Legionellosis symptoms

Symptoms of legionellosis are characterized by a wide spectrum. Infectious process can occur subclinically, asymptomatically (according to some data, more than 20% of older persons are seropositive). Legionellosis can be manifested by type of acute respiratory disease, pneumonia, bronchitis, alveolitis, and can be characterized by a severe condition, multi-organ lesions with the development of sepsis.

There are acute respiratory legionellosis (Pontiac fever), pneumonia (Legionnaires' disease, acute alveolitis), fever with exanthema (Fort-Bragg fever).

[1], [2], [3], [4],

Acute respiratory legionellosis

In many ways it resembles ARI. The duration of the incubation period is from 6 hours to 3 days. The disease begins with a progressive malaise, diffuse muscle pain. From the first days of the disease is characterized by an increase in body temperature from 37.9 to 40 ° C. This is accompanied by chills, headache, muscle pains. Often marked neurological symptoms of legionellosis: dizziness, photophobia. Insomnia, impaired consciousness of varying degrees and coordination.

The respiratory syndrome is characterized by a dry cough, pain in the chest is possible with breathing. Some patients complain of sore throat and dryness in the oropharynx. Symptoms of legionella, respiratory syndrome are often combined with pain in the abdomen, vomiting. As a rule, there are no signs of kidney and liver damage in these patients. Changes in the hemogram consist in moderate leukocytosis. Acute illness ends without treatment within 2-5 days. During the period of convalescence, the asthenovegetative syndrome persists for a long time.

[5], [6], [7], [8], [9], [10], [11], [12]

Pneumonia (Legionnaires' disease, acute alveolitis)

The incubation period lasts from 2 to 10 (more often up to 5) days. The disease begins subacute with a prodromal period, which lasts 1-2 days. In this periot, patients complain of increased fatigue, a decrease in appetite, and a mild headache. Quite often in the prodromal period, diarrheal syndrome develops. The peak period is characterized by an increase in temperature to 39-40 ° C. Fever (the most constant sign of legionella infection) can last up to 2 weeks. It has a remitting or incorrect character. Ends with lysis. For the peak period, the following symptoms of legionellosis are common: profuse sweat, severe asthenia, intense chest pain associated with breathing. Pleural pain is typical for most patients. In a third of patients, localization and intensity of pain exactly corresponds to developing parapneumonic fibrinous pleurisy, aggravating respiratory failure. From the 2nd or 3rd day of the disease there is a dry cough. Sputum is scanty, viscous, mucopurulent. A third of patients report hemoptysis. Pneumonia is defined both physically and radiological. Above the affected area of the lung, shortening of the percussion sound is determined, with auscultation - wet, small bubbling rales. At half of patients dry rales are heard, indicating the development of bronchial obstruction. Legionellosis pneumonia is distinguished from other pneumonia by a variety of localization of the pathological process and a significant frequency of total and subtotal lesions of the lung (in every fifth patient). Radiographically, one-sided pleuropneumonia is more often defined, for which long-term persistence of infiltration, pleural changes and their slow involution are characteristic. In patients with immunodeficiency of different genesis, the destruction of the lung tissue is determined.

Patients with legionellosis rapidly develop symptoms of pulmonary insufficiency. Typical pronounced dyspnea, many patients already in the early period have to be transferred to the ventilator.

Along with the defeat of the respiratory system, signs of pathology in other organs and systems are often observed. Thus, in most patients in the acute period of the disease, arterial hypotension, relative bradycardia, followed by tachycardia are noted. The heart sounds are muffled. More than a third of patients on the 4th-5th day of the disease have a liquid watery stool. Diarrhea lasts an average of about 7 days and is accompanied by abdominal pain of various localization and flatulence. Approximately in 30% of patients, liver damage is manifested by increased activity of aminotransferases, jaundice is possible. The liver function is restored within the first 2 weeks of the disease, and liver failure is not observed later. In the course of the disease, kidney function is often impaired, mainly due to focal nephritis. It is possible to develop renal failure, which can persist for a long time after the acute phase of the disease (up to 9 months).

CNS lesions are more or less characteristic of most patients. Basically, they are manifested headache, encephalopathy. The structures of the cerebellum and brainstem are most often affected. This is manifested by dysarthria. Ataxia, nystagmus, paralysis of the oculomotor muscles. Characteristic of depression, emotional lability. Possible meningoencephalitis. In the period of convalescence, many patients complain of a memory impairment, some of them can not remember the events that happened to them in the acute phase of the disease.

In peripheral blood, an increase in leukocytes is observed up to 10-15x10 ⁹ / l. Often observed shift of the leukocyte formula to the left, in severe cases, thrombocytopenia and lymphopenia are possible. ESR can be increased to 80 mm / h.

With a favorable course of the disease from the 2nd week, the condition of the patients improves. In the period of convalescence, weakness and dizziness persist for a long time. Irritability. Radiographic changes in the lungs can persist for 10 weeks. In isolated cases, the disease is complicated by an abscess of the lungs and the empyema of the pleura. A more frequent complication of the disease is the development of an infectious-toxic shock.

Acute alveolitis

Characterized by an acute onset with an increase in body temperature to 39-40 ° C. Patients complain of headaches, muscle pains. From the first days of illness there is a dry cough. In the future, shortness of breath increases, there is a cough with the separation of sparse (mucous or mucopurulent) sputum. With auscultation of the lungs, a widespread bilateral, profuse, long-lasting crepitation is determined. With a prolonged progressing course develops fibrosing alveolitis.

[13], [14], [15]

Acute febrile illness

The incubation period ranges from several hours to 10 days. The main symptoms of legionellosis: fever up to 38 ° C, chills, headache, polymorphic rash. The duration of the disease is 3-7 days. The flow is favorable.

[16], [17], [18], [19], [20], [21], [22]

Legionella complications

The most formidable complications of legionellosis are acute respiratory failure, acute renal failure, an infectious-toxic shock. There may be bleeding (nasal, gastrointestinal and uterine) and thromboembolism. Rarely, acute hepatic insufficiency and suppuration in the lungs are rarely recorded (lung abscess, pleural empyema).

Mortality

When the pneumonic form of legionellosis reaches 15-20%, more often observed in individuals with chronic lung diseases, immunodeficiency. Causes of death - the development of infectious-toxic shock, pulmonary-cardiac failure or superinfection.