Severe cavitary pneumonia caused by <i>Legionella pneumophila</i> serotype 6: a case report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WU Jianhui ¹ , ZHANG Canhui ¹ , PENG Zhiwen ² , ZHENG Yali ³ , LAI Zibiao ¹ , DENG Xinyu ¹ , PENG Yunjuan ⁴ , GAO Zhancheng ³ ,  XUE Qing ² ,  JIAO Weike ¹

1. Department of Pulmonary and Critical Care Medicine, Ningde Municipal Hospital of Ningde Normal University, Educational Hospital of Fujian Medical University, Ningde, Fujian 352100, P. R. China;
2. Respiratory Intensive Care Unit, Ningde Municipal Hospital of Ningde Normal University, Educational Hospital of Fujian Medical University, Ningde, Fujian 352100, P. R. China;
3. Department of Pulmonary and Critical Care Medicine, People's Hospital of Peking University, Beijing 100044, P. R. China;
4. Clinical Laboratory, Ningde Municipal Hospital of Ningde Normal University, Educational Hospital of Fujian Medical University, Ningde, Fujian 352100, P. R. China;

Corresponding?author：

XUE Qing, Email: surky@163.com; JIAO Weike, Email: surky@163.com

Keywords：

Legionella; Community-acquired pneumonia; Lung abscess; Severe pneumonia

DOI：

10.7507/1671-6205.201908010

Video：

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Objective To analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.Methods The data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.Results A 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.Conclusions Legionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.

Citation： WU Jianhui, ZHANG Canhui, PENG Zhiwen, ZHENG Yali, LAI Zibiao, DENG Xinyu, PENG Yunjuan, GAO Zhancheng, XUE Qing, JIAO Weike. Severe cavitary pneumonia caused by Legionella pneumophila serotype 6: a case report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(2): 106-113. doi: 10.7507/1671-6205.201908010 Copy

