Journal Article

Trends in Legionnaires Disease, 1980–1998: Declining Mortality and New Patterns of Diagnosis

Andrea L. Benin, Robert F. Benson and Richard E. Besser

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 35, issue 9, pages 1039-1046
Published in print November 2002 | ISSN: 1058-4838
Published online November 2002 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/342903
Trends in Legionnaires Disease, 1980–1998: Declining Mortality and New Patterns of Diagnosis

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New diagnostic tests and empirical therapy for pneumonia may have important ramifications for the identification, treatment, and control of legionnaires disease (LD). To determine trends in the epidemiology of LD, we analyzed data for 1980–1998 from the passive surveillance system of the Centers for Disease Control and Prevention. During this time period, there were 6757 confirmed cases of LD (median annual number, 360 cases/year). Diagnosis by culture and by direct fluorescent antibody and serologic testing decreased significantly; diagnosis by urine antigen testing increased from 0% to 69%. The frequency of isolates other than Legionella pneumophila serogroup 1 (LP1) decreased from 38% to 4% (P = .003). The case-fatality rate decreased significantly, from 34% to 12% (P < .001) for all cases, from 46% to 14% (P < .0001) for nosocomial cases, and from 26% to 10% (P = .05) for community-acquired cases. LD-related mortality has decreased dramatically. The decrease in culture-based diagnosis limits the recognition of non-LP1 disease and impairs outbreak investigation, because fewer Legionella isolates are provided for further examination.

Journal Article.  4042 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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