Cunha Burke A
Infectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501, USA.
Heart Lung. 2008 Jul-Aug;37(4):311-20. doi: 10.1016/j.hrtlng.2007.12.003.
Legionnaires' disease is a systemic infection involving the lungs and accompanied by a characteristic pattern of extrapulmonary organ involvement. Legionnaires' disease is one of the non-zoonotic causes of atypical community-acquired pneumonia (CAP). Legionnaires' disease commonly presents as severe CAP requiring hospitalization and intensive care. Each atypical CAP has its own characteristic pattern of extrapulmonary laboratory clinical findings and abnormalities that are the basis of clinical syndromic diagnosis. Studies have been unsuccessful in identifying individual clinical and laboratory parameters that are specific for Legionella. Individually, clinical and laboratory abnormalities lack diagnostic specificity. The diagnostic specificity of clinical and laboratory findings is increased when combined and are the basis of a clinical syndromic diagnosis. The importance of serial nonspecific laboratory abnormalities with Legionnaires' disease is emphasized. The sensitivity and specificity of a clinical syndromic diagnosis are enhanced if they are based on a weighted point score system. A diagnostic weighted point score system is based on the varying diagnostic importance of clinical and laboratory diagnostic findings. The Winthrop-University Hospital's Infectious Disease Division's rapid clinical diagnostic weighted point system is based on a weighted point score of clinical and laboratory findings. The case presented is that of a 55-year-old man with severe CAP who required hospitalization and intensive care admission. The presumptive clinical diagnosis of Legionella CAP was based on the Winthrop-University Hospital Infectious Disease Division's weighted point score system, which permitted early empiric anti-Legionella antimicrobial therapy and prompted specific Legionella testing. Legionnaires' disease is definitively diagnosed by serology or a urinary Legionella antigen test. This case of severe Legionnaires' CAP was confirmed by urinary antigen test reported on hospital day 6. The Winthrop-University Hospital is weighted point score system (modified) permits a rapid clinical presumptive diagnosis of Legionnaires' disease and is an accurate predictor of Legionella CAP.
军团病是一种累及肺部的全身性感染，并伴有肺外器官受累的特征性模式。军团病是非人畜共患的非典型社区获得性肺炎（CAP）病因之一。军团病通常表现为严重的CAP，需要住院和重症监护。每种非典型CAP都有其独特的肺外实验室临床发现和异常模式，这些是临床综合征诊断的基础。研究未能确定军团菌特有的个体临床和实验室参数。单独来看，临床和实验室异常缺乏诊断特异性。临床和实验室检查结果联合时诊断特异性增加，是临床综合征诊断的基础。强调了军团病系列非特异性实验室异常的重要性。如果基于加权评分系统，临床综合征诊断的敏感性和特异性会增强。诊断加权评分系统基于临床和实验室诊断结果的不同诊断重要性。温思罗普大学医院传染病科的快速临床诊断加权系统基于临床和实验室检查结果的加权评分。所呈现的病例是一名55岁患有严重CAP的男性，需要住院和重症监护入院。军团菌CAP的临床初步诊断基于温思罗普大学医院传染病科的加权评分系统，该系统允许早期经验性抗军团菌抗菌治疗并促使进行特定的军团菌检测。军团病通过血清学或尿液军团菌抗原检测确诊。该例严重军团菌CAP在住院第6天通过尿液抗原检测得到证实。温思罗普大学医院的加权评分系统（改良版）允许对军团病进行快速临床初步诊断，并且是军团菌CAP的准确预测指标。
