Legionellosis in Patients With Cancer. Issue 4 (July 2015)

• Record Type: Journal Article
• Authors: Yacoub, Abraham; Sadic, Edin; Flynn, Alexandra; Katayama, Mitsuya; Greene, John
• Is Part Of: Infectious diseases in clinical practice. Volume 23:Issue 4(2015:Jul.)
• Publication Date: 2015-07
• Subjects: Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Periodicals; Electronic journals; 616.9
• DOI: 10.1097/IPC.0000000000000223
• Languages: English
• ISSNs: 1056-9103

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p> <italic>Legionella</italic> species cause severe pneumonia in the immunocompromised population, especially those with cell-mediated immunodeficiency. However, the varied clinical and radiographic presentation of Legionnaires disease can make diagnosis very difficult, which can result in a delay of appropriate therapy. For that reason, we performed this study to review the characteristics of <italic>Legionella</italic> pneumonia in immunocompromised patients with underlying cancer.</p> </sec> <sec> <title>Methods</title> <p>The study was a retrospective chart review of 11 patients with <italic>Legionella</italic> pneumonia at the Moffitt Cancer Center diagnosed between March 2005 and February 2014. The patients were identified on the basis of a positive bronchoalveolar lavage culture for <italic>Legionella</italic> and/or a positive <italic>Legionella</italic> urine antigen. Summarized host characteristics included underlying malignancy, absolute neutrophil count, and absolute lymphocyte count at the time of diagnosis as well as the computed tomographic chest imaging findings.</p> </sec> <sec> <title>Results</title> <p>Of the 11 patients included, 10 had <italic>Legionella pneumophila</italic> and 1 had <italic>L. feeleii</italic>. Nine (81.8%) of the 11 patients had a hematologic malignancy and 2 (18.2%) of the 11 patients had a solid organ tumor. One (9.0%) of the 11 patients had an underlying lung disease. At the time of the diagnosis, 3 (27.2%) of the 11 patients were neutropenic (absolute neutrophil count, <500 cells/mm<sup>3</sup>) and 8 (72.7%) of the 11 patients were lymphopenic (absolute lymphocyte count, <1500 cells/mm<sup>3</sup>). Four (36.3%) of the 11 patients had bilateral pneumonia. Three (27.2%) of the 11 patients had nodular consolidation. However, only 2 (18%) of the 11 patients were found to have consolidation along with ground-glass opacity. All patients were treated with levofloxacin. Seven (63.6%) of the 11 patients adequately responded to the therapy, 1 (9.0%) patient died because of pneumonia, and 3 (27.3%) patients died because of the underlying cancer.</p> </sec> <sec> <title>Conclusions</title> <p>Legionnaire disease remains a life-threatening illness in patients with cancer. Our study found that most patients are lymphopenic, with multifocal consolidation in 2 of 3 patients. In addition, nodular opacities on computed tomographic imaging were described in more than one third of our patients, which resembles a mold pneumonia. All the cases that were thought to be a mold pneumonia were diagnosed as <italic>Legionella</italic> by bronchoalveolar lavage culture or the <italic>Legionella</italic> urine antigen, emphasizing the need for heightened awareness and testing for this pathogen.</p> </sec> </abstract>