Legionnaire's Disease Nursing Management and Interventions

Legionnaire's disease is an acute bronchopneumonia caused by the gram-negative bacillus Legionella pneumophila. It is a respiratory infection that hits middle-aged, elderly, and immunocompromised patients hardest, so your priorities are protecting the airway, supporting respiratory status, replacing fluids, and getting antibiotics in. The disease was named after the 1976 outbreak that struck 182 people (29 of whom died) at an American Legion convention in Philadelphia in July 1976.

Etiology

Legionella pneumophila is an aerobic gram-negative bacillus that flourishes in soil and spreads airborne through cooling towers and air-conditioning systems.

Risk Factors

Middle-aged and elderly people; immunocompromised patients or those with lymphoma or other disorders of delayed hypersensitivity; patients with chronic underlying disease such as diabetes, chronic renal failure, or COPD; people with alcoholism; cigarette smokers; and people on a ventilator for extended periods.

Incubation Period

About 2 to 10 days.

Manifestations

Diarrhea, anorexia, malaise, diffuse myalgias and generalized weakness, headache and recurrent chills, and blood-tinged sputum.

Diagnostic Findings

White blood count shows leukocytosis, chest X-ray shows consolidations, and auscultation reveals fine crackles. Definitive tests include direct immunofluorescence of respiratory tract secretions and tissue, culture of L. pneumophila, and indirect fluorescent antibody testing of serum comparing acute samples with convalescent samples drawn at least 3 weeks later. A convalescent serum showing a fourfold or greater rise in antibody titer for Legionella confirms the diagnosis.

Treatment

Quinolones (ciprofloxacin) and macrolides (erythromycin).

Nursing Management

Closely monitor respiratory status, continually monitor vital signs, replace fluid and electrolytes, provide mechanical ventilation and other respiratory therapy, and give antibiotic therapy as indicated.