LEGIONELLA BOZEMANII CAVITARY PNEUMONIA POORLY RESPONSIVE TO ERYTHROMYCIN - CASE-REPORT AND REVIEW

A case of pneumonia due to Legionella bozemanii-only the 20th culture- proven case reported so far-progressed with cavitation 9 days after th e initiation of intravenous therapy with erythromycin. Review of all 2 0 reported cases revealed a similar propensity toward radiographic pro gression (25%) and cavitation (25%) during therapy. A slow response to long courses of erythromycin was the rule (35% of cases). In two inst ances, long courses of intravenous erythromycin failed and the patient died. Pleural effusion was reported in 60% of patients, including two with empyema. Overall mortality was high (40%). Although mortality wa s only 21% among patients who lived long enough to receive adequate co urses of erythromycin, all three such patients who died had received e rythromycin alone. Combination therapy with erythromycin and rifampin proved more effective in terms of survival. Infections due to non-pneu mophila Legionella may be overlooked because of the organisms' special serological and culture requirements.