Saravolatz L D, Burch K H, Fisher E, Madhavan T, Kiani D, Neblett T, Quinn E L
Ann Intern Med. 1979 Apr;90(4):533-7. doi: 10.7326/0003-4819-90-4-533.
Pneumonia caused by Legionnaires' disease bacterium was recognized in eight patients during a 7-month period. The patients were immunosuppressed by their underlying illness, corticosteroid therapy, and other exogenous immunosuppressive agents. Five of the patients had received immunosuppressive therapy for less than 16 days. Clinical presentation was similar to that of other bacterial pneumonias in compromised patients. Legionnaires' disease progressed to necrotizing pneumonia with abscess formation and respiratory failure in two patients. Diagnosis was made by [1] culture of lung tissue and bronchial washings; [2] direct fluorescent antibody staining of lung tissue, sputum, and bronchial washings; and [3] serologic evidence of infection. Therapy with oral erythromycin was ineffective. Intravenous erythromycin was given to six patients, with a good response. However, two patients showed further clinical improvement after rifampin was added. Because this illness may be more severe in compromised hosts, open lung biopsy and special microbiologic tests should be done when Legionnaires' disease is suspected.
在7个月的时间里，有8名患者被确诊为由军团菌病细菌引起的肺炎。这些患者因基础疾病、皮质类固醇治疗及其他外源性免疫抑制剂而处于免疫抑制状态。其中5名患者接受免疫抑制治疗的时间不到16天。临床表现与其他免疫功能受损患者的细菌性肺炎相似。两名患者的军团菌病进展为坏死性肺炎并形成脓肿，出现呼吸衰竭。诊断依据为：[1]肺组织和支气管灌洗物培养；[2]肺组织、痰液和支气管灌洗物的直接荧光抗体染色；[3]感染的血清学证据。口服红霉素治疗无效。6名患者接受了静脉注射红霉素治疗，反应良好。然而，两名患者在加用利福平后临床症状进一步改善。由于这种疾病在免疫功能受损宿主中可能更为严重，因此当怀疑为军团菌病时，应进行开胸肺活检和特殊微生物学检查。
