Legionella pericarditis, an unusual presentation

Abdelghany, Mahmoud; Pruchnic, William; Waseem, Saba; Hussain, KM Anwar

doi:10.13070/rs.en.1.896

Cited by 1 publication

(1 citation statement)

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“…In addition, several extra thoracic involvements due to Legionella species infection have been described and well-documented, known as extrapulmonary legionellosis, particularly among immunocompromised patients. Within the cardiovascular system this can cause myopericarditis and endocarditis [55][56][57]; encephalitis, brain abscess or cerebellar ataxia as neurological complications [55,58,59]; a gastrointestinal compromise with pancreatitis, colitis, liver and spleen involvement [60]; joint [61] and skin damage (cellulitis, necrotising fasciitis) [62][63][64]; and disseminated intravascular coagulation, among others. Extrapulmonary forms mainly occur secondary to a pulmonary localization due to the spread of Legionella through the blood, even though the primary focus may be outside the lung: for example, single skin infection developing after direct inoculation from the environment [61,64].…”

Section: Clinical Picturementioning

confidence: 99%

Severe Legionnaires’ disease

Rello,

Allam,

Ruiz-Spinelli

et al. 2024

Ann. Intensive Care

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Background Legionnaires’ disease (LD) is a common but under-diagnosed cause of community-acquired pneumonia (CAP), although rapid detection of urine antigen testing (UAT) and advances in molecular testing have improved the diagnosis. LD entails intensive care unit (ICU) admission in almost one-third of cases, and the mortality rate ranges from 4% to 40%. This review aims to discuss recent advances in the study of this condition and to provide an update on the diagnosis, pathogenesis and management of severe LD. Results The overall incidence of LD has increased worldwide in recent years due to the higher number of patients with risk factors, especially immunosuppression, and to improvements in diagnostic methods. Although LD is responsible for only around 5% of all-cause CAP, it is one of the three most common causes of CAP requiring ICU admission. Mortality in ICU patients, immunocompromised patients or patients with a nosocomial source of LD can reach 40% despite appropriate antimicrobial therapy. Regarding pathogenesis, no Legionella-specific virulence factors have been associated with severity; however, recent reports have found high pulmonary Legionella DNA loads, and impairments in immune response and lung microbiome in the most severe cases. The clinical picture includes severe lung injury requiring respiratory and/or hemodynamic support, extrapulmonary symptoms and non-specific laboratory findings. LD diagnostic methods have improved due to the broad use of UAT and the development of molecular methods allowing the detection of all Lp serogroups. Therapy is currently based on macrolides, quinolones, or a combination of the two, with prolonged treatment in severe cases. Conclusions Numerous factors influence the mortality rate of LD, such as ICU admission, the underlying immune status, and the nosocomial source of the infection. The host immune response (hyperinflammation and/or immunoparalysis) may also be associated with increased severity. Given that the incidence of LD is rising, studies on specific biomarkers of severity may be of great interest. Further assessments comparing different regimens and/or evaluating host-directed therapies are nowadays needed. Graphical Abstract

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