Cases Of Legionella Pneumonia Research Articles

A Case of Legionella Pneumonia with Rhabdomyolysis, with Extremely high Creatinine Kinase without Acute Kidney Injury in an Adult.

Legionella pneumonia is difficult to distinguish from bacterial pneumonia, therefore rapid Legionella testing, particularly in areas with high rates of incidence, is important for targeted therapy.Legionella pneumonia with rhabdomyolysis with extremely high CPK levels is usually associated with AKI but preserved kidney function is possible and early diagnosis and treatment can lead to decreased mortality and morbidity in severe cases.

A Legionella’s outbreak in a COVID-19 pandemic setting

In this report, the author intends to reinforce the need to test for another potencial causes of pneumonia which present with similar symptoms of SARS-CoV-2 infection and can also be responsible for outbreaks and sometimes fatal, particularly Legionnaires’ disease. Legionellabacteria are aerobic, gram-negative, ubiquitous freshwater and soil inhabitants. Pneumonia is the most commonly described manifestation of Legionella infection (Legionnaires’ disease), acquired through inhalation of aerosolized water droplets containing the bacteria. Legionella pneumophilais the most consistently reported species, being an important cause of severe community-acquired pneumonia that often requires hospitalization and is fatal in approximately 10% of cases. Most cases present sporadically, however, outbreaks can occur when there are appropriate conditions for bacteria to grow and spread, like stagnating water in piping systems in large facilities. Furthermore, the pathogenesis of Legionella pneumonia is complex and it is clinically and radiographically similar to other forms of pneumonia. In the context of pandemic COVID-19, the use of Legionella urinary antigen testing continues to be crucial and strongly recommended. Thus, in the outbreak faced in the author’s hospital, this screening method proved to be effective and all cases of Legionellapneumonia were promptly recognized and notified, allowing public health measures to be taken to prevent the development of other potencial clusters.

A CASE OF FANCONI SYNDROME SECONDARY TO LEGIONELLA PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Fanconi syndrome is a generalized dysfunction of the renal proximal tubules without primary glomerular involvement, characterized by wasting of phosphate, amino acids, or glucose by the proximal tubules. In addition, hypokalemia, hypouricemia, metabolic acidosis and proteinuria can be found (1, 2, 3). Acquired forms of Fanconi syndrome are caused by paraproteinemia, Sjogren syndrome, Primary Biliary Cirrhosis, and medications like cisplatin. Infectious diseases have not been reported as a common cause of Fanconi Syndrome (2). In this case report, we present an extremely rare case of Legionella pneumonia complicated by Fanconi syndrome. CASE PRESENTATION: A 42 year old woman with no past medical history was admitted to the hospital with fever, myalgias, diarrhea, and dyspnea. Vital signs on admission were; temperature 38.4 °C, blood pressure 114/57 mmHg, pulse 102 beats/min, respiration rate 20. Labs showed a white blood cell count of 10.9 x 10^3/ul, sedimentation rate of 126 mm/hr, procalcitonin 0.17 ng/ml, and C-reactive protein of 22.9 mg/dL. A CXR revealed a mild left lower lobe opacity compatible with pneumonia (figure 1). The patient tested positive for the Legionella urine antigen and was diagnosed with Legionella pneumonia. Multiple electrolyte abnormalities coexisted with the pneumonia including hypokalemia of 2.8mm/l, hypouricemia of 1.9mg/dl, hypophosphatemia of 1.8mg/dl and hypocalcemia of 8mg/dl. The patient's renal function was normal with no indication of metabolic acidosis. The urinalysis showed 4+ proteinuria, glucosuria and bilirubin with no WBCs. The patient was diagnosed with Fanconi Syndrome based on these findings. The patient was treated for Legionella pneumonia with Levaquin and improved clinically and serum electrolytes normalized. The repeat urinalysis after treatment revealed trace amounts of protein, negative glucose, decreased urobilinogen, and negative bilirubin. DISCUSSION: In this case because the electrolyte abnormalities disappeared after treatment for Legionella pneumonia and there was no evidence of other causes of Fanconi syndrome, it is most likely that Fanconi syndrome was associated with Legionella pneumonia. However, we are uncertain; (1) if Legionella pneumophila entered from basolateral/apical side of the renal proximal tubular cells and (2) why it specifically targeted the proximal tubular cells, developing reabsorption defects but not distal tubular cells. To our knowledge, only two cases (2, 3) have been reported in the literature linking Fanconi syndrome to Legionella pneumonia which makes our case exceedingly rare. CONCLUSIONS: This is an extremely rare case of Fanconi syndrome associated with Legionella pneumonia. Further studies are needed to understand the mechanisms responsible for electrolyte imbalances, which is important for the management of this potentially fatal infection. REFERENCE #1: Klootwijk ED, Reichold M, Unwin RJ, Kleta R, Warth R, Bockenhauer D. Renal Fanconi syndrome: taking a proximal look at the nephron. Nephrol Dial Transplant 30: 1456-1460, 2015. REFERENCE #2: Kinoshita-Katahashi, N., Fukasawa, H., Ishigaki, S., Isobe, S., Imokawa, S., Fujigaki, Y., & Furuya, R. (2013). Acquired Fanconi syndrome in patients with Legionella pneumonia. BMC nephrology, 14, 171. REFERENCE #3: Ryuge, A., Ito, Y., Yamakawa, T., Tanaka, H., Yasui, H., Mashimo, S., Watanabe, K., Nomura, R., Suganuma, N., & Maruyama, S. (2016). Fanconi Syndrome Associated with Hyponatremia in Two Patients with Legionella Pneumonia. Internal medicine (Tokyo, Japan), 55(23), 3479–3484. DISCLOSURES: No relevant relationships by Dilesha Kumanayaka, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Bhavik Patel, source=Web Response

