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OVERVIEW

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The death toll in the outbreak of the mysterious respiratory disease in Philadelphia rose by two to 25 as medical detectives accelerated efforts today to seek a chemical or poison as the possible cause.

—The New York Times, August 7, 1976

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Overview

Legionella are thin, pleomorphic, long, gram-negative rods that stain poorly and require special media for isolation. They are ubiquitous and persistent in the environment, especially in water and soil. When inhaled into the lung, Legionella enter alveolar macrophages, escape host defenses, and produce a destructive pneumonia marked by headache, fever, chills, dry cough, and chest pain. There may be multiple foci in both lungs and extension to the pleura, but spread outside the respiratory tree is very rare.

Coxiella (agent of Q fever) are tiny gram-negative coccobacilli that when inhaled from animal and soil environmental sources cause pneumonia. In addition to the lung, Coxiella also have a tropism for the liver where they reside in macrophages and cause granulomatous hepatitis. Less commonly, Coxiella causes infective endocarditis not detected by culturing blood.

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Legionella is a genus of gram-negative bacilli that takes its name from the outbreak at the American Legion convention where it was first discovered. The name of the type species, Legionella pneumophila, reflects its propensity to cause the necrotizing pneumonia known as Legionnaires disease. Legionella species are now known to be widespread in the environment in ponds, amoebas, and the plumbing of large buildings. Coxiella, a cause of pneumonia known long before Legionella, shares many pathogenic, epidemiologic, and clinical features with it.

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LEGIONELLA

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BACTERIOLOGY

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STRUCTURE
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Legionella pneumophila is a thin, pleomorphic, gram-negative rod that may show elongated, filamentous forms up to 20 μm long. In clinical specimens, the organism stains poorly or not at all by Gram stain or the usual histologic stains; however, it can be demonstrated by certain silver impregnation methods (Dieterle stain) and by some simple stains without decolorization steps. Polar, subpolar, and lateral flagella may be present. Most species of Legionella are motile. Spores are not found.

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✺ Gram-negative rod that stains with difficulty

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Structurally, L pneumophila has features similar to those of gram-negative bacteria with a typical outer membrane, thin peptidoglycan layer, and cytoplasmic membrane. The toxicity of L pneumophila lipopolysaccharide (LPS) is significantly less than that of other gram-negative bacteria such as Neisseria and the Enterobacteriaceae. This has been attributed to chemical makeup of the LPS side chains that renders the cell surface highly hydrophobic, a property which may promote distribution in aerosols.

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✺ LPS is less toxic than that of most gram-negative species

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Side chains are hydrophobic

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METABOLISM
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Legionella is a facultative intracellular pathogen multiplying to high numbers inside free-living amoebas, other protozoa, and macrophages. In human-made water systems ...

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