1.	Chahin A, Opal SM. Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations. Infect Dis Clin North Am, 2017, 31(1): 111-121.
2.	張志剛. 軍團菌肺炎的影像學特征. 實用放射學雜志, 2016, 32(11): 1800-1802.
3.	中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016 年版). 中華結核和呼吸雜志, 2016, 39(4): 253-279.
4.	Guy SD, Worth LJ, Thursky KA, et al. Legionella pneumophila lung abscess associated with immune suppression. Intern Med J, 2011, 41(10): 715-721.
5.	Heine S, Fuchs A, von Müller L, et al. Legionellosis must be kept in mind in case of pneumonia with lung abscesses in children receiving therapeutic steroids. Infection, 2011, 39(5): 481-484.
6.	Miller ML, Hayden R, Gaur A. Legionella bozemanii pulmonary abscess in a pediatric allogeneic stem cell transplant recipient. Pediatr Infect Dis J, 2007, 26(8): 760-762.
7.	Girard LP, Gregson DB. Community-acquired lung abscess caused by Legionella micdadei in a myeloma patient receiving thalidomide treatment. J Clin Microbiol, 2007, 45(9): 3135-3137.
8.	Di Stefano F, Verna N, Di Gioacchino M. Cavitary Legionella pneumonia in a patient with immunodeficiency due to Hyper-IgE syndrome. J Infect, 2007, 54(3): e121-123.
9.	Myers C, Corbelli R, Schrenzel J, et al. Multiple pulmonary abscesses caused by Legionella pneumophila infection in an infant with croup. Pediatr Infect Dis J, 2006, 25(8): 753-754.
10.	Fraser TG, Zembower TR, Lynch P, et al. Cavitary Legionella pneumonia in a liver transplant recipient. Transpl Infect Dis, 2004, 6(2): 77-80.
11.	Miyara T, Tokashiki K, Shimoji T, et al. Rapidly expanding lung abscess caused by Legionella pneumophila in immunocompromised patients: a report of two cases. Intern Med, 2002, 41(2): 133-137.
12.	吳睿, 俞婉珍. 嗜肺軍團桿菌肺炎合并肺部空洞 5 例臨床分析. 南京醫科大學學報(自然科學版), 2001, 21(4): 361-362.
13.	Nzerue C, Gowda A. Legionella micdadei lung abscess in a patient with HIV-associated nephropathy. J Natl Med Assoc, 2001, 93(6): 220-223.
14.	Schindel C, Siepmann U, Han S, et al. Persistent Legionella infection in a patient after bone marrow transplantation. J Clin Microbiol, 2000, 38(11): 4294-4295.
15.	Ernst A, Gordon FD, Hayek J, et al. Lung abcess complicating Legionella micdadei pneumonia in an adult liver transplant recipient: case report and review. Transplantation, 1998, 65(1): 130-134.
16.	Johnson KM, Huseby JS. Lung abscess caused by Legionella micdadei. Chest, 1997, 111(1): 252-253.
17.	Buggy BP, Saravolatz LD. Treatment of Legionella pneumophila lung abscess with clindamycin. Clin Infect Dis, 1995, 20(5): 1158-1162.
18.	Halberstam M, Isenberg HD, Hilton E. Abscess and empyema caused by Legionella micdadei. J Clin Microbiol, 1992, 30(2): 512-513.
19.	Ishida T, Tachibana H, Ito A, et al. Clinical characteristics of severe community-acquired pneumonia among younger patients: an analysis of 18 years at a community hospital. J Infect Chemother, 2014, 20(8): 471-476.
20.	Winn WC, Myerowitz RL. The pathology of the Legionella pneumonias. A review of 74 cases and the literature. Hum Pathol, 1981, 12(5): 401-422.
21.	蔣露晰, 陳愉, 夏書月, 等. 尿抗原檢測法診斷軍團菌肺炎的臨床價值. 中華結核和呼吸雜志, 2015, 38(1): 29-33.
22.	Mercante JW, Winchell JM. Current and emerging Legionella diagnostics for laboratory and outbreak investigations. Clin Microbiol Rev, 2015, 28(1): 95-133.
23.	Hase R, Miyoshi K, Matsuura Y, et al. Legionella pneumonia appeared during hospitalization in a patient with hematological malignancy confirmed by sputum culture after negative urine antigen test. J Infect Chemother, 2018, 24(7): 579-582.
24.	范曉姍, 嚴慧, 朱慶義. 基因芯片在軍團菌分型檢測中的應用. 中華臨床實驗室管理電子雜志, 2016, 4(2): 82-85.
25.	袁世洋, 謝軍平. 軍團菌肺炎致低鈉血癥機制的研究進展. 中華結核和呼吸雜志, 2017, 40(10): 772-774.
26.	Fumikazu S, Hitoshi T, Hajime G, et al. Computed tomographic features of Legionella pneumophila pneumonia in 38 cases. J Comput Assist Tomogr, 2007, 31(1): 125-131.
27.	原靈, 陳愛平, 楊勁松, 等. 福建省嗜肺軍團菌血清 1 型及血清 6 型菌株 PFGE 分型研究. 中國人獸共患病學報, 2012, 28(5): 461-463.
28.	于玲玲, 胡必杰, 黃聲雷, 等. 大環內酯類和氟喹諾酮類藥物對細胞內嗜肺軍團菌的作用. 中華結核和呼吸雜志, 2011, 34(6): 409-412.
29.	Edelstein PH, Cianciotto NP. Legionella. In: Mandell GL, Douglass JE, Dolin R, eds. Mandell, Douglass and Bennett’s Principles and Practice of Infectious Diseases. Vol. 2, 7th edn. New York: Churchill Livingstone, 201, 2969–2984.
30.	陳佰義, 何禮賢, 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中華醫學雜志, 2012, 92(2): 76-85.
31.	汪亞儒, 陳愉, 趙思宏, 等. 社區獲得性米克戴德軍團菌肺炎一例. 中華醫學雜志, 2016, 96(14): 1144-1145.
32.	O'Reilly KM, Urban MA, Barriero T, et al. Persistent culture-positive Legionella infection in an immunocompromised host. Clin Infect Dis, 2005, 40(10): e87-89.
33.	謝劍鋒, 邱海波. 降鈣素原對醫院獲得性肺炎的診治價值. 中華結核和呼吸雜志, 2013, 36(2): 152-154.
34.	李嫣, 張玉華, 樊毫軍, 等. 醫院內軍團菌肺炎暴發六例分析. 中華結核和呼吸雜志, 2015, 38(4): 294-297.