Legionella pneumophila recovery using Legiolert and a traditional culture method

AbstractMethods for recovery and identification of Legionella spp. in water have not been improved significantly since the traditional culture method using buffered charcoal yeast extract (BCYE) agar was developed in 1979. Variations to the BCYE method include sample concentration techniques, acid and heat treatment of samples, and inclusions of antibiotics and dyes in the medium to improve Legionella recovery. A new culture method—Legiolert—was developed and is targeted specifically for recovery and enumeration of Legionella pneumophila, the pathogen responsible for >97% of Legionella pneumonia cases. This study assessed the performance of the Legiolert and BCYE methods in water samples. A total of 247 potable water samples were collected and analyzed using both methods. Mean recoveries in reagent water were similar for both methods (~70%), while Legiolert was more likely than BCYE to detect L. pneumophila when it is present in low numbers.Article Impact StatementThe Legiolert method for enumeration of Legionella pneumophila in water is a significant improvement over the buffered charcoal yeast extract method and should be adopted.

Legionella Pneumonia on Point-of-care Ultrasound in the Emergency Department: A Case Report.

IntroductionLegionella is an uncommon, atypical organism that can cause community-acquired pneumonia. Commonly associated with high fevers, gastrointestinal symptoms, and hyponatremia, it can be easily overlooked, especially during the coronavirus disease of 2019 (COVID-19) pandemic. Legionella has specific antibiotic treatment that will improve outcome; thus, its recognition is important.Case ReportWe present a case of Legionella pneumonia in a man presenting with shortness of breath and fever. The patient’s initial chest radiography was negative. With the use of point-of-care ultrasound (POCUS) the changes of atypical pneumonia could be seen. Ultimately Legionella was confirmed with urine antigen testing, and appropriate antibiotic treatment was started.DiscussionGiven the increased awareness of COVID-19 it is important to consider a broad differential with respiratory illness. Legionella pneumonia on POCUS is consistent with atypical pneumonia descriptions on ultrasound. Point-of-care ultrasound can be used to diagnose atypical pneumonia, specifically caused by Legionella in our case.ConclusionLegionella is evident on POCUS but is difficult to distinguish from other infections with POCUS alone. One should consider Legionella if POCUS is positive for signs of atypical infection.

Clinical and computed tomographic features of Legionella pneumonia with negative urine antigen test results.

