ROLE OF IMMUNOSUPPRESSION IN THE EVOLUTION OF LEGIONNAIRES-DISEASE

The clinical course of legionella pneumonia in immunosuppressed patien ts is uncertain. This study was undertaken to determine the clinical e volution of legionellosis on the basis of the immune state and to esta blish the variables associated with death directly related to legionel losis. The study included 78 patients: 28 with chronic disease who had received immunosuppressive treatment (group 1), 24 with chronic disea se without immunosuppressive treatment (group 2), and 26 controls. Inc lusion criteria were the occurrence of nosocomially acquired pneumonia , Legionella pneumophila infection, and erythromycin therapy that was initiated within 72 hours following diagnosis. Respiratory and extrare spiratory complications were observed more frequently in groups 1 and 2. Bilateral radiological involvement was most frequent in group 1, an d recurrence of legionella pneumonia was observed exclusively in group 1. None of these variables achieved statistical significance, The glo bal mortality of the series was 11.5% (17.9%, 12.5%, and 3.8% in group s 1, 2, and 3, respectively). Variables statistically related to morta lity were acute renal failure, shock, and need far mechanical ventilat ion. Although many of the variables analyzed lacked statistical signif icance, a trend was seen between complications and basal immunosuppres sion, as previously suggested.