Legionnaire’s Disease and Immunosuppressive Drugs

Htwe, Tin Han; Khardori, N.M.

doi:10.1016/j.idc.2016.10.003

Cited by 15 publications

(12 citation statements)

References 61 publications

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“…It is well documented that infectious pulmonary edema is primarily caused by increased PCP, which is also an important indicator of the severity of lung injury (5). Lp infection induces severe pneumonia more readily in immunosuppressed hosts compared with immunocompetent hosts (6). However, whether the increase of PCP or pulmonary edema are more severe in Lp-infected immunosuppressed hosts compared with hosts with normal immune function remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Altered pulmonary capillary permeability in immunosuppressed guinea pigs infected with Legionella pneumophila serogroup 1

Cai

et al. 2019

Exp Ther Med

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In immunosuppressed hosts, Legionella pneumophila (Lp) infection usually develops into severe pneumonia, which is pathologically characterized by increased vascular permeability and pulmonary edema. At present, mechanisms associated with changes in pulmonary capillary permeability (PCP) and the pathogenesis of pulmonary edema in immunosuppressed hosts with Lp infection are unclear. Therefore, in the present study an animal model of normal and immunosuppressed guinea pigs infected with Lp was established. An isolated perfused lung system was used to investigate the extent of changes in PCP. Pathological and immunofluorescence examinations were performed to explore the mechanism underlying these changes. The results indicated that PCP increased with the highest magnitude in immunosuppressed guinea pigs infected with Lp, with repeated ANOVA indicating synergism between infection and immunosuppression (P=0.0444). Hematoxylin and eosin staining and electron microscopy revealed more severe morphological damages in the lung tissues and pulmonary capillaries of the immunosuppressed animals infected with Lp compared with normal animals infected with Lp. Immunofluorescence analysis showed that immunosuppression reduced the expression of the vascular endothelial cell junction protein VE-cadherin (P=0.027). Following Lp infection, VE-cadherin expression was significantly lower in the immunosuppressed guinea pigs compared with their immunocompetent counterparts (P=0.001). These results suggest that immunosuppression combined with Lp infection induces more significant damage to pulmonary capillaries compared with Lp infection alone, resulting in a significantly increased PCP.

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Section: Introductionmentioning

confidence: 99%

Altered pulmonary capillary permeability in immunosuppressed guinea pigs infected with Legionella pneumophila serogroup 1

Cai

et al. 2019

Exp Ther Med

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“…Fallo terapéutico. El fracaso terapéutico se define como la ausencia de estabilidad clínica tras 3-4 días de tratamiento antibiótico o la aparición de deterioro clínico, insuficiencia res-En el ámbito de la atención primaria, las recomendaciones de diferentes guías [32] abogan por el uso de terapia combinada solo cuando existen factores de riesgo para L. pneumophila [edad ≥ 65 años, sexo masculino, inmunosupresión, incluida la ocasionada por fármacos (corticoides, terapia anti-TNF-α, quimioterapia), la asociada al trasplante de órganos, tumores hematológicos (leucemia de células pilosas), comorbilidad crónica múltiple (enfermedad cardíaca o pulmonar crónica, diabetes, insuficiencia renal terminal), sobrecarga de hierro, tabaquismo de larga evolución y abuso crónico de alcohol] [33][34][35]. La sospecha aumenta en una neumonía de rápida evolución hacia la gravedad en personas con algunas de estas características, o con independencia de la gravedad una neumonía que aparece en el contexto de un brote epidemiológico de legionelosis y existe riesgo de explosión ambiental (torres de enfriamiento para aire acondicionado, sistemas de agua fría y caliente, humidificadores e instalaciones de hidromasaje) [33,34].…”

Section: Manejo Terapéuticounclassified

Community-acquired pneumonia: selection of empirical treatment and sequential therapy. SARS-CoV-2 implications

