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The prognostic significance of delayed therapy in Legionnaires' disease is poorly defined. Thirty-nine consecutive serologically confirmed cases of Legionnaires' disease were reviewed to examine whether an association exists between delayed therapy and prognosis. Clinical and laboratory factors predictive of mortality were also sought. Thirty-one cases (79%) were classified as having severe pneumonia at diagnosis. Thirty-six patients (92%) had community-acquired infection, and three patients (8%) had nosocomial disease. Ten patients died, resulting in a crude mortality rate of 26%. At the first assessment, variables noted for pneumonia associated with death were low diastolic blood pressure (p < 0.02), low serum albumin concentration (p < 0.04), and increased number of days from onset of pneumonia to hospitalisation (prodrome) (p < 0.02). However, multiple logistic regression analysis revealed that the prodrome was the only variable noted at diagnosis that achieved significance (p = 0.024). Mortality also correlated with both delay in the initiation of erythromycin therapy following admission (p < 0.001) and the total delay in starting erythromycin therapy (p < 0.001). It is therefore recommended that erythromycin be included early in the empiric therapy of severe community-acquired pneumonia.

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The life-cycle of Brachylaima cribbi n. sp. was established in the laboratory. Asymmetrical brachylaimid eggs, measuring 26-32 microm (29.1 microm) long and 16 -17.5 microm (16.6 microm) wide, were recovered from human faeces and fed to the helicid land snail Theba pisana as the first intermediate host. Sporocysts and cercariae were recovered from the T. pisana eight weeks after infection. The cercariae were used to infect the helicid land snails Cernuella virgata and Helix aspersa as second intermediate hosts. Metacercariae were recovered from the kidneys of these snails and used to infect mice. Adults of Brachylaima cribbi n. sp. were recovered from the small intestine of the mice. The differential features of B. cribbi n. sp. are the specificity for helicid snails as first and second intermediate hosts; characteristic ventral sucker and body cercarial chaetotaxy; and a long slender adult worm with equal size suckers in the first quarter of the worm, the ventral sucker occupying 41% of the body width, the uterus extending anterior to the ventral sucker and the vitelline follicles falling short of the posterior margin of the ventral sucker. No other known Brachylaima species exhibits all of these features. B. cribbi n. sp. is the first brachylaimid known to have infected humans and is probably of European origin, as the intermediate host snails were all introduced into Australia from Europe.