Gump D W, Keegan M
Department of Medicine, University of Vermont College of Medicine, Burlington 05405.
Semin Respir Infect. 1986 Sep;1(3):151-9.
At present, 11 different species of Legionella have been implicated in human disease. It has become apparent that disease caused by Legionella is acquired from a variety of environmental sources and that water is the factor that links many of them. Patients who are immunosuppressed, such as individuals receiving cancer chemotherapy or therapy designed to prevent organ rejection, are particularly susceptible to such environmental sources. It appears that intact cell-mediated immunity is more important in host defense than are adequate numbers of granulocytes or immunoglobulin concentrations. Diagnostic steps should be undertaken in all patients developing nosocomial pneumonia who present with a picture suspicious for this disorder. In the meantime, appropriate antimicrobial therapy with erythromycin and rifampin should be begun. If clusters of cases are detected in a hospital, immediate steps should be taken to attempt to isolate the organism from any aqueous environmental sources, and if found appropriate, steps taken. Awareness of the threat of legionnaires' disease must be maintained among clinicians and hospital epidemiologists because it is unlikely that the problem of nosocomial legionnaires' disease will disappear.
目前，已有11种不同的军团菌与人类疾病有关。显然，军团菌引起的疾病源自多种环境来源，而水是将其中许多来源联系起来的因素。免疫功能低下的患者，如接受癌症化疗或旨在预防器官排斥的治疗的个体，尤其易受此类环境来源的影响。看来，完整的细胞介导免疫在宿主防御中比足够数量的粒细胞或免疫球蛋白浓度更为重要。对于所有发生医院获得性肺炎且表现出疑似该病症状的患者，都应采取诊断措施。同时，应开始使用红霉素和利福平进行适当的抗菌治疗。如果在医院中检测到病例聚集，应立即采取措施，试图从任何水性环境来源中分离出该病原体，如发现合适，应采取相应措施。临床医生和医院流行病学家必须始终意识到军团病的威胁，因为医院获得性军团病问题不太可能消失。
