Pneumonia due to <i>Legionella feeleii</i>: case report and review of the literature

Lee, J.; Caplivski, Daniel; Wu, Maoxin; Huprikar, Shirish

doi:10.1111/j.1399-3062.2009.00390.x

Cited by 18 publications

(14 citation statements)

References 12 publications

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“…Immunocompromised individuals, especially transplant recipients on immunosuppressive regimens, are at an increased risk of developing LD due to Lp1 or other species and serogroups (524)(525)(526)(527)(528). In addition, case-fatality rates for LD are higher among older males and the immunosuppressed (121).…”

Section: High-profile Legionnaires' Disease Outbreaksmentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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SUMMARY Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

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Section: High-profile Legionnaires' Disease Outbreaksmentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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“…Nevertheless, in 5% of Legionnaires' disease the species was not identified. The most common Legionella identified in our study was L. feeleii, which despite being known to produce Legionnaires' disease, cellulites and pericarditis, was not identified in the most recent European surveillance (Lee et al, 2009;Loridant et al, 2011). Diagnosing L. feeleii is not easy (Loridant et al, 2011); for Legionella identification, a urine antigen test or latex agglutination test after culture are normally used (81.7% and 9.3% respectively) but neither of them can detect L. feeleii.…”

Section: Discussionmentioning

confidence: 93%

Vectorial role of Acanthamoeba in Legionella propagation in water for human use

Magnet

Peralta

Gomes

et al. 2015

Science of The Total Environment

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“…Cases of non-pneumophila Legionella pneumonia have been found more frequently in the immunosuppressed (8,10,14,19,24), including a man with chronic lymphocytic leukemia (14). Only rarely have cases been reported in healthy individuals (27).…”

Section: Case Reportmentioning

confidence: 99%

“…Since the identification of L. feeleii in 1984 as the cause of Pontiac fever (7), there have only been 13 reported cases of L. feeleii pneumonia, of which 7 were community acquired (12,14,19,24,31), 3 were hospital acquired (8,10,12), and 3 were not clearly defined (27,28). Mortality rates as high as 37.5% have been reported (10). The prevalence of L. feeleii pneumonia is difficult to determine, but it is presumably rare.…”

Section: Case Reportmentioning

confidence: 99%

Legionella feeleii Serotype 2 Pneumonia in a Man with Chronic Lymphocytic Leukemia: a Challenging Diagnosis

et al. 2010

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Legionella feeleii has rarely been reported as causing pneumonia in patients with hematologic malignancies. We present a case of Legionella feeleii serotype 2 pneumonia with empyema in a man with chronic lymphocytic leukemia and describe the methods of identifying this organism using both standard methods and newer diagnostic techniques. CASE REPORTA 53-year-old white man presented to the National Institutes of Health, Bethesda, MD, to start his fourth cycle of fludarabine and rituximab for chronic lymphocytic leukemia (CLL). He had been diagnosed with CLL in 1998 but had only been started on chemotherapy 3 months prior to this admission when he experienced fatigue, anorexia, progressive lymphadenopathy, and a new left pleural effusion. On this presentation to the hospital, the patient complained of 7 days of fevers (39°C to 40°C), chills, a dry nonproductive cough, sharp rightsided lower back pain when lying down, and drenching night sweats. He denied diarrhea and had had no sick contacts. He had had a dental cleaning 7 days prior to the onset of these symptoms. He lived in Montana, where he worked in an officebased job in the construction industry, was a nonsmoker, had no pets, and had never received either a pneumococcal or influenza vaccine.The patient was nontoxic appearing and able to speak in full sentences. His temperature on admission was 38.4°C, blood pressure 115/69 mm Hg, heart rate 102 beats per minute, and respiratory rate 20 breaths per minute, with an oxygen saturation of 95% on ambient air. His examination was unremarkable, with clear breath sounds bilaterally without rhonchi or wheezes. He had mild leukopenia (white blood cell count of 2,800 cells/l, 69% neutrophils, 14% lymphocytes, and 13% monocytes), mild anemia (hemoglobin, 9.7 g/dl), and moderately elevated liver enzymes (aspartate aminotransferase, 58 IU/liter; alanine aminotransferase, 82 IU/liter). Immunoglobulins were low (IgG level, 323 mg/dl; IgA, 21 mg/dl; IgM, 14 mg/dl). A computed tomography (CT) scan of the chest showed bilateral hilar lymphadenopathy, a small leftsided pleural effusion, airspace disease in the right lower lobe with loculated effusions, and an area of cavitation (Fig. 1).Bronchoscopy revealed scant white secretions, and the bronchioalveolar lavage (BAL) fluid showed moderate neutrophils, few Gram-negative bacilli, no acid-fast or modified acid-fast bacilli, and a few budding yeast. A thoracentesis yielded cloudy, amber pleural fluid. The pleural fluid showed a white blood cell count of 8,350 cells/l (65% neutrophils), a glucose level of 80 mg/dl, a lactate dehydrogenase level of 945 U/liter, and a total protein level of 3.5 g/dl, consistent with an exudative effusion. After the procedures, ceftriaxone and azithromycin were initiated for community-acquired pneumonia. The patient became afebrile within 24 h of admission and did not require any supplemental oxygen. In-house real-time PCR performed on the BAL fluid was negative for both Legionella pneumophila serogroups 1 to 16 (mip gene) and Pneumocystis jirovecii (...

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Pneumonia due to Legionella feeleii: case report and review of the literature

Cited by 18 publications

References 12 publications

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Vectorial role of Acanthamoeba in Legionella propagation in water for human use

Legionella feeleii Serotype 2 Pneumonia in a Man with Chronic Lymphocytic Leukemia: a Challenging Diagnosis

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