Pathogenesis of acute Legionnaires' disease pneumonia.

Immunofluorescent study of the lungs in cases of fatal suspected acute Legionnaires' disease enabled confirmation of the presence of Legionella pneumophila. In addition, probable pathogenetic mechanisms that had not been as clearly visualized by light microscopy became apparent: the retrograde involvement of the larger bronchioles and proximal airways, invasion of the interstitium, extension to pleura, and lymphatic and hematogenous spread. Organisms were demonstrated to occur in the liver and spleen of one patient. The development of technics for the earliest possible diagnostic verification of Legionnaires' disease, with specimens obtained as untraumatically as practical from selected sites and screened by specific immunofluorescent microscopic examination, should contribute to patient survival.