Seven cases of fulminant
Legionnaires' disease treated at Kitasato University Hospital between 1985 and 1992 were reviewed. These patients were male with a mean age of 55.9 years (range, 37-67 yrs), and five were heavy alcohol drinkers. All seven patients required
mechanical ventilation. Four patients recovered (group 1) and three expired due to
respiratory failure (group 2). The mean interval from initial symptoms to the development of
respiratory failure was 8.8 days in group 1 and 6.0 days in group 2, except in the one patient with
lung cancer (case 6). The progression of
pneumonia was more rapid in group 2. The mean intervals from admission to administration of
erythromycin were 1.5 days and 3.5 days, respectively, in groups 1 and 2. In group 1, pulmonary infiltrates and
respiratory insufficiency worsened for the first few days after
erythromycin administration but improved thereafter. The average duration of ventilatory care in group 1 was 13.3 days. The administration of
rifampicin combined with
erythromycin may be useful for the treatment of fulminant
Legionnaires' disease. When fulminant
pneumonia is encountered in a middle-aged or elderly male alcoholic,
Legionnaires' disease should be suspected and
erythromycin administration with
rifampicin should be initiated as early as possible.