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Topic Outline
Introduction
Etiologic Agent
Mode of Transmission
Signs & Symptoms and Manifestations
Prevention and Control Measures
Medical Management
Nursing Intervention
Introduction
(1976) American Legion Convention in Philadelphia

182 people Major

became ill, Outbreak
29 died

American Legionnaires

Legionnaire¶s Disease
Legionnaire¶s Disease

‡ Serious and sometimes fatal form of pneumonia

‡ Legionellosis or Legionella pneumonia
‡ important cause of nosocomial and community-
acquired pneumonia (CAP)
‡ Men > women (3:1)
Some say it was radiation,
Some say there was acid on the microphone,
Some say a combination that turned their hearts to stone,
But whatever it was, it drove them to their knees.
Oh, Legionnaire's disease.

- Bob Dylan, ³Legionnaire¶s Disease´

Etiologic Agent

‡ Legionella pneumophila
‡ an aerobic, gram-negative bacillus
‡ thrive in warm, damp environments (lakes, rivers, hot
springs, soil, water systems, air conditioning systems)
Mode of Transmission

‡ aerosolized water droplets/droplet nuclei

‡ by aspiration, direct inhalation
‡ develop infections after inhaling contaminated droplets
for a few minutes
‡ no direct human-to-human transmission
S/S and Manifestations
‡Fever greater than 40 º C (range, 38.8-40.5°C)
‡Chills
‡Cough - Dry or productive, hemoptysis is rare
‡Hypotension
‡Relative bradycardia in all
‡Chest pain
‡Neurologic symptoms
Headache
Lethargy
Mental status changes - Depressed mental status or agitation
‡GI symptoms
Diarrhea - Watery, not bloody
Nausea, vomiting, and abdominal pain
‡Muscle pain
Prevention & Control Measures
‡ Avoid smoking - single most important thing you can do!

‡ no vaccine currently available for LD

‡ good maintenance of possible sources:
including regular cleaning and disinfection and the application of
other physical (temperature) or chemical measures (biocide) to
minimize growth
Prevention & Control Measures
‡Prevention and control of nosocomial legionellosis

‡If one definite case or 2 possible cases of nosocomial (LD) occur

among inpatients, initiate an investigation for a hospital source.

‡Use only sterile water for filling and rinsing of nebulization devices.
Medical Management
‡ Antibiotics
‡ Most patients require hospitalization with parenteral antibiotics
‡ Doxycycline, azithromycin, macrolides, and quinolones are more active
against (LD) than erythromycin
‡Supportive measures (oxygen, fluid and electrolyte replacement)
Nursing Intervention
‡ Monitor V/S
‡ Monitor RR: tachypnea, dyspnea
‡ Auscultate the breathing: fine or coarse crackles
‡ Percuss chest for dullness: consolidation or pleural effusions
‡ Monitor BP and HR: hypotension and bradycardia
‡ MIO: possible renal complications
‡ O2 per cannula at 2 to 4 L/min is effective with many patients
‡Chest physiotherapy
Nursing Intervention
‡ Encourage OFI up to 3 L/day to assist in loosening pulmonary
secretions and to replace fluid lost
‡Provide mechanical ventilation and other respiratory therapy as
ordered
‡ Sterile technique during endotracheal suctioning of the patient
‡ Fever reducing measures, TSB
‡ Semi fowler¶s position
‡ Give antibiotic therapy as indicated