Legionella Coinfection in a Patient With COVID-19 Pneumonia

Subedi, Yogesh; Haas, Christopher

doi:10.7759/cureus.17356

Cureus

2021

DOI: 10.7759/cureus.17356

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Legionella Coinfection in a Patient With COVID-19 Pneumonia

Yogesh Subedi¹,

Christopher Haas²

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Cited by 3 publications

(2 citation statements)

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“…Diarrhea was also mentioned in some cases. [16][17][18] In terms of laboratory data, hyponatremia was observed in some cases, 16,17,19 which is consistent with common findings among patients with Legionnaires' disease. Inflammation and infection parameters, including white blood cells and C-reactive protein, may or may not be in the normal range.…”

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confidence: 80%

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Diagnosis of Legionnaires’ Disease Assisted by Next-Generation Sequencing in a Patient with COVID-19

Huang¹,

Huang²,

Lee³

et al. 2023

IDR

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Coinfection in COVID-19 patients is associated with worsening outcome. Among patients with COVID-19, Legionella pneumophila, a common cause of pneumonia, has been reported as a co-occurring respiratory infection. A nonspecific clinical presentation, however, makes an early diagnosis difficult. Bronchoalveolar lavage fluid was collected from a patient suffering from COVID-19 and presenting with pneumonia and sent for metagenomic analysis. Differential abundance analysis was carried out by comparing each taxon reads per million between the bronchoalveolar lavage fluid sample and the negative control. Two replicates of metagenomic sequencing were conducted on bronchoalveolar lavage fluid samples. Within each replicated sequencing, one negative control was sequenced for comparison of taxon abundance in the BALF sample. In both replicates, Legionella pneumophila was the only taxon with significantly higher abundance when compared with the negative control. PCR of the bronchoalveolar further confirmed the presence of L. pneumophila. Several studies have estimated that the incidence of Legionnaires' disease co-infection in patients with COVID-19 infection is approximately 0% to 1.5%. There are some common characteristics of COVID-19 and co-infection with Legionnaires' disease, making it difficult to diagnose bacterial infection early. The diagnosis of these cases is important due to the different treatments used. Current diagnostic tests for Legionnaires' disease include conventional culture, urinary antigen for L. pneumophila serogroup 1, polymerase chain reaction, direct fluorescent antibody stain, and paired serology. The current study demonstrated that metagenomics is a promising approach that facilitated the diagnosis of Legionnaires' disease.

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supporting

confidence: 80%

“…Regarding chest radiographs, findings ranged from non-significant to consolidation or massive infiltration. 16 Chest CT was surveyed in some cases, 16,18,20 and there…”

mentioning

confidence: 99%

Diagnosis of Legionnaires’ Disease Assisted by Next-Generation Sequencing in a Patient with COVID-19

Huang¹,

Huang²,

Lee³

et al. 2023

IDR

View full text Add to dashboard Cite

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A Patient with Concurrent Legionella and COVID-19 Infection in a UK District General Hospital

Tong

Long

Russell

2022

Case Reports in Infectious Diseases

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A 65 year-old gentleman had been brought to our Respiratory Emergency Department for patients with respiratory symptoms and a possible COVID-19 infection with a 3-day history of shortness of breath (SOB), fever, a productive cough of yellow sputum, and right-sided chest pain. The patient had received both vaccinations at the time and initially reported no travel history, although later it was revealed that he had recently stayed at a hotel. He tested positive for COVID-19 and had hyponatremia and a raised procalcitonin, indicating a bacterial infection as well. He had been initiated on our local treatment guidelines for COVID with antibiotics, guided by local hospital guidelines. An atypical pneumonia screen returned a positive result for Legionella urine antigen, and his antibiotic regime was changed accordingly. Our patient deteriorated significantly, and despite being escalated to our intensive care unit (ICU), he unfortunately passed away. Our case highlights the importance of early ICU involvement and escalation of antibiotics in cases of suspected concurrent Legionella and COVID-19 infections.

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SARS-CoV-2–Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020–2021)

et al. 2022

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Legionnaires’ Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila. Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129–0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2–Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.

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Legionella Coinfection in a Patient With COVID-19 Pneumonia

Cited by 3 publications

References 16 publications

Diagnosis of Legionnaires’ Disease Assisted by Next-Generation Sequencing in a Patient with COVID-19

Diagnosis of Legionnaires’ Disease Assisted by Next-Generation Sequencing in a Patient with COVID-19

A Patient with Concurrent Legionella and COVID-19 Infection in a UK District General Hospital

SARS-CoV-2–Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020–2021)

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