Resumen
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- pessoa conhecida com Legionella
- febre
- cefaleia
- estertores/roncos
Other diagnostic factors
- tosse produtiva
- dispneia
- náuseas/vômitos
- dor abdominal
- hipóxia
- taquicardia
Risk factors
- abastecimento de água não municipal
- reparo recente em encanamento residencial
- tabagismo
- quimioterapia citotóxica
- receptor de transplante de pulmão
- corticosteroides
- aquecedor de água elétrico
- trabalhar >40 horas por semana
- viagem recente
- diabetes mellitus
- motorista profissional
- uso de banheiras de hidromassagem
- morar próximo a uma torre de resfriamento
- nebulizadores, umidificadores, tubos de ventilação ou equipamentos de lavagem com água da torneira
- alta proximidade de fontes de água decorativas
- consumo de gelo contaminado por Legionella pneumophila
- parto na água
- exposição a compostagem contaminada
- exposição à água da chuva
Diagnostic investigations
1st investigations to order
- Hemograma completo
- perfil metabólico completo
- radiografia torácica
- TC abdominal
- detecção de antígeno urinário de Legionella pneumophila do sorogrupo 1
- coloração de Gram de expectoração
- culturas
Investigations to consider
- reação em cadeia da polimerase (PCR) para Legionella pneumophila
- sorologia para Legionella pneumophilia
Treatment algorithm
pneumonia leve/moderada por Legionella
pneumonia por Legionella grave ou ausência de resposta à terapia inicial
Contributors
Authors
Forest W. Arnold, DO, MSc, FIDSA
Professor of Medicine
Division of Infectious Diseases
Department of Medicine
School of Medicine
University of Louisville
Louisville
KY
Disclosures
FWA has received grants from the National Institutes of Health, Health Resources and Services Administration, as well as Pfizer, Covarsa, Merck, and Gilead pharmaceutical companies.
Acknowledgements
Dr Forest W. Arnold would like to gratefully acknowledge Dr Allen Griffin, a previous contributor to this topic.
Disclosures
AG declares that he has no competing interests.
Peer reviewers
Victor L. Yu, MD
Professor of Medicine
University of Pittsburgh
Pittsburgh
PA
Disclosures
VLY declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Phin N, Parry-Ford F, Harrison T, et al. Epidemiology and clinical management of Legionnaires' disease. Lancet Infect Dis. 2014 Oct;14(10):1011-21.Full text Abstract
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases (bacterial) - legionnaires' disease & pontiac fever. May 2023 [internet publication].Full text
US Centers for Disease Control and Prevention. Legionella (Legionnaires' disease and pontiac fever): diagnosis, treatment, & prevention. March 2021 [internet publication].Full text
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-67.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Doença do coronavírus 2019 (COVID-19)
- Pneumonia bacteriana
- Pneumonia hospitalar
More DifferentialsGuidelines
- Pneumonia in adults: diagnosis and management
- Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults
More GuidelinesCalculadoras
Índice de gravidade de pneumonia adquirida na Comunidade (PSI) para adultos
Escore CURB-65 de gravidade de uma pneumonia.
Mais Calculadoras
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal