Legionnaires’ disease in the EU/EEA*: increasing trend from 2017 to 2019

Samuelsson, J.; Hallström, Lara Payne; Marrone, Gaetano; Dias, Joana Gomes

doi:10.2807/1560-7917.es.2023.28.11.2200114

Cited by 6 publications

(8 citation statements)

References 15 publications

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“…LD may be a cause of severe hospital-acquired pneumonia [ 21 ] but there is no evidence to suggest a role in aspiration pneumonia [ 22 ]. In temperate climates, most LD cases occur from late spring to early autumn [ 23 , 24 ], but in tropical regions they may be recorded throughout the year [ 25 ]. A general increase in incidence has been observed in Europe, the US, Canada and Australia in recent years [ 24 , 26 , 27 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…In temperate climates, most LD cases occur from late spring to early autumn [ 23 , 24 ], but in tropical regions they may be recorded throughout the year [ 25 ]. A general increase in incidence has been observed in Europe, the US, Canada and Australia in recent years [ 24 , 26 , 27 ]. The reasons for this worldwide increase are not totally elucidated, but it is most pronounced in older age groups (> 60 years) and with a general accentuation of seasonal trends, without any systematic changes in the methods used for its diagnosis in Europe [ 24 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…A general increase in incidence has been observed in Europe, the US, Canada and Australia in recent years [ 24 , 26 , 27 ]. The reasons for this worldwide increase are not totally elucidated, but it is most pronounced in older age groups (> 60 years) and with a general accentuation of seasonal trends, without any systematic changes in the methods used for its diagnosis in Europe [ 24 ]. Many studies have found that increased precipitation, temperature, and relative humidity are positively associated with the occurrence of LD, particularly a sequence of elevated temperatures followed by a period of increased precipitation, high relative humidity, and low wind [ 28 , 29 ].…”

Section: Epidemiologymentioning

confidence: 99%

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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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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

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Severe Legionnaires’ disease

Rello,

Allam,

Ruiz-Spinelli

et al. 2024

Ann. Intensive Care

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“…Meanwhile, data from the European Union/European Economic Area (EU/EEA) has shown an upward trend in the notification rate for Legionella disease. This rate increased from 1.2 to 1.4/100,000 population between 2012 and 2016, and further increased to 1.8-2.2 during 2017-2019 (2). Given the limited awareness about the disease among clinicians and the difficulty of early diagnosis, the actual incidence of LP is likely higher.…”

Section: Introductionmentioning

confidence: 99%

Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia

Bu,

Lei,

Chen

et al. 2023

Front. Med.

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Legionella is an aerobic, gram-negative, intracellular pathogen and is an important cause of community-acquired pneumonia. Legionella pneumophila is the most common causative agent of Legionella pneumonia. Clinical diagnosis of Legionella pneumonia is challenging due to the lack of specific clinical manifestations and the low positive rates of conventional pathogen detection methods. In this study, we report a case of a patient with chronic myeloid leukemia who developed rigors and high fever after chemotherapy and immunotherapy. Chest computed tomography revealed consolidation in the left lower lobe of the lung and ground-glass opacities in both lower lobes. Multiple blood cultures showed Escherichia coli, Staphylococcus aureus, Bacillus licheniformis, and positive results in the β-D-glucan test (G test). The patient was treated with various sensitive antimicrobial agents, including meropenem plus fluconazole, meropenem plus carpofungin, and vancomycin. Unfortunately, the patient’s condition gradually worsened and eventually resulted in death. On the following day of death, metagenomic next-generation sequencing (mNGS) of 1whole blood revealed L. pneumophila pneumonia with concurrent bloodstream infection (blood mNGS reads 114,302). These findings suggest that when conventional empirical antimicrobial therapy proves ineffective for critically ill patients with pneumonia, the possibility of combined Legionella infection must be considered, and mNGS can provide a diagnostic tool in such cases.

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“…Lp is also able to colonise and replicate within various phagocytic cells including human alveolar macrophages, resulting in a severe pneumonia known as Legionnaires’ disease. Immunocompromised and elderly individuals are especially susceptible to infection ( Samuelsson et al., 2023 ) and treatment failure is a serious issue as infections have a 5-10% mortality rate ( Herwaldt and Marra, 2018 ). Studies into antibiotic resistance in Lp demonstrated that in vitro evolution can lead to the emergence of macrolide-resistant clones carrying mutations in 23S RNA and ribosomal proteins L4 and L22 ( Herwaldt and Marra, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Bacterial persistence in Legionella pneumophila clinical isolates from patients with recurring legionellosis

Adams-Ward,

Chapalain,

Ginevra

et al. 2023

Front. Cell. Infect. Microbiol.

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Bacterial persisters are a transient subpopulation of non-growing, antibiotic-tolerant cells. There is increasing evidence that bacterial persisters play an important role in treatment failure leading to recurring infections and promoting the development of antibiotic resistance. Current research reveals that recurring legionellosis is often the result of relapse rather than reinfection and suggests that the mechanism of bacterial persistence may play a role. The development of single-cell techniques such as the Timerbac system allows us to identify potential persister cells and investigate their physiology. Here, we tested the persister forming capacity of 7 pairs of Legionella pneumophila (Lp) clinical isolates, with isolate pairs corresponding to two episodes of legionellosis in the same patient. We distinguished non-growing subpopulations from their replicating counterparts during infection in an amoeba model. Imaging flow cytometry allowed us to identify single non-growing bacteria within amoeba cells 17 h post-infection, thus corresponding to this subpopulation of potential persister cells. Interestingly the magnitude of this subpopulation varies between the 7 pairs of Lp clinical isolates. Biphasic killing kinetics using ofloxacin stress confirmed the persister development capacity of ST1 clinical isolates, highlighting enhanced persister formation during the host cell infection. Thus, persister formation appears to be strain or ST (sequence type) dependent. Genome sequence analysis was carried out between ST1 clinical isolates and ST1 Paris. No genetic microevolution (SNP) linked to possible increase of persistence capacity was revealed among all the clones tested, even in clones issued from two persistence cycle experiments, confirming the transient reversible phenotypic status of persistence. Treatment failure in legionellosis is a serious issue as infections have a 5-10% mortality rate, and investigations into persistence in a clinical context and the mechanisms involved may allow us to combat this issue.

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Legionnaires’ disease in the EU/EEA*: increasing trend from 2017 to 2019

Cited by 6 publications

References 15 publications

Severe Legionnaires’ disease

Severe Legionnaires’ disease

Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia

Bacterial persistence in Legionella pneumophila clinical isolates from patients with recurring legionellosis

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