Discrimination between Legionnaires' Disease and Pneumococcal Pneumonia Based on the Clinical and Laboratory Features: A Quantitative Approach Using the Modified Winthrop-University Hospital Weighted Point System

作者：Yamakuchi Hiroki^*; Hamada Yohei; Urakami Tosiharu; Aoki Yosuke

来源：Internal Medicine, 2017, 56(5): 487-491.

DOI：10.2169/internalmedicine.56.7399

• Legionnaires' disease
• WUH system
• pneumococcal pneumonia

Objective Legionnaires' disease (LD) is a common form of lobar pneumonia, but the optimum diagnostic modality has long been a subject of debate due to incomplete sensitivity and specificity. A delay in the initiation of specific therapy for LD is associated with increased mortality. The decision to treat a patient for Legionella must be made quickly. The purpose of this study was to evaluate the ability of the modified Winthrop-University Hospital WUH system to identify LD while discriminating against pneumococcal pneumonia at the time of hospitalization for community-acquired pneumonia.
Methods Five patients with LD and 13 patients with pneumococcal pneumonia were retrospectively analyzed.
Results The WUH system identified 4 of 5 patients with LD (sensitivity, 80%) while excluding legionellosis in 12 of 13 patients with pneumococcal pneumonia (specificity, 92%). The positive and negative likelihood ratios were 10.4 and 0.2. The area under the receiver operating characteristic curve was 0.969.
Conclusion The WUH system is useful for obtaining a rapid presumptive clinical diagnosis of LD. Further investigation with a larger number of patients is strongly recommended.

• 出版日期2017