that may be as high as 35%.[1]
- Individuals with significant co-morbidities (e.g. renal failure, advanced COPD) are at higher risk of legionellosis-related death.
- A substantially higher proportion of fatal cases occur during nosocomial outbreaks.
- Pontiac fever has an excellent prognosis and is almost always a self-limited disease.