Legionella pneumophila cases in a community hospital: A 12-month retrospective review

Sunkaru Touray, Michael C Newstein, Justin K Lui, Maureen Harris, Kim Knox, Sunkaru Touray, Michael C Newstein, Justin K Lui, Maureen Harris, Kim Knox

Abstract

Background: Legionella pneumonia has long been recognized as an important cause of community-acquired pneumonia associated with significant morbidity and mortality; however, the description of the incidence of this disease is restricted to sporadic cases in the literature. With the advent of an inexpensive and rapid urine antigen test, routine testing has become more common. We report findings of a retrospective review of 266 patients who were admitted with a clinical diagnosis of community-acquired pneumonia over a 12-month period and were tested for Legionella pneumophila serogroup 1, reporting the prevalence and determinants of Legionella infection.

Methods: Chart reviews of 266 patients admitted for community-acquired pneumonia and who underwent urine antigen testing for Legionella pneumophila during a 1-year time period were conducted, looking at demographic information as well as clinical and laboratory presentation, reporting on the prevalence and determinants of urine antigen positivity using multivariate logistic regression analysis.

Results: Legionella pneumophila serogroup 1 was found in 2.3% of cases of community-acquired pneumonia. We also found that altered mental status, diarrhea, history of lung disease, and alcohol intake were significantly associated with pneumonia associated with Legionella. The presence of these four factors had a low sensitivity in predicting Legionella infection (33%); however, they had a positive predictive value of 98%, with a specificity of 100. All the Legionella-infected patients in our study required admission to the intensive care unit, and one of them developed Guillain-Barré syndrome, which to our knowledge represents the only reported case of this syndrome related to Legionella infection in an adult in the English scientific literature.

Conclusion: Legionella pneumophila serogroup 1 is a common cause of sporadic cases of community-acquired pneumonia associated with a high morbidity and protean manifestations. Clinical features have a poor sensitivity in identifying cases, and routine urine antigen testing in patients with suggestive clinical symptoms appears to be a rational approach in the evaluation of community-acquired pneumonia.

Keywords: Legionella pneumophila serogroup 1; Legionella urinary antigen test; community-acquired pneumonia; hyponatremia.

Conflict of interest statement

Declaration of conflicting interests: We declare that we have no competing interests.

References

    1. Fang GD, Fine M, Orloff J, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine 1990; 69(5): 307–316.
    1. Stout JE, Yu VL. Legionellosis. N Engl J Med 1997; 337(10): 682–687.
    1. Cabello H, Cortés C, Ruiz M, et al. Community acquired pneumonia. Report of 8 cases of severe pneumonia by serogroup 1 Legionella pneumophila in Chile. Rev Med Chil 2002; 130(3): 309–313.
    1. Sharrar RG, Friedman HM, Miller WT, et al. Summertime pneumonias in Philadelphia in 1976. An epidemiologic study. Ann Intern Med 1979; 90(4): 577–580.
    1. Tsai TF, Finn DR, Plikaytis BD, et al. Legionnaires’ disease: clinical features of the epidemic in Philadelphia. Ann Intern Med 1979; 90(4): 509–517.
    1. Mulazimoglu L, Yu VL. Can Legionnaires disease be diagnosed by clinical criteria? A critical review. Chest J 2001; 120(4): 1049–1053.
    1. Von Baum H, Ewig S, Marre R, et al. Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia. Clin Infect Dis 2008; 46(9): 1356–1364.
    1. Pedro-Botet ML, Stout J, Yu V. Clinical manifestations and diagnosis of Legionella infection. UpToDate, 2013,
    1. Kazandjian D, Chiew R, Gilbert GL. Rapid diagnosis of Legionella pneumophila serogroup 1 infection with the Binax enzyme immunoassay urinary antigen test. J Clin Microbiol 1997; 35(4): 954–956.
    1. Yu VL, Plouffe JF, Pastoris MC, et al. Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis 2002; 186(1): 127–128.
    1. Helbig JH, Uldum SA, Bernander S, et al. Clinical utility of urinary antigen detection for diagnosis of community-acquired, travel-associated, and nosocomial Legionnaires’ disease. J Clin Microbiol 2003; 41(2): 838–840.
    1. Murdoch DR, Podmore RG, Anderson TP, et al. Impact of routine systematic polymerase chain reaction testing on case finding for Legionnaires’ disease: a pre-post comparison study. Clin Infect Dis 2013; 57(9): 1275–1281.
    1. Cunha BA. Severe Legionella pneumonia: rapid presumptive clinical diagnosis with Winthrop-University Hospital’s weighted point score system (modified). Heart Lung 2008; 37(4): 311–320.
    1. Yu VL, Kroboth FJ, Shonnard J, et al. Legionnaires’ disease: new clinical perspective from a prospective pneumonia study. Am J Med 1982; 73(3): 357–361.
    1. Falcó V, Fernández de Sevilla T, Alegre J, et al. Legionella pneumophila. A cause of severe community-acquired pneumonia. Chest 1991; 100(4): 1007–1011.
    1. Cunha BA. Legionnaires’ disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin North Am 2010; 24(1): 73–105.
    1. Lui JK, Touray S, Tosches WA, Richard K. Acute inflammatory demyelinating polyradiculopathy in Legionella pneumonia. Muscle Nerve. 2014. July 15.
    1. Akyildiz B, Gümüs H, Kumandas S, et al. Guillain-Barré syndrome associated with Legionnella infection. J Trop Pediatr 2008; 54(4): 275–277.
    1. Canpolat M, Kumandas S, Yikilmaz A, et al. Transverse myelitis and acute motor sensory axonal neuropathy due to Legionella pneumophila: a case report. Pediatr Int 2013; 55(6): 778–782.

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