1976 Philadelphia Legionnaires' disease outbreak States Center for Disease Control and Prevention (CDC) in 2017 only use the term Legionnaires' disease to refer to the serious version with pneumonia. CDC investigators quickly discovered outbreaks of respiratory disease caused by "L. pneumophila" dating back to 1959. An outbreak of what was dubbed Pontiac fever occurred in a health department in Pontiac, Michigan in July 1967. No one died. Although caused by the same bacterium, Pontiac fever is a milder ailment than Legionnaires' disease. Pneumonia is absent in those with Pontiac fever. An outbreak of pneumonia in July–August, 1965, at St. Elizabeths Hospital in Washington, DC, which
Hospital-acquired pneumonia by so-called skorvatch microaspiration of upper airway secretions, through inapparent aspiration, into the lower respiratory tract. Also, "macroaspirations" of esophageal or gastric material is known to result in HAP. Since it results from aspiration either type is called aspiration pneumonia. Although gram-negative bacilli are a common cause they are rarely found in the respiratory tract of people without pneumonia, which has led to speculation of the mouth and throat as origin of the infection. In hospitalised patients who develop respiratory symptoms and fever, one should consider the diagnosis. The likelihood increases when upon investigation symptoms are found of respiratory insufficiency,