Huerta Michael, Castel Hana, Grotto Itamar, Shpilberg Ofer, Alkan Michael, Harman-Boehm Ilana
Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Isr Med Assoc J. 2003 Aug;5(8):560-3.
We treated two patients diagnosed with legionellosis and simultaneous Rickettsia conorii co-infection.
To report the clinical and laboratory characteristics of this unusual combination, and to describe the execution and results of our environmental and epidemiologic investigations.
Serial serologic testing was conducted 1, 4 and 7 weeks after initial presentation. Water samples from the patients' residence were cultured for Legionella. Follow-up cultures were taken from identical points at 2 weeks and at 3 months after the initial survey.
Both patients initially expressed a non-specific rise in anti-Legionella immunoglobulin M titers to multiple serotypes. By week 4 a definite pattern of specifically elevated IgG titers became apparent, with patient 1 demonstrating a rise in specific anti-L. pneumophila 12 IgG titer and patient 2 an identical response to L. jordanis. At 4 weeks both patients were positive for both IgM and IgG anti-R. conorii antibodies at a titer > or = 1:100. Heavy growth of Legionella was found in water sampled from the shower heads in the rooms of both patients. Indirect immunofluorescence of water cultures was positive for L. pneumophila 12 and for L. jordanis.
Although most cases of community-acquired Legionella pneumonia in our region appear simultaneously with at least one other causative agent, co-infection with R. conorii is unusual and has not been reported to date. This report illustrates the importance of cooperation between clinicians and public health practitioners.
我们治疗了两名被诊断为军团病并同时合并康氏立克次体感染的患者。
报告这种不寻常组合的临床和实验室特征，并描述我们的环境和流行病学调查的实施情况及结果。
在初次就诊后1周、4周和7周进行系列血清学检测。对患者住所的水样进行军团菌培养。在初次调查后2周和3个月从相同地点采集后续培养样本。
两名患者最初均表现出针对多种血清型的抗军团菌免疫球蛋白M滴度非特异性升高。到第4周时，特异性升高的IgG滴度出现明确模式，患者1显示抗嗜肺军团菌12 IgG滴度升高，患者2对约旦军团菌有相同反应。在4周时，两名患者的抗康氏立克次体IgM和IgG抗体滴度均≥1:100呈阳性。在两名患者房间的淋浴喷头采集的水样中发现大量军团菌生长。水培养物的间接免疫荧光显示嗜肺军团菌12型和约旦军团菌呈阳性。
尽管我们地区大多数社区获得性军团菌肺炎病例同时与至少一种其他病原体一起出现，但与康氏立克次体合并感染并不常见，且迄今为止尚未有报道。本报告说明了临床医生和公共卫生从业者之间合作的重要性。
