Legionella Pneumonia and HIV: Case Reports and Review of the Literature

Abstract

Although Legionnaires' disease occurs more commonly in patients with some degree of immunosuppression (diabetes, chronic lung disease, end stage renal disease, cancer, etc.), it has been infrequently described in patients infected with human immunodeficiency virus (HIV) and AIDS. Some studies suggest that pneumonia caused by Legionella tends to present with more severe clinical features and complications in the HIV-infected population. The use of antibiotic prophylaxis or the association of severe pneumonia with other pathogens may account for under diagnosis of the disease. We diagnosed five cases of Legionella pneumonia in patients with HIV infection at our institution during a 1-year period. The cases seen ranged in severity, regardless of the CD4(+) counts of the patients. Based on our observations, it seems impossible to discern whether HIV infection is an additional risk factor for Legionnaires' disease. We describe those five cases and review the available literature.

Legionnaires’ Disease: Clinicoradiological Comparison of Sporadic Versus Outbreak Cases

“…Interestingly, although HIV infection is associated with impaired cellular immunity, few clinical reports have explored the effects of an individual’s HIV infection on development of Legionnaires’ disease. In described cases, the disease’s severity varies independently from the patients’ CD4 + counts 26. In our study, we saw no differences in patients with and without HIV infection with respect to demographic features, clinical risk factors, presentation, and outcomes.…”

Detection of Legionella pneumophila serogroup 1 in blood cultures from a patient treated with tumor necrosis factor-alpha inhibitor

“…However, the incidence of LD arising in patients under therapy with anti-cancer drugs (such as S-1) does not seem to be increased. A previous study did not find an unusually high incidence of LD among patients with neutropenia, acute leukemia or HIV [33].…”

AIDS and Opportunistic Infections

“…P. aeruginosa has been increasingly recognized as an important source of bacterial pneumonia in HIV-infected individuals, particularly in those with advanced HIV/AIDS (CD4 cell count less than 50 cells/μL), underlying structural lung disease (bronchiectasis), neutropenia, indwelling catheters, receipt of corticosteroid therapy, multiple antibiotic therapy, and severe malnutrition. Atypical pathogens such as Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila species are less frequent causes of pneumonia (Sandkovsky et al, 2008). Other less causes of pneumonia include Rhodococcus equi, Nocardia species Bartonella henselae and quintana.…”