A) Hypernatremia
B) Hyponatremia
Answer: B
LEGIONELLA PNEUMONIA is also called LEGIONNAIRES' DISEASE because it may carry some clinical symptoms that may raise suspicion of it from other forms of pneumonia. However, no clinical features can reliably distinguish Legionnaires' disease from other types of pneumonia.
Associated symptoms that should lead a clinician to think of it are:
- Gastrointestinal symptoms such as nausea, vomiting, and diarrhea
- Hyponatremia (see reference # 3)
- Elevated hepatic transaminases
- C-reactive protein levels >100 mg/L
- Failure to respond to treatment for pneumonia with beta-lactam monotherapy
The index of suspicion should also stay high where contamination of water supplies in large facilities such as hospitals, hotels, or apartment buildings is reported or when a patient reports a history of travel in an endemic area with exposure to hot tubs or fountains.
These patients tend to get sicker. Almost one out of five patients needs ICU care, and in present days, an ECMO call may be needed. Interestingly, despite their potential for severity, local complications such as empyema and lung abscesses are not common. Extrapulmonary infections such as cellulitis, abscesses, endocarditis, or meningitis are uncommon.
#pulmonary
#ID
#electrolytes
References:
1. Sopena N, Sabrià-Leal M, Pedro-Botet ML, et al. Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias. Chest 1998; 113:1195.
2. Roig J, Aguilar X, Ruiz J, et al. Comparative study of Legionella pneumophila and other nosocomial-acquired pneumonias. Chest 1991; 99:344.
3. Schuetz P, Haubitz S, Christ-Crain M, Albrich WC, Zimmerli W, Mueller B; ProHOSP Study Group. Hyponatremia and anti-diuretic hormone in Legionnaires' disease. BMC Infect Dis. 2013 Dec 11;13:585. doi: 10.1186/1471-2334-13-585. PMID: 24330484; PMCID: PMC3880094.
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