van Riemsdijk-van Overbeeke I C, van den Berg B
Department of Internal Medicine I, University Hospital Dijkzigt, Rotterdam, Netherlands.
Neth J Med. 1996 Nov;49(5):196-201. doi: 10.1016/0300-2977(96)00046-0.
Legionnaire's disease is well known as severe pneumonia requiring intensive care treatment in many cases. In this study the clinical course is described of patients admitted to the medical ICU of the University Hospital of Rotterdam for respiratory distress due to Legionnaire's disease.
From the register of admissions to the medical ICU all patients suffering from Legionnaire's disease were identified. All data on clinical signs and symptoms present on admission were collected. The circumstances in which the infections were contracted were sought, as well as the tests establishing the diagnosis. The occurrence of various organ failures and complications were noted, as were the causes of death on the ICU.
From 1978 till 1995 the diagnosis of Legionella pneumonia was made in 17 patients admitted to the ICU: in 13 patients a community-acquired infection was established. As in 12 patients Legionnaire's disease was diagnosed on serological tests, it took several weeks before the diagnosis could be established in these patients. In all patients the circumstances predisposing to Legionnaire's disease were noted. Respiratory distress was present in all patients, ventilatory support was required in 14. Apart from this, both profound shock and renal failure were commonly encountered. As complications jaundice, rhabdomyolysis and polyneuropathy were frequently noted. Three patients died: 2 due to irreversible shock and 1 due to hospital-acquired sepsis.
Legionnaire's disease can develop into life-threatening pneumonia requiring intensive care treatment in previously healthy subjects. As the clinical features are aspecific, careful search for predisposing circumstances such as recent travel or use of a contaminated water-supply is mandatory. As the diagnosis required positive serological tests in most patients, a considerable delay in diagnosis was noted. Despite the frequent occurrence of multiple organ failure, a favourable outcome can be anticipated in most cases.
军团病以严重肺炎而闻名，在许多情况下需要重症监护治疗。本研究描述了因军团病导致呼吸窘迫而入住鹿特丹大学医院内科重症监护病房（ICU）的患者的临床病程。
从内科ICU的入院登记中识别出所有患有军团病的患者。收集入院时所有存在的临床体征和症状数据。寻找感染发生的情况以及确诊的检查。记录各种器官衰竭和并发症的发生情况，以及ICU中的死亡原因。
1978年至1995年期间，17名入住ICU的患者被诊断为军团菌肺炎：其中13名患者为社区获得性感染。由于12名患者通过血清学检测确诊为军团病，这些患者在确诊前花费了数周时间。在所有患者中都记录了易患军团病的情况。所有患者均有呼吸窘迫，14名患者需要通气支持。除此之外，严重休克和肾衰竭也很常见。作为并发症，黄疸、横纹肌溶解和多发性神经病经常被注意到。3名患者死亡：2名死于不可逆休克，1名死于医院获得性败血症。
军团病可发展为危及生命的肺炎，在既往健康的个体中需要重症监护治疗。由于临床特征不具特异性，必须仔细寻找易患因素，如近期旅行或使用受污染的水源。由于大多数患者的诊断需要血清学检测呈阳性，因此诊断有相当大的延迟。尽管多器官衰竭经常发生，但在大多数情况下仍可预期有良好的结果。
