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Chapter 4 : Hospital-and Community-Acquired Legionella Pneumonia: Two Faces of the Same Disease?
This chapter compares the individual risk factors, clinical features, and mortality of Legionella pneumonia in hospital and community scenarios. A comparative study was performed from 1983 to 2005, with 425 cases of pneumonia due to Legionella pneumophila being diagnosed during this time. The patients were divided into two groups based on the site of acquisition. Group 1 included 197 patients with community-acquired Legionella pneumonia (CALP), and group 2 included 123 patients with hospital-acquired Legionella pneumonia (HALP). Respiratory symptoms, gastrointestinal, neurological manifestations, and laboratory abnormalities prevailed in the community setting probably for two reasons: first, the CALP patients entered the hospital late because of the lack of specificity in initial symptomatology, allowing extrapulmonary symptoms to develop. Second, in hospitals with endemic legionellosis, the diagnosis and the onset of treatment for nosocomial Legionella pneumonia is immediate because of the high level of suspicion. This makes the extrapulmonary manifestations of Legionella infection less likely to be observed. The best way to prevent HALP is by culturing the hospital water supply, and, if colonized, Legionella tests should be used in any case of hospital-acquired pneumonia.
Key Concept Ranking
- Legionella pneumophila