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Can Legionnaires Disease Be Diagnosed by Clinical Criteria? : A Critical Review

Lutfiye Mulazimoglu, MD; Victor L. Yu, MD
Author and Funding Information

Affiliations: Istanbul, Turkey 
 ,  Pittsburgh, PA 
 ,  Dr. Mulazimoglu is Associate Professor of Infectious Diseases and Clinical Microbiology, Marmara University, and Dr. Yu is Professor of Medicine, VA Medical Center and University of Pittsburgh.

Correspondence to: Victor L. Yu, MD, Professor of Medicine, Infectious Disease Section (111E-U), VA Medical Center, University Dr C, Pittsburgh, PA 15240; e-mail: vly+@pitt.edu



Chest. 2001;120(4):1049-1053. doi:10.1378/chest.120.4.1049
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Legionella is a relatively common cause of pneumonia. In patients with community-acquired pneumonia, the incidence ranges from 2 to 15%. Of pathogens that are of consequence in patients with community-acquired pneumonia, the mortality rate is highest for those with bacteremic pneumococcal pneumonia and Legionnaires disease. Of the atypical pneumonia pathogens, the mortality for Chlamydia pneumoniae and Mycoplasma pneumoniae is low. Consensus guidelines on empiric antibiotic therapy for patients with community-acquired pneumonia recommend that coverage be extended to Legionella in suspicious cases, although the criteria for“ suspicious” is not explicitly delineated. Although numerous studies have shown that the clinical manifestations of Legionnaires disease are nonspecific, Burke Cunha1 from Winthrop University Hospital (WUH) has claimed that Legionnaires disease is a unique clinical syndrome as originally depicted in the early studies (Table 1 ). Cunha even devised a weighted point system, referred to as the WUH point scale for Legionnaires disease. If the WUH score was valid, then antibiotic selection might be simplified. We sought to assess the utility of the syndromic approach on the management of community-acquired pneumonia and Legionnaires disease.

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