Castillo¹,

Julián-Jiménez²,

Candel³

2021

Rev Esp Quimioter

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Pneumonia is a major cause of global mortality in developed countries. The adequacy of the antibiotic treatment is essential for the good evolution of the patients. When selecting the antimicrobial, the severity of the patient, the characteristics of the antibiotics, and the profile of the patient to be treated should be considered. Recommendations for the selection of antibiotic treatment may differ between the patient who requires admission and the one who can be treated as outpatient. Beta-lactams, fluoroquinolones, and macrolides are the most widely used antimicrobials in this last circumstance. However, not all are the same in terms of efficacy, safety and ecological impact. This review delves into the aforementioned aspects to improve decision-making and offers concrete recommendations for the selection of antibiotic treatment. Likewise, it includes recommendations for performing sequential therapy. Finally, a brief review is made about the impact of SARS-CoV-2 infection on this pathology.

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“…Htwe and Khardori in 2017 reported that HCL has the highest association with Legionella of the hematological malignancies. 12 Severe monocytopenia with reduced activation is thought to be the driving cause leading to increased risk for all intracellular pathogens. 3 , 12 Literature review returned a single case of a patient with a new diagnosis of HCL that was treated with VV-ECMO for severe ARDS.…”

Section: Introductionmentioning

confidence: 99%

“… 12 Severe monocytopenia with reduced activation is thought to be the driving cause leading to increased risk for all intracellular pathogens. 3 , 12 Literature review returned a single case of a patient with a new diagnosis of HCL that was treated with VV-ECMO for severe ARDS. This patient presented with severe ARDS secondary to L pneumophilia , was successfully treated, decannulated, and later reached hematologic remission.…”

Section: Introductionmentioning

confidence: 99%

Severe ARDS Secondary to Legionella Pneumonia Requiring VV ECMO in the Setting of Newly Diagnosed Hairy Cell Leukemia

Gorman

Green

Puri

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Venovenous (VV) extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) is initiated in patients with high mortality as a potential lifesaving intervention. Hematologic malignancy (HM) is considered a relative exclusion criterion by the Extracorporeal Life Support Organization (ELSO). This case examines the relative contraindication and presents a successful outcome. A healthy 59-year-old male presented with respiratory distress. On arrival his SpO2 on room air was 82%, chest x-ray revealed a lobar infiltrate, complete blood count demonstrated severe leukopenia, and a peripheral blood smear demonstrated cytoplasmic inclusions concerning for hairy cells. He was intubated and decision was made to initiate VV-ECMO during hospital day (HD) 1. Cytometry later confirmed a diagnosis of hairy cell leukemia (HCL). A diagnosis of Legionella was confirmed on HD 5. Initial hospitalization was complicated by progression to complete bilateral lung involvement, pulmonary hemorrhage, recurrent tachyarrhythmias, hemodynamic instability, and acute renal failure. Respiratory status stabilized and eventually began to improve. On HD 27, he was decannulated and later discharged to rehabilitation. Four months later he received inpatient chemotherapy and is currently in full remission. This is a successful outcome in a patient with severe ARDS requiring VV-ECMO in the setting of newly diagnosed HCL. The 10-year survival for treated HCL is near 100%. Due to favorable prognosis, HCL should not be considered a relative contraindication to VV-ECMO. While HM remains a relative exclusion criterion by the ELSO, it is important to analyze each patient individually and make decisions based on evolving bodies of evidence.

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Legionnaire’s Disease and Immunosuppressive Drugs

Cited by 15 publications

References 61 publications

Altered pulmonary capillary permeability in immunosuppressed guinea pigs infected with Legionella pneumophila serogroup 1

Altered pulmonary capillary permeability in immunosuppressed guinea pigs infected with Legionella pneumophila serogroup 1

Community-acquired pneumonia: selection of empirical treatment and sequential therapy. SARS-CoV-2 implications

Severe ARDS Secondary to Legionella Pneumonia Requiring VV ECMO in the Setting of Newly Diagnosed Hairy Cell Leukemia

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