The mortality rate of our patients with L pneumophila pneumonia was 10 percent, which was higher than for pneumococcal pneumonia. While some authors also find that mortality for L pneumophila-caused pneumonia is higher than for other pneumonia caused by other organisms, others observe that all pathogens have the same mortality. The mortality rate has been 10 percent but it has been greater in patients with heart disease, respiratory failure, mul-tilobar involvement and the wrong empiric therapy. The early institution of appropiate therapy is of great importance to improve the outcome. If not adequately treated, the disease spreads to adjacent and other areas of the same and the contralateral lung. We have observed that in patients not treated with erythromycin initially the mortality increased to 27 percent. Ruf and colleagues also found that mortality in patients treated with erythromycin was 4.5 percent while in those treated with other antibiotics it was 57.9 percent.
We believe that in patients with a severe community-acquired pneumonia with respiratory failure and radiologic progression L pneumophila as an etiologic agent warrants strong consideration and empiric therapy with erythromycin should be started.