Cargnelli Stephanie, Powis Jeff, Tsang Jennifer L Y
Michael G. DeGroote School of Medicine, Niagara Regional Campus, McMaster University, MDCL 3107, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Toronto East General Hospital, 825 Cowell Avenue, Toronto, ON, M4C 3E7, Canada.
J Med Case Rep. 2016 Dec 1;10(1):336. doi: 10.1186/s13256-016-1105-2.
Legionella pneumophila, a major cause of Legionnaires' disease, accounts for 2-15 % of all community-acquired pneumonia requiring hospitalization and up to 30 % of community-acquired pneumonia requiring intensive care unit admission. Early initiation of appropriate antimicrobial therapy is a crucial step in the prevention of morbidity and mortality. However, recognition of Legionnaires' disease continues to be challenging because of its nonspecific clinical features. We sought to describe hospitalized community-acquired Legionnaires' disease to increase awareness of this important and potentially lethal disease.
A retrospective multicenter observational study was conducted with all patients with confirmed Legionnaires' disease in the Niagara Region of the Province of Ontario, Canada, from June to December 2013.
From June to December 2013, there were 14 hospitalized cases of Legionnaires' disease in the Niagara Region. Of these, 86 % (12 patients) had at least one comorbidity and 71 % (10 patients) were cigarette smokers. In our cohort, Legionnaires' disease was diagnosed with a combination of a urinary Legionella antigen test and a Legionella real-time polymerase chain reaction assay. Delay in effective antimicrobial therapy in the treatment of Legionella infection led to clinical deterioration. The majority of patients had met systemic inflammatory response syndrome criteria with fever >38 °C (71 %), heart rate >90 beats per minute (71 %), and respiratory rate >20 breaths per minute (86 %). Eleven patients (79 %) required admission to the intensive care unit or step-down unit, and nine patients (64 %) required intubation. Clinical improvement after initiation of antimicrobials was protracted.
Legionnaires' disease should be considered during the late spring and summer months in patients with a history of tobacco use and various comorbidities. Clinically, patients presented with severe, nonspecific, multisystem disease characterized by shortness of breath, abnormal vital signs, and laboratory derangements including hyponatremia, elevated creatine kinase, and evidence of organ dysfunction. In addition, antimicrobial therapy with newer macrolides or respiratory fluoroquinolones should be initiated for severe community-acquired pneumonia requiring intensive care unit admission, prior to laboratory confirmation of diagnosis, especially when a clinical suspicion of Legionella infection exists.
嗜肺军团菌是军团病的主要病因，在所有需要住院治疗的社区获得性肺炎中占2% - 15%，在需要入住重症监护病房的社区获得性肺炎中占比高达30%。尽早开始适当的抗菌治疗是预防发病和死亡的关键步骤。然而，由于军团病的临床特征不具特异性，对其的识别仍然具有挑战性。我们试图描述住院的社区获得性军团病，以提高对这种重要且可能致命疾病的认识。
对2013年6月至12月在加拿大安大略省尼亚加拉地区所有确诊为军团病的患者进行了一项回顾性多中心观察性研究。
2013年6月至12月，尼亚加拉地区有14例住院的军团病病例。其中，86%（12例患者）至少有一种合并症，71%（10例患者）为吸烟者。在我们的队列中，通过尿军团菌抗原检测和军团菌实时聚合酶链反应检测相结合的方法诊断军团病。军团菌感染治疗中有效抗菌治疗的延迟导致临床病情恶化。大多数患者符合全身炎症反应综合征标准，发热>38℃（71%），心率>90次/分钟（71%），呼吸频率>20次/分钟（86%）。11例患者（79%）需要入住重症监护病房或降级病房，9例患者（64%）需要插管。开始使用抗菌药物后临床改善过程较为漫长。
在春末和夏季，对于有吸烟史和各种合并症的患者应考虑军团病。临床上，患者表现为严重的、非特异性的多系统疾病，其特征为呼吸急促、生命体征异常以及实验室检查异常，包括低钠血症、肌酸激酶升高和器官功能障碍的证据。此外，对于需要入住重症监护病房的严重社区获得性肺炎，在实验室确诊之前，尤其是当临床怀疑有军团菌感染时，应开始使用新型大环内酯类或呼吸氟喹诺酮类进行抗菌治疗。
