Highlights
- •Legionella infection can present as nodular lung lesions in immunocompromised patients.
- •Radiographic presentation of Legionella mimics invasive fungal infection.
- •Nodular disease is mostly caused by infection with non-pneumophila species.
- •Atypical pulmonary nodule(s) due to Legionella cause a clinically mild illness.
Summary
Background
Immunocompromised patients, especially those receiving treatment with corticosteroids
and cytotoxic chemotherapy are at increased risk for developing Legionella pneumonia.
Objective
The aim of this study was to determine clinical and radiographic characteristics of
pulmonary infection due to Legionella in persons undergoing treatment for cancer and stem cell transplant (SCT) recipients.
Methods
Retrospective review of Legionella cases at MSKCC over a fifteen-year study period from January 1999 and December 2013.
Cases were identified by review of microbiology records.
Results
During the study period, 40 cases of Legionella infection were identified; nine among these were due to non-pneumophila species.
Most cases occurred during the summer. The majority [8/9, (89%)] of patients with
non-pneumophila infection had underlying hematologic malignancy, compared to 18/31 (58%) with Legionella pneumophila infections. Radiographic findings were varied-nodular infiltrates mimicking invasive
fungal infection were seen only among patients with hematologic malignancy and hematopoietic
stem cell transplant (SCT) recipients and were frequently associated with non-pneumophila infections (50% vs 16%; P = 0.0594). All cases of nodular Legionella pneumonia were found incidentally or had an indolent clinical course.
Conclusions
Legionella should be considered in the differential diagnosis of nodular lung lesions in immunocompromised
patients, especially those with hematologic malignancy and SCT recipients. Most cases
of nodular disease due to Legionella are associated with non-pneumophila infections.
Keywords
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References
- Emergence of Legionella pneumophila pneumonia in patients receiving tumor necrosis factor-alpha antagonists.Clin Infect Dis. 2006; 43: e95-e100
- Community-acquired lung abscess caused by Legionella micdadei in a myeloma patient receiving thalidomide treatment.J Clin Microbiol. 2007; 45: 3135-3137
- Infection due to Legionella species other than L. pneumophila.Clin Infect Dis. 2002; 35: 990-998
- Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey.J Infect Dis. 2002; 186: 127-128
- Legionellosis in a bone marrow transplant center.Bone Marrow Transplant. 1996; 18: 361-368
- Legionnaires' disease in immunocompromised patients: a case report of Legionella longbeachae pneumonia and review of the literature.J Med Microbiol. 2008; 57: 384-387
- Chest computed tomographic findings and clinical features of Legionella pneumonia.J Comput Assist Tomogr. 2007; 31: 950-955
- Rapid expanding pulmonary nodule caused by Pittsburgh pneumonia agent.JAMA. 1981; 245: 1558-1559
- Lung abcess complicating Legionella micdadei pneumonia in an adult liver transplant recipient.Transplantation. 1998; 65: 130-134
- Legionella jordanis in hematopoietic SCT patients radiographically mimicking invasive mold infection.Bone Marrow Transplant. 2011 Aug; 46: 1099-1103
- Asymptomatic pulmonary nodules in a patient with newly diagnosed primary central nervous system (CNS) lymphoma.Chest. 2010; 138
- Legionella: a major opportunistic pathogen in transplant recipients.Semin Respir Infect. 1998; 13: 132-139
- It's not the heat, it's the humidity: wet weather increases legionellosis risk in the greater Philadelphia metropolitan area.J Infect Dis. 2005; 192: 2066-2073
- Seasonal variation of Legionnaires' disease in Scotland.J Infect. 1991 Mar; 22: 153-160
MMRW, CDC, August 19, 2011/60(32); 1083–1086.
Naikm FC, Zhao H, Harrison TG, Phin N. Legionnaires’ disease in England and Wales, 2011. Health Protection Report/Respiratory Archives 2012.
Article info
Publication history
Published online: October 21, 2015
Accepted:
October 12,
2015
Footnotes
☆Previously presented at ICAAC annual meeting on 9/8/2014, oral presentation number T-1295a.
Identification
Copyright
© 2015 The British Infection Association. Published by Elsevier Inc. All rights reserved.
