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

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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.	张志刚. 军团菌肺炎的影像学特征. 实用放射学杂志, 2016, 32(11): 1800-1802.
3.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 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.	吴睿, 俞婉珍. 嗜肺军团杆菌肺炎合并肺部空洞 5 例临床分析. 南京医科大学学报(自然科学版), 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.	蒋露晰, 陈愉, 夏书月, 等. 尿抗原检测法诊断军团菌肺炎的临床价值. 中华结核和呼吸杂志, 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.	范晓姗, 严慧, 朱庆义. 基因芯片在军团菌分型检测中的应用. 中华临床实验室管理电子杂志, 2016, 4(2): 82-85.
25.	袁世洋, 谢军平. 军团菌肺炎致低钠血症机制的研究进展. 中华结核和呼吸杂志, 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.	原灵, 陈爱平, 杨劲松, 等. 福建省嗜肺军团菌血清 1 型及血清 6 型菌株 PFGE 分型研究. 中国人兽共患病学报, 2012, 28(5): 461-463.
28.	于玲玲, 胡必杰, 黄声雷, 等. 大环内酯类和氟喹诺酮类药物对细胞内嗜肺军团菌的作用. 中华结核和呼吸杂志, 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.	陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中华医学杂志, 2012, 92(2): 76-85.
31.	汪亚儒, 陈愉, 赵思宏, 等. 社区获得性米克戴德军团菌肺炎一例. 中华医学杂志, 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.	谢剑锋, 邱海波. 降钙素原对医院获得性肺炎的诊治价值. 中华结核和呼吸杂志, 2013, 36(2): 152-154.
34.	李嫣, 张玉华, 樊毫军, 等. 医院内军团菌肺炎暴发六例分析. 中华结核和呼吸杂志, 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. 张志刚. 军团菌肺炎的影像学特征. 实用放射学杂志, 2016, 32(11): 1800-1802.
3. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 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. 吴睿, 俞婉珍. 嗜肺军团杆菌肺炎合并肺部空洞 5 例临床分析. 南京医科大学学报(自然科学版), 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. 蒋露晰, 陈愉, 夏书月, 等. 尿抗原检测法诊断军团菌肺炎的临床价值. 中华结核和呼吸杂志, 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. 范晓姗, 严慧, 朱庆义. 基因芯片在军团菌分型检测中的应用. 中华临床实验室管理电子杂志, 2016, 4(2): 82-85.
25. 袁世洋, 谢军平. 军团菌肺炎致低钠血症机制的研究进展. 中华结核和呼吸杂志, 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. 原灵, 陈爱平, 杨劲松, 等. 福建省嗜肺军团菌血清 1 型及血清 6 型菌株 PFGE 分型研究. 中国人兽共患病学报, 2012, 28(5): 461-463.
28. 于玲玲, 胡必杰, 黄声雷, 等. 大环内酯类和氟喹诺酮类药物对细胞内嗜肺军团菌的作用. 中华结核和呼吸杂志, 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. 陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中华医学杂志, 2012, 92(2): 76-85.
31. 汪亚儒, 陈愉, 赵思宏, 等. 社区获得性米克戴德军团菌肺炎一例. 中华医学杂志, 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. 谢剑锋, 邱海波. 降钙素原对医院获得性肺炎的诊治价值. 中华结核和呼吸杂志, 2013, 36(2): 152-154.
34. 李嫣, 张玉华, 樊毫军, 等. 医院内军团菌肺炎暴发六例分析. 中华结核和呼吸杂志, 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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