A client is admitted to hospital to rule out Legionnaire disease following a canoe trip where he was sprayed in the face with a lot of “creek” water. Which of the following manifestations are characteristic of Legionnaire pneumonia? Select all that apply.

A) Temperature of 103.5°, pulse 80
B) "Talking but not making a lot of sense" (confusion)
C) Decreased abdominal bowel sounds
D) Productive cough with thick, yellow secretions
E) Chest x-ray that reveals areas of consolidation suggestive of pneumonia

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Ans: A, B, E
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 Legionella pneumonia typically presents acutely with malaise, weakness, lethargy, fever, and dry cough. Other manifestations include disturbances of central nervous system function and elevation in body temperature, sometimes to more than 104°F (40°C). The presence of pneumonia along with diarrhea, hyponatremia, and confusion is characteristic of Legionella pneumonia. The disease causes consolidation of lung tissues and impairs gas exchange. Another characteristic of the disease is a lack of a normal pulse–temperature relationship in which a fever is not accompanied by an appropriate rise in heart rate. For example, a temperature of 102°F is normally accompanied by a heart rate of 110 beats/minute; in Legionella pneumonia it is often less than 100 beats/minute.