Legionella spp. can cause severe pneumonia and most Legionella pneumonia (LP) cases are diagnosed using the urine antigen test (UAT). However, diagnosis of LP with negative UAT results (LPNUAT) is challenging. We investigated the clinical and radiological features of LPNUAT. We retrospectively collected LP cases with positive UAT (LPPUAT) and cases of suspected LP with negative UAT that were examined by Legionella culture between July 2014 and March 2020. We investigated the clinical and CT findings for LP that showed negative UAT results and was diagnosed by culture and compared these findings with those for other pneumonias suspicious for LP with negative results in UAT and Legionella culture (OPSLP). Eight LPNUAT, 20 LPPUAT, and 19 OPSLP cases were included in this study. There were no significant differences in the clinical and CT findings between LPPUAT and LPNUAT when examined by UAT. In LPNUAT, dyspnea, renal dysfunction, liver dysfunction, and bilateral lesions were more commonly observed and inflammatory changes and the number of affected lobes were significantly higher when examined by culture than when examined by UAT. Comparison to OPSLP, LPNUAT did not show such differences, but rather showed disturbances in consciousness, hyponatremia and rhabdomyolysis. Furthermore, lobar consolidation was observed more frequently and bronchial wall thickening and centrilobular nodules were observed less frequently in LPNUAT. LP characteristics such as disturbance of consciousness, hyponatremia, rhabdomyolysis, lobar consolidation, and less bronchial wall thickening and centrilobular nodule contribute to the diagnosis of LP in patients with negative UAT results.

Legionella pneumonia presenting with reverse halo sign

A case of a previously healthy man with community-acquired pneumonia who progressed to acute respiratory distress syndrome, with reverse halo sign (RHS) on chest computed tomography, is reported. A urinary Legionella antigen test was positive for Legionella pneumophila. The typical radiographic features of Legionella pneumonia are bilateral or unilateral, single or multifocal airspace opacifications (most common), and/or ground-glass opacities. However, a wide variety of radiographic findings have been observed. The RHS is characterized by a central ground-glass opacity surrounded by a more or less complete ring of consolidation. First reported in cryptogenic organizing pneumonia, it was initially thought to be specific for this disease, but was subsequently described in a variety of neoplastic and non-neoplastic pulmonary diseases. In this manuscript, we present a case of Legionella pneumonia with a RHS.

Legionella pneumonia with rhabdomyolysis in a healthy young patient

Legionella pneumonia is a lung infection caused by Legionella Pneumophila. Immune suppression, smoking, advanced age and chronic lung disease are the risk factors for Legionella Pneumonia. Pneumonia which developed outside hospital in a patient without an immune deficiency is defined as community-acquired pneumonia. Pneumonia with subacute onset, prodromal symptoms and extra pulmonary manifestations, often seen at a young age, is called atypical pneumonia. Although it is more common as a causative agent of pneumonia in patients with immune deficiency, Legionella Pneumophila is also an important cause of community-acquired atypical pneumonia. As a rare complication of legionella pneumonia, rhabdomyolysis causes a significant increase in mortality. We present a case of Legionella Pneumonia accompanied by rhabdomyolysis and acute renal injury.

2225. Are Fluoroquinolones or Macrolides Better for Treating Legionella Pneumonia? A Systematic Review and Meta-Analysis

BackgroundReported cases of Legionella pneumonia continue to rise in the United States; with mortality rates of 9–25%. The Infectious Disease Society of America recommends either a fluoroquinolone or azithromycin as the first-line treatment for legionellosis. While treatment of Legionella pneumonia improves outcome, it is uncertain as to which antibiotic offers optimal clinical outcomes. We undertook a systematic review and meta-analysis to compare the effectiveness of fluoroquinolone vs. macrolide monotherapy in Legionella pneumonia.MethodsWe conducted a systematic search of literature in multiple databases through April 2019. Studies on patients diagnosed with Legionella pneumonia and treated with either antibiotic of interest were included. Mortality was used as the primary outcome to compare fluoroquinolones and macrolides. Secondary outcomes were clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. We estimated pooled odd ratios to compare the odds of death, clinical cure, and complications. The standard mean difference was estimated for LOS and time to apyrexia. We used a random-effects model and estimated heterogeneity using the I2 statistic. We also analyzed the risk of mortality by setting, i.e., intensive care unit (ICU) vs. non-ICU studies.ResultsOf the 1,583 abstracts reviewed, 20 studies with a total of 3,656 patients met inclusion criteria. The mean age of the population was 60.9 years and 68.5% were men. The mortality rate for patients treated with fluoroquinolones was 7% (102/1454) and 7.7% (125/1615) among those treated with macrolides. The overall pooled odds ratio (OR) assessing mortality risk for patients treated with fluoroquinolones vs. macrolides was 0.95 (95% CI 0.71–1.27, I2 = 0%, p = 0.54). Odds ratios for subgroup analyses were: ICU studies (OR = 1.27, 95% CI: 0.18–9.08, I2 = 45%, p = 0.158); non-ICU studies (OR = 0.96, 95% CI: 0.71–1.32, I2 = 0%, p = 0.616) (figure). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ between fluoroquinolones and macrolides.ConclusionFluoroquinolones and macrolides were found to have similar effectiveness in treatment of Legionella pneumonia for mortality outcomes. However, insufficient data for secondary outcomes was a limitation of this analysis. Disclosures All authors: No reported disclosures.

Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system

BackgroundBecause of a limited number of reports, we aimed to investigate the clinical characteristics of patients with Legionella pneumonia due to non-Legionella pneumophila serogroup 1 and the diagnostic usefulness of the six-point scoring system for such patients compared with patients with pneumonia caused by L. pneumophila serogroup 1.MethodsWe retrospectively analysed patients diagnosed with Legionella pneumonia due to non-L. pneumophila serogroup 1 between March 2001 and June 2016. We examined the clinical characteristics, including symptoms, laboratory findings, radiologic findings, pneumonia severity, initial treatment and prognosis. We also calculated scores using the six-point scoring system in these patients. Furthermore, we compared the clinical characteristics and six-point scores between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients among hospitalized community-acquired pneumonia patients enrolled prospectively between October 2010 and July 2016.ResultsEleven patients had pneumonia due to non-L. pneumophila serogroup 1; their median age was 66 years and 8 patients (72.7%) were male. The most common pathogen was L. pneumophila serogroup 3 (6/11), followed by L. pneumophila serogroup 9 (3/11), L. pneumophila serogroup 6 (1/11) and L. longbeachae (1/11). Non-specific symptoms, such as fever and cough, were common. Six patients (54.5%) had liver enzyme elevation, but no patient developed hyponatraemia at <130 mEq/L. Nine patients (81.8%) showed lobar pneumonia and 7 patients (63.6%) manifested with consolidation and ground-glass opacity. Patients with mild to moderate severity comprised 10 (90.9%) by CURB-65 and 5 (45.5%) by the Pneumonia Severity Index. Of all patients, 4 were admitted to the intensive care unit and 3 died despite appropriate empiric therapy. The clinical characteristics were not significantly different between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients (n = 23). At a cut-off value of ≥ 2 points, the sensitivity of the six-point scoring system was 54.5% (6/11) for non-L. pneumophila serogroup 1 patients and 95.7% (22/23) for L. pneumophila serogroup 1 patients.ConclusionsCases of non-L. pneumophila serogroup 1 pneumonia varied in severity from mild to severe and the clinical characteristics were often non-specific. The six-point scoring system was not useful in predicting such Legionella pneumonia cases.

A case of legionella pneumonia with cerebellar dysfunction

A case of legionella pneumonia with cerebellar dysfunction

Clinical Utility of Testing for Legionella Pneumonia in Central Texas

Legionella pneumophila is an uncommon cause of community-acquired pneumonia in the south central region of the United States, and regular testing may not be cost effective in areas of low incidence. To evaluate the incidence of Legionella in central Texas and to determine the cost effectiveness of Legionella urinary antigen testing. We performed a single-center retrospective cohort study of patients admitted with pneumonia between January 2001 and December 2013. Patients were identified by Binax Legionella urinary antigen and International Classification of Disease, Ninth Revision codes. Demographic characteristics and clinical history of the confirmed Legionella pneumonia cases were obtained by chart review. Descriptive statistics were used to describe patient characteristics. Over 12 years, 5,807 patients with 11,377 admissions for pneumonia were tested for Legionella urinary antigen. A positive Legionella urinary antigen was found in 17 patients. Cumulative incidence during the study period was 0.23%. Among the Legionella-positive patients, intensive care unit admission and median length of stay were 58.8% and 8.5 days, respectively. Most patients (64.7%) met American Thoracic Society criteria for severe pneumonia. All patients empirically received either a macrolide or fluoroquinolone covering Legionella. There were two in-hospital and three total 90-day deaths in those with a positive urinary antigen. The estimated cost of screening this population with Legionella urinary antigen was $214,438 over 13 years. This study reveals the low incidence of Legionella pneumonia in central Texas. Use of guideline-concordant antibiotic treatment provides coverage for Legionella. We speculate that testing in a low-prevalence area would not influence outcomes or be cost effective.

