Isenman Heather L, Chambers Stephen T, Pithie Alan D, MacDonald Sharyn L S, Hegarty Justin M, Fenwick Joanna L, Maze Michael J, Metcalf Sarah C L, Murdoch David R
Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand.
Department of Pathology, University of Otago, Christchurch, New Zealand.
Respirology. 2016 Oct;21(7):1292-9. doi: 10.1111/resp.12808. Epub 2016 May 19.
Legionella longbeachae is a predominant cause of Legionnaires' disease in some parts of the world, particularly in Australasia. Clinical reports of L. longbeachae infection are limited to case reports or small case series, and culture-confirmed cases.
We reviewed the clinical characteristics and outcomes of L. longbeachae pneumonia in a large case series from Christchurch, New Zealand during a 4-year period when both PCR and cultures were used as routine diagnostic tools for Legionnaires' disease. Cases of Legionella pneumophila pneumonia were reviewed for comparison.
A total of 107 cases of L. longbeachae infection were identified by PCR and/or culture. The median age was 65 years (range 25-90 years), 63% were male, and most became unwell during spring or summer. Presenting clinical features were similar to those reported for community-acquired pneumonia, with headache, myalgia and diarrhoea being common. Elevated C-reactive protein, hyponatraemia and abnormal liver function tests were also common. History of productive cough, involvement of both lungs, and high bacterial load were independently associated with culture of Legionella from lower respiratory samples. One quarter required intensive care unit admission, and 5% died. Among patients given antimicrobial therapy before admission, those given agents without anti-Legionella activity were more likely to be admitted to the intensive care unit. Limited comparisons were made with the 19 L. pneumophila cases over the same time period.
Characteristics of L. longbeachae pneumonia are broadly similar to those reported for community-acquired pneumonia from a variety of other populations, except for the spring/summer seasonality.
长滩军团菌是世界上某些地区，尤其是澳大拉西亚地区退伍军人病的主要病因。长滩军团菌感染的临床报告仅限于病例报告、小病例系列以及培养确诊病例。
我们回顾了新西兰克赖斯特彻奇市一个大型病例系列中长滩军团菌肺炎的临床特征与转归，该病例系列来自4年期间，当时聚合酶链反应（PCR）和培养均被用作退伍军人病的常规诊断工具。同时回顾了嗜肺军团菌肺炎病例以作比较。
通过PCR和/或培养共鉴定出107例长滩军团菌感染病例。中位年龄为65岁（范围25 - 90岁），63%为男性，大多数在春季或夏季发病。呈现的临床特征与社区获得性肺炎报道的相似，头痛、肌痛和腹泻较为常见。C反应蛋白升高、低钠血症和肝功能检查异常也很常见。有咳痰史、双肺受累以及细菌载量高与下呼吸道样本培养出军团菌独立相关。四分之一的患者需要入住重症监护病房，5%死亡。在入院前接受抗菌治疗的患者中，接受无抗军团菌活性药物治疗的患者更有可能入住重症监护病房。同期对19例嗜肺军团菌病例进行了有限的比较。
长滩军团菌肺炎的特征与其他各种人群社区获得性肺炎报道的大致相似，但有春季/夏季季节性差异。
