Clinical features and outcomes of Legionnaires' disease in solid organ transplant recipients

Gudiol, Carlota; García-Vidal, Carolina; Sabé, N.; Verdaguer, Ricard; Lladó, Laura; Roca, Josep; Gil-Vernet, S.; Carratalà, Jordi

doi:10.1111/j.1399-3062.2008.00337.x

Cited by 37 publications

(19 citation statements)

References 20 publications

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“…Immunocompromised individuals, especially transplant recipients on immunosuppressive regimens, are at an increased risk of developing LD due to Lp1 or other species and serogroups (524)(525)(526)(527)(528). In addition, case-fatality rates for LD are higher among older males and the immunosuppressed (121).…”

Section: High-profile Legionnaires' Disease Outbreaksmentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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SUMMARY Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

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Section: High-profile Legionnaires' Disease Outbreaksmentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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“…L. longbeachae , for example, has been shown to occur at an increased frequency regardless of immune status in some parts of the world, perhaps a result of differences in virulence seen in L. longbeachae isolates from these regions . In most non‐outbreak‐related longitudinal studies, L. pneumophila is the most commonly implicated species even among immunocompromised patients, and when LNLP infections are reported, the numbers are often small …”

Section: Discussionmentioning

confidence: 99%

“…restricted to case reports, [8][9][10][11] outbreaks, [12][13][14] and studies on cancer patients, [15][16][17] or to those 18 that include only a small subset of transplant recipients. Notable exceptions include a study on SOT recipients 19 and an older study from our center on HCT recipients. 20 In infections accounted for half the cases of LD.…”

Section: Management and Outcomementioning

confidence: 99%

“…L. longbeachae, for example, has been shown to occur at an increased frequency regardless of immune status in some parts of the world, 22,24,25 perhaps a result of differences in virulence seen in L. longbeachae isolates from these regions. 26 In most non-outbreakrelated longitudinal studies, L. pneumophila is the most commonly implicated species even among immunocompromised patients, 15,16,19 and when LNLP infections are reported, the numbers are often small. 15,16 Important exceptions have been noted, including an older study from our center 20 and a more recent study in a cancer center in the US, which consisted of nine HCT recipients who developed LD caused by L. pneumophila (44%), L. micdadei (11%), "Legionella donaldsonii" (11%), and unknown Legionella species (33%).…”

Section: Management and Outcomementioning

confidence: 99%

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Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center

Sivagnanam

Podczervinski

Butler-Wu

et al. 2017

Transplant Infectious Dis

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Legionnaires' disease (LD) can be fatal among high-risk transplant recipients. To understand the epidemiology of LD, we reviewed 15-year longitudinal data from a center in Seattle, Washington that cares for both solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We identified all laboratory-confirmed LD and extracted data on species, diagnostic modalities, clinical presentation, management, and outcomes from medical records. Among 32 patients with LD, transplant recipients made up the majority of diagnoses (22, 69%; SOT 10, HCT 12). Approximately 0.8% of transplant recipients who underwent Legionella-specific testing were positive. Non-pneumophila Legionella species (LNLP), which are not detected by urinary antigen test, accounted for half the cases, led by Legionella micdadei (32%). The severity and outcome between Legionella pneumophila and LNLP infections were similar (attributed mortality, 36% vs 27%); all LNLP deaths occurred in transplant recipients with L. micdadei. The clinical and radiological features mimicked other opportunistic pathogens; 32% (n=7) were not on empiric treatment at the time of diagnosis. These data add to the emerging literature describing the importance of LD and highlight the need for both routine Legionella testing on transplant recipients with pulmonary findings and empiric Legionella-active antibiotic therapy.

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“…There is also an increase in early Grampositive pneumonias, particularly with MRSA [47]. Legionella pneumonia was reported in 3 of 1041 liver transplant recipients in a study, between 6 and 60 months [48]. PCP has rarely been seen in liver transplant recipients and studies suggest shortening of prophylaxis from 6 to 3 months [49].…”

Section: Solid-organ Transplantationmentioning

confidence: 95%

Pulmonary infections in transplant recipients

Küpeli̇¹,

F²,

Haberal

2012

Current Opinion in Pulmonary Medicine

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Clinical features and outcomes of Legionnaires' disease in solid organ transplant recipients

Cited by 37 publications

References 20 publications

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center

Pulmonary infections in transplant recipients

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