1. Chahin A, Opal SM. Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations. Infect Dis Clin North Am, 2017, 31(1): 111-121.
2. 張志剛. 軍團菌肺炎的影像學特征. 實用放射學雜志, 2016, 32(11): 1800-1802.
3. 中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016 年版). 中華結核和呼吸雜志, 2016, 39(4): 253-279.
4. Guy SD, Worth LJ, Thursky KA, et al. Legionella pneumophila lung abscess associated with immune suppression. Intern Med J, 2011, 41(10): 715-721.
5. Heine S, Fuchs A, von Müller L, et al. Legionellosis must be kept in mind in case of pneumonia with lung abscesses in children receiving therapeutic steroids. Infection, 2011, 39(5): 481-484.
6. Miller ML, Hayden R, Gaur A. Legionella bozemanii pulmonary abscess in a pediatric allogeneic stem cell transplant recipient. Pediatr Infect Dis J, 2007, 26(8): 760-762.
7. Girard LP, Gregson DB. Community-acquired lung abscess caused by Legionella micdadei in a myeloma patient receiving thalidomide treatment. J Clin Microbiol, 2007, 45(9): 3135-3137.
8. Di Stefano F, Verna N, Di Gioacchino M. Cavitary Legionella pneumonia in a patient with immunodeficiency due to Hyper-IgE syndrome. J Infect, 2007, 54(3): e121-123.
9. Myers C, Corbelli R, Schrenzel J, et al. Multiple pulmonary abscesses caused by Legionella pneumophila infection in an infant with croup. Pediatr Infect Dis J, 2006, 25(8): 753-754.
10. Fraser TG, Zembower TR, Lynch P, et al. Cavitary Legionella pneumonia in a liver transplant recipient. Transpl Infect Dis, 2004, 6(2): 77-80.
11. Miyara T, Tokashiki K, Shimoji T, et al. Rapidly expanding lung abscess caused by Legionella pneumophila in immunocompromised patients: a report of two cases. Intern Med, 2002, 41(2): 133-137.
12. 吳睿, 俞婉珍. 嗜肺軍團桿菌肺炎合并肺部空洞 5 例臨床分析. 南京醫科大學學報(自然科學版), 2001, 21(4): 361-362.
13. Nzerue C, Gowda A. Legionella micdadei lung abscess in a patient with HIV-associated nephropathy. J Natl Med Assoc, 2001, 93(6): 220-223.
14. Schindel C, Siepmann U, Han S, et al. Persistent Legionella infection in a patient after bone marrow transplantation. J Clin Microbiol, 2000, 38(11): 4294-4295.
15. Ernst A, Gordon FD, Hayek J, et al. Lung abcess complicating Legionella micdadei pneumonia in an adult liver transplant recipient: case report and review. Transplantation, 1998, 65(1): 130-134.
16. Johnson KM, Huseby JS. Lung abscess caused by Legionella micdadei. Chest, 1997, 111(1): 252-253.
17. Buggy BP, Saravolatz LD. Treatment of Legionella pneumophila lung abscess with clindamycin. Clin Infect Dis, 1995, 20(5): 1158-1162.
18. Halberstam M, Isenberg HD, Hilton E. Abscess and empyema caused by Legionella micdadei. J Clin Microbiol, 1992, 30(2): 512-513.
19. Ishida T, Tachibana H, Ito A, et al. Clinical characteristics of severe community-acquired pneumonia among younger patients: an analysis of 18 years at a community hospital. J Infect Chemother, 2014, 20(8): 471-476.
20. Winn WC, Myerowitz RL. The pathology of the Legionella pneumonias. A review of 74 cases and the literature. Hum Pathol, 1981, 12(5): 401-422.
21. 蔣露晰, 陳愉, 夏書月, 等. 尿抗原檢測法診斷軍團菌肺炎的臨床價值. 中華結核和呼吸雜志, 2015, 38(1): 29-33.
22. Mercante JW, Winchell JM. Current and emerging Legionella diagnostics for laboratory and outbreak investigations. Clin Microbiol Rev, 2015, 28(1): 95-133.
23. Hase R, Miyoshi K, Matsuura Y, et al. Legionella pneumonia appeared during hospitalization in a patient with hematological malignancy confirmed by sputum culture after negative urine antigen test. J Infect Chemother, 2018, 24(7): 579-582.
24. 范曉姍, 嚴慧, 朱慶義. 基因芯片在軍團菌分型檢測中的應用. 中華臨床實驗室管理電子雜志, 2016, 4(2): 82-85.
25. 袁世洋, 謝軍平. 軍團菌肺炎致低鈉血癥機制的研究進展. 中華結核和呼吸雜志, 2017, 40(10): 772-774.
26. Fumikazu S, Hitoshi T, Hajime G, et al. Computed tomographic features of Legionella pneumophila pneumonia in 38 cases. J Comput Assist Tomogr, 2007, 31(1): 125-131.
27. 原靈, 陳愛平, 楊勁松, 等. 福建省嗜肺軍團菌血清 1 型及血清 6 型菌株 PFGE 分型研究. 中國人獸共患病學報, 2012, 28(5): 461-463.
28. 于玲玲, 胡必杰, 黃聲雷, 等. 大環內酯類和氟喹諾酮類藥物對細胞內嗜肺軍團菌的作用. 中華結核和呼吸雜志, 2011, 34(6): 409-412.
29. Edelstein PH, Cianciotto NP. Legionella. In: Mandell GL, Douglass JE, Dolin R, eds. Mandell, Douglass and Bennett’s Principles and Practice of Infectious Diseases. Vol. 2, 7th edn. New York: Churchill Livingstone, 201, 2969–2984.
30. 陳佰義, 何禮賢, 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中華醫學雜志, 2012, 92(2): 76-85.
31. 汪亞儒, 陳愉, 趙思宏, 等. 社區獲得性米克戴德軍團菌肺炎一例. 中華醫學雜志, 2016, 96(14): 1144-1145.
32. O'Reilly KM, Urban MA, Barriero T, et al. Persistent culture-positive Legionella infection in an immunocompromised host. Clin Infect Dis, 2005, 40(10): e87-89.
33. 謝劍鋒, 邱海波. 降鈣素原對醫院獲得性肺炎的診治價值. 中華結核和呼吸雜志, 2013, 36(2): 152-154.
34. 李嫣, 張玉華, 樊毫軍, 等. 醫院內軍團菌肺炎暴發六例分析. 中華結核和呼吸雜志, 2015, 38(4): 294-297.

Chinese Journal of Respiratory and Critical Care Medicine

Severe cavitary pneumonia caused by Legionella pneumophila serotype 6: a case report and literature review

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