Does Legionella lead to ARDS? My brother was hospitalized with the former and now has the later.
Legionnaires’ disease can be complicated by ARDS. I hope that with antibiotic therapy that he will recover, but the hospital course may be stormy. Good luck.
Follow Up Question:
Thank you for your reply. Unfortunately, the storm has arrived. He is on many antibiotics with his fever unrelenting. We are now bringing in Infectious Diseases to look for other sources of infection. 60% c-Pap administered oxygen, all complicated by a poor performance of mitral heart valve repaired ten years ago. He is a 66-year-old practicing judge/attorney. Thanks again.
Follow Up Answer:
Please give the Infectious Disease consultant and the ICU Attending the message below:
Unrelenting fever in a patient with persistent pulmonary infiltrates in a patient with confirmed Legionnaires’ disease may be a result of 2 unsuspected diagnoses:
- Legionella endocarditis (!) This is rarely diagnosed and there is virtually no literature on this except for our publications. I would ask the ID attending to look at these two articles describing a cluster of cases of prosthetic valve endocarditis at Stanford that occurred in the 80’s
Tompkins, L.S., B. Roessler, S.C. Redd, L. Markowitz and M.L. Cohen. 1988. Legionella prosthetic valve endocarditis. New Engl. J. Med. 318:530-35
Lowry, P.W., R.J. Blankenship, W. Gridley, N.J. Troup and L.S.Tompkins. 1991. A cluster of Legionella sternal-wound infections due to postoperative topical exposure to contaminated tap water. New Engl. J. Med. 324:109-112.
- Nosocomial endocarditis due to Staph aureus. If TTE shows vegetations, empiric quinolone at super maximal doses (levofloxacin 750 q 12 or cipro 500 q 8 – adjusted for renal dysfunction)) should be strongly considered. Short-course rifampin in combination with a quinolone may break the fever. Although drug interactions and rising serum bilirubinemia will always be problematic. Note that quinolone plus rifampin is also active therapy against MRSA. Finally, if vegetations are present, surgical resection of the valve should be performed – although cardiothoracic surgery will have to be persuaded.