Modern features of legionellosis

Abstract

Relevance. Community-acquired Legionella pneumonia, classified as atypical pneumonia, is an important problem worldwide. Late initiation of etiotropic therapy for Legionnaires' disease worsens the prognosis and increases the risk of death.
 The purpose of the study is to clinically and epidemiologically characterize Legionnaires' disease using the example of incidence in the Krasnodar region and to attract the attention of doctors to the timely diagnosis of Legionnaires' disease and the prescription of adequate etiotropic therapy.
 Materials and methods. A hospital cohort of 26 patients who were hospitalized between 2017 and 2022 was studied for legionellosis, confirmed in laboratory by detection of legionella antigen in urine using the immunochromatographic method.
 Results. The Krasnodar region is characterized by a sporadic incidence of legionellosis, with a tendency to increase during years with high average humidity. Cases of legionellosis are recorded year-round with peaks in summer and winter. The rise in incidence shifts from year to year and follows the month with the highest rainfall and average monthly temperature above 20 C°. Severe and moderate course of legionellosis is typical for men over 50 years old with comorbid pathology, accompanied by damage to the lungs of varying severity; some patients may experience diarrhea (11.5%), transient dysfunction of the liver and kidneys. The nature of lung damage in the form of polysegmental pneumonia does not have clear clinical differential diagnostics, which makes early diagnosis of the disease difficult. An epidemiological anamnesis indicating contact with aerosol water and soil, air conditioning systems acquires important diagnostic significance. Seeking specialized medical care after the 7th day of illness increases the risk of developing severe forms of the disease with the formation of complications.
 Conclusion. In severe community-acquired pneumonia, it is recommended to take into account the epidemiological history, assess kidney and liver function, conduct a urine test for Legionella antigen, and prescribe early empirical therapy with fluoroquinolones and macrolides.