恶性黑色素瘤合并嗜肺军团菌感染性肺炎病例报告

Legionella pneumonia is mainly in community-acquired and nosocomial pneumonias caused by the L. pneumophila. The paper reported a case of Legionella pneumonia caused by Legionella pneumophila Sg1 in a man with malignant melanoma. The method for diagnosing Legionella pneumonia by standard culture method，serotyping，PCR-enzymatic digestion analysis and gene sequencing was elaborate. To confirm the diagnosis result of this rapid diagnostic method, sequencing of the bacteria in patient’s sputum partial gene was also carried out. The diagnosis result of this rapid diagnostic method was consistent with the culture method which indicated that it was effective in diagnosing L. pneumophila infection.

Legionellosis and biologic therapies

Biologic therapies are widely used in inflammatory diseases, and they are associated to an increased infection risk, especially to granulomatous and intracellular infections such as Legionella. A review of the literature revealed 105 cases of Legionella pneumonia in patients taking biologic therapies. Sixty-four patients (65.3%) were treated with infliximab, 23 (23.5%) with adalimumab, 5 (5%) with etanercept and 3 (3%) with rituximab. Seventy-one per cent of the patients were treated for rheumatologic diseases and 16% for inflammatory bowel diseases. The majority of the patients received one or more concomitant immunosuppressive drugs, especially steroids (43%). Overall mortality was 19%. Legionella pneumonia might complicate therapy with biologic therapies, especially in patients being treated with infliximab or adalimumab given concomitantly with other immunosuppressive medications during their first 6 months of treatment. Physicians should be aware of this potentially severe association. Early recognition and treatment would likely result in reduced morbidity and mortality.

English

Legionella&nbsp;pneumonia&nbsp;is mainly caused by the inhalation of&nbsp;Legionella&nbsp;contaminated aerosol, aspiration or wound infection. Patients undergoing a severe immunosuppressive therapy such as organ transplant or cancer therapy are particularly at risk of infection.This study reported a case of&nbsp;Legionella&nbsp;pneumonia caused by&nbsp;Legionella pneumophila&nbsp;in a man with malignant melanoma. The method for diagnosing&nbsp;Legionella&nbsp;pneumonia&nbsp;by standard culture method was elaborate. A rapid diagnostic method derived from a two-step scheme assay with 99.42% accuracy for identification and differentiation of&nbsp;L. pneumophila&nbsp;and non-&nbsp;L. pneumophila&nbsp;in environmental&nbsp;Legionella&nbsp;isolates were also utilized in this study to evaluate whether this method was available for diagnosingLegionella&nbsp;infection. To confirm the diagnosis result of this rapid diagnostic method, sequencing of the bacteria in patient&rsquo;s&nbsp;sputum&nbsp;partial gene was also carried out. The diagnosis result of this rapid diagnostic method was consistent with the culture method which indicated that it was effective in diagnosing&nbsp;L. pneumophila&nbsp;infection. &nbsp; Key words:&nbsp;Legionella pneumophila, malignant melanoma, pneumonia.

