Tolentino A, Ahkee S, Ramirez J
Division of Infectious Diseases, University of Louisville, School of Medicine, KY, USA.
J Ky Med Assoc. 1996 Sep;94(9):393-4.
Legionella pneumophila is the cause of Legionnaires' disease, and Pontiac fever, an influenza-like condition without pneumonia. We present a case of Pontiac fever after exposure to a hot tub contaminated with L pneumophila. A 37 y/o wf presented to the office with acute onset of sore throat, fever, headache, and myalgia. Patient was hospitalized 3 days later because of worsening shortness of air. Chest x-ray was normal. Patient was treated with 2 days of IV erythromycin and was discharged home on oral erythromycin. Her Legionella IFA was 1:16,384. Two days later, she developed chest tightness, pleuritic chest pain, and increasing shortness of air but did not have any cough or sputum production. She was re-hospitalized with a diagnosis of Pontiac fever and treated with IV erythromycin plus oral rifampin. A repeat chest x-ray remained normal. After a detailed epidemiologic history was obtained, it was noted that she became ill after using a hot tub, which her two children also used and they themselves developed a self limited illness. Water from the hot tub was positive for L pneumophila by DFA, culture, and PCR. Patient improved gradually with therapy and was discharged home. This report emphasizes the importance of a complete epidemiologic history in the diagnosis of respiratory infections. It also demonstrates that aquatic environment can be contaminated with Legionella and serve as a source of infection.
嗜肺军团菌是军团病以及庞蒂亚克热（一种类似流感但无肺炎症状的疾病）的病原体。我们报告一例在接触被嗜肺军团菌污染的热水浴缸后发生庞蒂亚克热的病例。一名37岁女性因急性咽痛、发热、头痛和肌痛前来就诊。3天后，患者因气短加重而住院。胸部X线检查正常。患者接受了2天静脉注射红霉素治疗，之后口服红霉素出院。她的军团菌间接免疫荧光试验（IFA）结果为1:16,384。两天后，她出现胸闷、胸膜炎性胸痛和气促加重，但无咳嗽或咳痰。她因庞蒂亚克热再次住院，接受静脉注射红霉素加口服利福平治疗。复查胸部X线仍正常。在详细询问流行病学史后发现，她在使用热水浴缸后发病，她的两个孩子也使用了该浴缸，且他们自己也患上了自限性疾病。通过直接荧光抗体法（DFA）、培养和聚合酶链反应（PCR）检测，热水浴缸中的水嗜肺军团菌呈阳性。患者经治疗后逐渐好转并出院。本报告强调了完整的流行病学史在呼吸道感染诊断中的重要性。它还表明水生环境可能被军团菌污染并成为感染源。
