Table 1

Brain imaging abnormalities in patients with neurological dysfunction and Legionella infections

ReferenceAge/sexClinical symptoms, signs, outcomeImaging results
ADEM, acute disseminated encephalomyelitis; CSF, cerebrospinal fluid; CT, computed tomography; FLAIR, fluid attenuated inversion recovery; MRI, magnetic resonance imaging; PCR, polymerase chain reaction.
Weir (1982)153/FHeadache, confusion, nuchal rigidity, dysarthria, extensor left toe, ataxia of lower extremities; 3 years later she had ataxia in her lower extremities more than in her upper extremitiesHead CT, normal in acute setting; head CT 3 years later, cerebellar atrophy
Andersen (1987)733/MHeadache, seizure, confusion, expressive aphasia, right sided hyperreflexia, dysmetria in right upper extremity; Legionella jordanis serum antibodies present at high titres; “normal” 7 months later except for “slightly impaired memory”Head CT, left temporoparietal abscess, autologous leucocyte scan with enhancement in same region
Potasman (1990)826/FFevers, headache, generalised seizure followed by confusion, left hemiparesis, additional generalised seizures; Legionella bozemanii antibodies in CSF; discharged 1 month later with normal neurological examinationHead CT, effacement of sulci
Johnson (1984)2Various, 7 patients with imaging (2 abnormal)Patient with cerebral oedema on head CT had confusion leading to coma with otherwise normal neurological examination; patient survived. Patient with multifocal lesions on brain scan presented in coma and then developed left facial weakness, left hemiparesis, hyperreflexia, and an extensor left toe by day 12 of hospital stay; patient died and had necrotising haemorrhagic leucoencephalitis with bacilli seen on Dieterle stain at necropsyHead CT, normal in 4 patients; brain scintigraphy, normal in 1 patient; head CT, cerebral oedema in one patient; brain scintigraphy, multifocal lesions in one patient
Karim (2002)1021/MUnresponsive to verbal commands, with nuchal rigidity on admission, seizures followed, negative herpes simplex virus PCR; Legionella pneumophila by DFA after bronchoalveolar lavage; “the patient’s neurologic condition gradually improved”Head CT, normal initially, slight leptomeningeal enhancement on repeated study; brain MRI, bilateral mesiotemporal FLAIR hyperintensities
Sommer (2000)1258/MThree weeks after a probable Legionella pneumophila illness (non-productive cough, fever, diarrhoea, abdominal pain, headache) the patient developed headache, nausea, dizziness, left-beating nystagmus and bilateral horizontal diplopia, lost consciousness; complete recovery 4 weeks later with steroid treatmentBrain MRI, confluent hyperintensity of the bilateral periventricular and subcortical white matter and left cerebellar peduncle (ADEM)
Spieker (1998)1135/FSix weeks after Legionella cincinnatiensis CNS infection (confirmed by PCR detection) the patient developed headache, agitation, hallucinations, paranoia, generalised seizures, mutism, somnolence, right facial dyskinesias, rigidity and dystonia; amnesia for 2 months, other abnormalities on the neurological examination normalisedBrain MRI, bilateral symmetrical hyperintensity of the basal ganglia and left subcortical white matter (ADEM); improved on repeat imaging
Platzeck (1990)944/MLegionella bozemanii pneumonia followed by tetraparesis and severe midbrain syndrome; almost complete neurological recovery after several weeksHead CT, normal; brain MRI, symmetrical, bilateral foci of demyelination in the brain stem
Easterbrook (1992)1319/MPatient presented in coma with fever, CSF leucocytosis, Legionella pneumophila and Mycoplasma pneumoniae coinfection documented serologically; developed quadriplegia, anarthria, and dysphagia with little improvementHead CT, normal on admission; brain MRI, 6 weeks later, multifocal cerebral white matter disease