Table 5.
Modified Winthrop-University Hospital Infectious Disease Division's point system for diagnosing legionnaire's disease in adults. Adapted from Cunha, 2006 [6]
| Qualifying conditions | Point score | |
|---|---|---|
| Clinical features | ||
| Temperature > 103°Fa | With relative bradycardia | + 5 |
| Headache | Acute onset | + 2 |
| Mental confusion/lethargya | Not drug-induced or metabolically/ hypoxemia related | + 4 |
| Ear pain | Acute onset | − 3 |
| Nonexudative pharyngitis | Acute onset | − 3 |
| Hoarseness | Acute not chronic | − 3 |
| Sputum (purulent) | Excluding chronic bronchitis | − 3 |
| Haemoptysisa | Mild/moderate | − 3 |
| Chest pain (pleuritic) | acute onset | − 3 |
| Loose stools/watery diarrhoeaa | Not drug induced | + 3 |
| Abdominal paina | With/without diarrhoea | + 5 |
| Renal failurea | Acute not chronic | + 3 |
| Shock/hypotensiona | Not 2° to acute cardiac | − 5 |
| /pulmonary causes | + 5 | |
| Splenomegaly | Excluding non-CAP causes | − 5 |
| Lack of response to β-lactams | After 72 h (excluding viral pneumonias) | + 5 |
| Laboratory Features | ||
| Chest X-ray | Rapidly progressive asymmetrical infiltratesa (excluding severe influenza/SARS) | + 3 |
| ↓ PO2 with ↑ A-a gradient (> 35)a | (Excluding severe influenza/SARS) | − 5 |
| ↓ Na+ | Acute onset | + 1 |
| ↓ PO4a | Acute onset | + 5 |
| ↑ SGOT/SGPT (early mild/transient) | Acute onset | + 4 |
| ↑ Total bilirubin | Otherwise unexplained | + 1 |
| ↑ LDH (> 400)a | Excluding HIV/PCP | − 5 |
| ↑ CPK/aldolase | Otherwise unexplained | + 4 |
| ↑ CRP (> 30) | Acute onset | + 5 |
| ↑ Cold agglutinins (≥ 1 : 64) | Acute onset | − 5 |
| ↑ Creatinine | Acute onset | + 2 |
| Microscopic haematuriaa | Excluding trauma, BPH, Foley catheter, bladder/renal neoplasms | + 2 |
| Likelihood of Legionella (total points) | ||
| > 15 Legionella very likely | ||
| 5–15 Legionella likely | ||
| < 5 Legionella unlikely | ||
a
Otherwise unexplained (acute and associated with pneumonia).