Rainfall Is a Risk Factor for Sporadic Cases of Legionella pneumophila Pneumonia

It is not known whether rainfall increases the risk of sporadic cases of Legionella pneumonia. We sought to test this hypothesis in a prospective observational cohort study of non-immunosuppressed adults hospitalized for community-acquired pneumonia (1995–2011). Cases with Legionella pneumonia were compared with those with non-Legionella pneumonia. Using daily rainfall data obtained from the regional meteorological service we examined patterns of rainfall over the days prior to admission in each study group. Of 4168 patients, 231 (5.5%) had Legionella pneumonia. The diagnosis was based on one or more of the following: sputum (41 cases), antigenuria (206) and serology (98). Daily rainfall average was 0.556 liters/m2 in the Legionella pneumonia group vs. 0.328 liters/m2 for non-Legionella pneumonia cases (p = 0.04). A ROC curve was plotted to compare the incidence of Legionella pneumonia and the weighted median rainfall. The cut-off point was 0.42 (AUC 0.54). Patients who were admitted to hospital with a prior weighted median rainfall higher than 0.42 were more likely to have Legionella pneumonia (OR 1.35; 95% CI 1.02–1.78; p = .03). Spearman Rho correlations revealed a relationship between Legionella pneumonia and rainfall average during each two-week reporting period (0.14; p = 0.003). No relationship was found between rainfall average and non-Legionella pneumonia cases (−0.06; p = 0.24). As a conclusion, rainfall is a significant risk factor for sporadic Legionella pneumonia. Physicians should carefully consider Legionella pneumonia when selecting diagnostic tests and antimicrobial therapy for patients presenting with CAP after periods of rainfall.

Legionella pneumonia cases over a five-year period: a descriptive, retrospective study of outcomes in a UK district hospital

As the recent outbreaks in Edinburgh and Camarthen, UK, have shown, Legionella pneumonia (LP) remains a significant public health problem, which is not only confined to those who have travelled abroad. In both outbreaks and sporadic cases, diagnosis can go unrecognised. We reviewed the demographics, comorbidities, diagnosis, treatment and clinical outcome of LP cases over five years in a district general hospital in northwest England. Over half of LP cases were UK acquired and ‘classic' clinical features were common. Clinical criteria for diagnosing LP were confirmed, but few sputum samples were sent to reference laboratories, limiting further essential epidemiological mapping of UK cases. Following current UK community-acquired pneumonia guidance would have missed nearly one quarter of LP cases in our series, potentially leading to further morbidity and mortality.

A Culture-Proven Case of Community-AcquiredLegionellaPneumonia Apparently Classified as Nosocomial: Diagnostic and Public Health Implications

We report a case of Legionella pneumonia in a 78-year-old patient affected by cerebellar haemangioblastoma continuously hospitalised for 24 days prior to the onset of overt symptoms. According to the established case definition, this woman should have been definitely classified as a nosocomial case (patient spending all of the ten days in hospital before onset of symptoms). Water samples from the oncology ward were negative, notably the patient's room and the oxygen bubbler, and the revision of the case history induced us to verify possible contamination in water samples collected at home. We found that the clinical strain had identical rep-PCR fingerprint of L. pneumophila serogroup 1 isolated at home. The description of this culture-proven case of Legionnaires' disease has major clinical, legal, and public health consequences as the complexity of hospitalised patients poses limitations to the rule-of-thumb surveillance definition of nosocomial pneumonia based on 2–10-day incubation period.

Legionella pneumophila serogroup 3 pneumonia in a patient with low-grade 4 non-Hodgkin lymphoma: a case report

IntroductionNosocomial legionellosis has generally been described in immunodepressed patients, but Legionella pneumophila serogroup 3 has rarely been identified as the causative agent.Case presentationWe report the case of nosocomial L. pneumophila serogroup 3 pneumonia in a 70-year-old Caucasian man with non-Hodgkin lymphoma. Diagnosis was carried out by culture and real-time polymerase chain reaction of bronchoalveolar lavage fluid. The results of a urinary antigen test were negative. A hospital environmental investigation revealed that the hospital water system was highly colonized by L. pneumophila serogroups 3, 4, and 8. The hospital team involved in the prevention of infections was informed, long-term control measures to reduce the environmental bacterial load were adopted, and clinical monitoring of legionellosis occurrence in high-risk patients was performed. No further cases of Legionella pneumonia have been observed so far.ConclusionsIn this report, we describe a case of legionellosis caused by L. pneumophila serogroup 3, which is not usually a causative agent of nosocomial infection. Our research confirms the importance of carrying out cultures of respiratory secretions to diagnose legionellosis and highlights the limited value of the urinary antigen test for hospital infections, especially in immunocompromised patients. It also indicates that, to reduce the bacterial load and prevent nosocomial legionellosis, appropriate control measures should be implemented with systematic monitoring of hospital water systems.

経皮的心肺補助装置の使用で救命できた劇症型レジオネラ肺炎の1例

経皮的心肺補助装置の使用で救命できた劇症型レジオネラ肺炎の1例