Table 1 Winthrop-University Hospital Infectious Disease Division's diagnostic weighted point system for diagnosing Legionnaires' disease in adults (modified [15])
From: Respiratory failure presenting in H1N1 influenza with Legionnaires disease: two case reports
Presentation | Point score |
|---|---|
Clinical features | |
Temperature > 102 F* With relative bradycardia | 5 |
Headache Active onset | 2 |
Mental confusion/lethargy* Not drug-induced | 4 |
Ear pain Acute onset | 3 |
Nonexudative pharyngitis Acute onset | 3 |
Hoarseness Acute not chronic | 3 |
Sputum (purulent) Excluding AECB | 3 |
Hemoptysis* Mild/moderate | 3 |
Chest pain (pleuritic) | 3 |
Loose stools/watery diarrhea* Not drug-induced | 3 |
Abdominal pain* With/without diarrhea | 2 |
Renal failure* Acute (not chronic) | 3 |
Shock/hypotension* Excluding cardiac/pulmonary causes | 5 |
Splenomegaly Excluding non-CAP causes | 5 |
Lack of response to B-lactam antibiotics after 72 hours (excluding viral pneumonias) | 5 |
Laboratory tests | |
Chest x-ray Rapidly progressive asymmetric infiltrates* (excluding severe influenza (human, avian, swine), HPS, SARS) | 3 |
Severe hypoxemia with (A-a gradient (> 35)* Acute onset | 2 |
Hyponatremia* Acute onset | 1 |
Hypophosphatemia Acute onset | 5 |
Elevated SGOT/SGPT (early/mild/transient)* Acute onset | 2 |
Elevated Total bilirubin Acute onset | 1 |
Elevated LDH (> 400)* Acute onset | 5 |
Elevated CPK* Acute onset | 4 |
Elevated CRP* Acute onset | 5 |
Elevated Cold agglutinin titers (1:64) Acute onset | 5 |
Relative lymphopenia (< 21%)* Acute onset | 5 |
Elevated Ferritin (> 2 n)* | 5 |
Microscopic hematuria* Excluding trauma, BPH, Foley catheter, bladder and/or renal neoplasms | 2 |
Total point score Legionnaires' Disease very likely > 15 Legionnaires' Disease likely 5-15 Legionnaires' Disease unlikely < 5 | |