NEUROLOGIC AND PSYCHIATRIC MANIFESTATIONS OF LEGIONNAIRES-DISEASE

Legionella is a frequent etiologic agent in the development of both no socomial and community acquired pneumonias. Involvement of the nervous system is common in Legionella infections. We present a case of Legio nnaires' disease which illustrates distinctive neurologic findings inc luding delirium and cerebellar dysfunction. Furthermore, this paper re views the neurological and psychiatric features of 609 Legionella infe cted patients with involvement of the nervous system. The most common signs were disorientation (58%), headache (52.4%), and somnolence (39. 7%). less frequent or rare were: cerebellar dysfunction (11.2%), hallu cinations (8.4%), agitation or stupor (4.1%), affective disorders (3.1 %), peripheral neuropathy (2.8%), pyramidal disturbances (2.1%), memor y loss (1.6%), seizures (1.5%), cranial nerve palsies (1.5%), incontin ence (0.7%), and extrapyramidal disturbances (0.3%). Cranial CT scans, cerebrospinal fluid findings, and nerve and muscle biopsies were usual ly unremarkable. Neuropathologic examinations failed to demonstrate sp ecific characteristics. Hyponatremia and serum CPK level elevation wer e present in up to 89% and 50% of patients, respectively. Prognosis of disturbances of the nervous system was mainly good. We conclude that in the presence of definite neurological findings, pulmonary infection , hyponatremia, and CPK elevation Legionella infection should be consi dered.