Clinical presentation of Legionella pneumonia: Evaluation of clinical scoring systems and therapeutic efficacy

Miyashita, Naoyuki; Higa, Futoshi; Aoki, Yosuke; Kikuchi, Toshiaki; Seki, Masafumi; Tateda, Kazuhiro; Maki, Nobuko; Uchino, Kazuhiro; Ogasawara, Kazuhiko; Kiyota, Hiroshi; Watanabe, Akira

doi:10.1016/j.jiac.2017.09.001

Cited by 27 publications

(35 citation statements)

References 24 publications

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“…Being male, dyspnea, and absence of cough were identified as independent predictors of Legionella CAP in both the development and validation cohorts [17]. Previous Japanese studies also demonstrated that Legionella CAP was more frequently seen in male patients [29,30].…”

Section: Discussionmentioning

confidence: 79%

“…In the former development cohort, we included only selected CAP patients as controls who had established causative pathogens: S. pneumoniae and M. pneumoniae [17]. S. pneumoniae is the leading cause of CAP and M. pneumoniae is the leading cause of atypical pneumonia and second or third leading cause of CAP.…”

Section: Discussionmentioning

confidence: 99%

“…This study was conducted the 25 institutions between April 2010 and March 2018 and was an independent of a previous development cohort [17]. A complete list of participating facilities is provided in the appendix.…”

Section: Study Populationmentioning

confidence: 99%

“…To identify diagnostic predictors of Legionella CAP, we used baseline parameters of 176 patients with Legionella CAP and 419 patients with non-Legionella CAP as reported previously [17]. Logistic regression analysis revealed that being male, absence of cough, having dyspnea, elevated C-reactive proteins (CRP) level, high lactate dehydrogenase (LDH) level, and low sodium (Na) level increased the probability of Legionella pneumonia within our P value criteria (P < 0.001) ( Table 1).…”

Section: Legionella Scorementioning

confidence: 99%

“…Thus, many researchers have proposed rapid or simple scoring systems based on clinical and laboratory findings for the presumptive diagnosis of Legionella pneumonia, but the sensitivities and specificities of these scoring systems have not been sufficient [11e16]. Recently, we developed the Legionella Score to distinguish patients with Legionella and non-Legionella pneumonia based on clinical information at diagnosis using patients with Legionella CAP, Streptococcus pneumoniae CAP, and Mycoplasma pneumoniae CAP [17].…”

Section: Introductionmentioning

confidence: 99%

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Validation of a diagnostic score model for the prediction of Legionella pneumophila pneumonia

Miyashita

Horita

Higa

et al. 2019

Journal of Infection and Chemotherapy

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Background: Community-acquired pneumonia (CAP) due to Legionella has a high mortality rate in patients who do not receive adequate antibiotic therapy. In a previous study, we developed a simple Legionella Score to distinguish patients with Legionella and non-Legionella pneumonia based on clinical information at diagnosis. In the present study, we validated this Legionella Score for the presumptive diagnosis of Legionella CAP. Methods: This validation cohort included 109 patients with Legionella CAP and 683 patients with non-Legionella CAP. The Legionella Score includes six parameters by assigning one point for each of the following items: being male, absence of cough, dyspnea, C-reactive protein (CRP) ! 18 mg/dL, lactate dehydrogenase (LDH) ! 260 U/L, and sodium < 134 mmol/L. Results: When the Legionella CAP and non-Legionella CAP were compared by univariate analysis, most of the evaluated symptoms and laboratory test results differed substantially. The six parameters that were used for the Legionella Score also indicated clear differences between the Legionella and non-Legionella CAP. All Legionella patients had a score of 2 points or higher. The median Legionella Scores were 4 in the Legionella CAP cases and 2 in the non-Legionella CAP cases. A receiver operating characteristics curve showed that the area under the curve was 0.93. The proposed best cutoff, total score !3, had sensitivity of 93% and specificity of 75%. Conclusion: Our Legionella Score was shown to have good diagnostic ability with a positive likelihood of 3.7 and a negative likelihood of 0.10.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Legionella Scorementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validation of a diagnostic score model for the prediction of Legionella pneumophila pneumonia

Miyashita

Horita

Higa

et al. 2019

Journal of Infection and Chemotherapy

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A case of Legionella pneumonia after robot‐assisted radical prostatectomy

Nukaya,

Ishikawa,

Takahara

et al. 2024

IJU Case Reports

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IntroductionPostoperative Legionella pneumonia is very rare.Case presentationA 71‐year‐old male patient with prostate cancer (cT2bN0M0) underwent a robotic‐assisted radical prostatectomy. On the 5th postoperative day, the patient developed chills and a fever of 39.2°C. Chest radiography revealed decreased permeability in the right middle lung field, leading to the diagnosis of postoperative pneumonia. Antimicrobial therapy was initiated immediately. Blood tests on postoperative day 10 revealed mild liver function abnormalities, electrolyte abnormalities, and a markedly elevated inflammatory response. Legionella pneumonia was suspected based on blood sample results and systemic symptoms, such as diarrhea and nausea. Furthermore, Legionella antigens were detected in the patient's urine, prompting further administration of levofloxacin. The patient's subsequent clinical course was favorable.ConclusionWhen bacterial pneumonia fails to respond to antimicrobial therapy and systemic symptoms develop, atypical pneumonia, caused by pathogens such as Legionella pneumophila, should be considered even in cases of postoperative pneumonia.

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Legionella pneumonia as a rising public health threat in Argentina: Is it the time to worry?

Malik

Al-Tammemi²,

Mohanty³

et al. 2022

Annals of Medicine &Amp; Surgery

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Clinical presentation of Legionella pneumonia: Evaluation of clinical scoring systems and therapeutic efficacy

Cited by 27 publications

References 24 publications

Validation of a diagnostic score model for the prediction of Legionella pneumophila pneumonia

Validation of a diagnostic score model for the prediction of Legionella pneumophila pneumonia

A case of Legionella pneumonia after robot‐assisted radical prostatectomy

Legionella pneumonia as a rising public health threat in Argentina: Is it the time to worry?

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