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Implications for Underdiagnosis

Robert R. Muder, MD; Victor L. Yu, MD; Jonathan K. McClure, MD; Frank J. Kroboth, MD; Spryos D. Kominos, ScD; Robert M. Lumish, MD

JAMA. 1983;249(23):3184-3188.

Abstract
Most hospitals have yet to record a case of nosocomial legionnaires' disease; the importance of isolation of Legionella pneumophila in the water system of such an institution is unclear. We undertook a prospective pneumonia study in tandem at a veterans hospital where legionnaires' disease was known to be endemic and a community teaching hospital where legionnaires' disease had never been documented. Legionella serological tests were performed on all patients with pneumonia; selective culture media and direct fluorescent antibody testing for Legionella were made readily available. Simultaneous environmental surveys for Legionella were performed. At the community hospital, we discovered that 64% of sites in the water distribution system yielded L pneumophila and that 14.3% of nosocomial pneumonias were legionnaires' disease. The epidemiologic implications of these findings are discussed. Options concerning case detection and eradication measures in the face of hospital water contamination with L pneumophila are presented.

(JAMA 1983;249:3184-3188)

Author Affiliations
From the Departments of Medicine (Drs Muder, McClure, and Lumish) and Pathology (Dr Kominos), Mercy Hospital of Pittsburgh; and the Department of Medicine (Drs Muder, Yu, and Kroboth), Pittsburgh Veterans Administration Medical Center; and University of Pittsburgh, School of Medicine.

Footnotes
Reprint requests to Infectious Disease Section, Veterans Administration Medical Center, University Drive C, Pittsburgh, PA 15240 (Dr Yu).

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