A fatal pneumonia case is described here as the first case of Legionnaires' disease in Japan. A 64 year-old male with diabetes mellitus admitted to Nagasaki University hospital for high fever. The patient was treated with oral diabetic drugs by his general practtioner and was well until 27 October, 1980 when he felt weak to walk. The following day, he subsequently developed fever and confusion, and was admitted to our clinic as an emergency case with a temperature of 39.5° and drowsy state of consciousness.A chest X-ray showed no abnormality but the following day it showed right lower lobe infiltrates.Despite treatment with carbenicillin and then ceftezol (CTZ) and ticarcillin (TIPC), he continued to be febrile up to 41.5° and had increasing respiratory distress. The PO2 in his arterial blood fell to 46.2 torr, while receiving 100% 0 2 inhalation with 2 L/min. On the fourth hospital day his pneumonia had become panlobar .Blood culture by using commercial blood culture media was performed 5 times during the fourth hospital day, but no causative organism was obtained. At the fifth hospital day, he became hypotensive and his temperature was 40° and he was in severe respiratory failure with only scanty sputum and died.
At postmortem examination both lower lobes of the lung were consolidated. Alveolar spaces were filled with neutrophils and macrophages. Lung aspirates, small amounts of lung tissue in right lower lobe, heart blood and pleural effusion were taken out during the autopsy. These materialswere inoculated directly to buffered CYE Agar and biphasic media for detection of Legionella pneu mophila, and at the same time they were also injected to guinea pigs intraperitoneally. L. pneumophila (Serotype 1) was isolated directly from lung aspirates and lung tissue homogenates, and isolated through guinea pigs from lung homogenates and pleural effusion. Direct fluorescent antibody stain oflung tissue homogenates and lung tissues samples taken at autopsy were both positive in Serotype 1.
The strain isolated was identified in both our laboratory and VA Wadsworth Medical Cente r (Dr. P. H. Edelstein), Los Angeles. This organism was identified as Legionella pneumophila, serogroup I.
Indirect FA titer of his serum taken at autopsy was 1: 512 in L. pneumophila serogroup. I.