Legionnaires' Disease Presenting with Empyema

Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010

“…Although Legionella was not identified in a large recent series of UK adult pleural infections,2 it has rarely been reported as a cause of empyema138 and a macrolide antibiotic should be added in proven/suspected cases, although use of these antibiotics is not routinely recommended. Similarly, pleural effusions may occur in 5–20% of patients with pneumonia due to Mycoplasma pneumoniae 139 140.…”

BTS guidelines for the management of pleural infection

“…73 84 Pleural effusions may occur in patients with Legionella pneumonia and are usually self-resolving. 85 Legionella has rarely been reported as a cause of empyema 86 and a macrolide should only be added in suspected cases. Similarly, pleural effusions may occur in 5-20% of patients with pneumonia due to Mycoplasma pneumoniae, 87 88 but these are usually small reac-tive effusions.…”

Recent advances in respiratory medicine

“…The new antifungal agent ketoconazole, although effective in systemic candiosis, histoplasmosis and rarer fungal infections (Symoens, 1981) does not seem to have a major role in treatment of systemic aspergillus infection. Legionnaires' disease can respond to erythromycin, probably best combined with rifampicin (Randolph and Beekman, 1979), in these desperately ill patients.…”