Abstract
Legionnaires’ Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila. Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129–0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2–Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.
Highlights
During 2020, non-pharmacological interventions (NPI) were instrumental in managing the earlier stages of the coronavirus disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2,3,4]
It should be stressed that nearly half of the sampled cases were from intensive care units (ICU) (i.e., 47.4%), an estimate that exceeds most of the available reports for SARS-CoV-2 infections, even for the “first wave,” [75,76], when Grasselli et al reported a utilization of ICU equal to 16% of all hospitalizations [76]
The collected studies suggest that co-infections by Legionella spp. in SARSCoV-2 patients may be quite less frequent than suggested by early reports, when compared to other pathogens
Summary
During 2020, non-pharmacological interventions (NPI) were instrumental in managing the earlier stages of the coronavirus disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2,3,4]. Available reports suggest that NPI have impacted the transmission of the targeted SARS-CoV-2 and other pathogens. Early national reports for Legionnaires’ Disease (LD) suggest a more limited effect on the epidemiology of respiratory syndromes caused by Gram-negative bacilli from the genus Legionella [7,8,9,10,11,12,13].
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