Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2019 Jun;52(3):465-470. doi: 10.1016/j.jmii.2017.08.018. Epub 2017 Sep 18.
BACKGROUND/PURPOSE: Legionella pneumophila had been recognized as an important pathogen for community-acquired pneumonia. We aimed to investigate clinical features and outcomes of patients with Legionnaires' disease at a tertiary medical center in northern Taiwan.
From June 2012 to February 2017, a retrospective review of adult community-acquired. Legionnaires' disease at a medical center was conducted. All Legionella infections were confirmed by positive urinary Legionella antigen assay, sera indirect immunofluorescence assay, or sputum culture for Legionella. Literature review of Legionnaires' disease from Medline and PubMED websites was performed.
A total of 32 cases of Legionnaires' disease were identified. Their mean age was 64.3 years, with male predominance (27 cases, 84.3%). The underlying diseases were varied and most were attributed to chronic disorders, such as diabetes mellitus (31%) and cigarette smoking (40.6%). The most common symptoms were cough (68%) and fever (59.3%). More than half of patients (18, 56.2%) with Legionnaires' disease could initially present with extrapulmonary manifestations. Sixteen (50%) patients had delay in initiation of appropriate antibiotic therapy. Patients without adequately initiation of appropriate antibiotic therapy had higher proportion (11 of 16, 68.7%) of intensive care unit admission than patients with adequate initiation (5 of 16, 31.2%). Our results inferred that a delay in treatment might result in worsening of disease severity and the need for more intensive management. Overall mortality rate was 21.8%. Development of vasopressor requirement is an independent risk factor associated with mortality.
Legionnaires' disease in Taiwan frequently present with extrapulmonary manifestations. Patients with hemodynamic instability that need vasopressor therapy associated with mortality.
背景/目的：嗜肺军团菌已被认为是社区获得性肺炎的重要病原体。本研究旨在探讨台湾北部一家三级医学中心成人社区获得性嗜肺军团菌病的临床特征和结局。
本研究回顾性分析了 2012 年 6 月至 2017 年 2 月期间在该医学中心发生的成人社区获得性嗜肺军团菌病。所有军团菌感染均通过尿军团菌抗原检测、血清间接免疫荧光法或痰培养阳性来确认。通过 Medline 和 Pubmed 网站对军团病文献进行了复习。
共确诊 32 例军团病，患者平均年龄为 64.3 岁，男性居多（27 例，84.3%）。基础疾病多种多样，主要为慢性疾病，如糖尿病（31%）和吸烟（40.6%）。最常见的症状是咳嗽（68%）和发热（59.3%）。超过一半的军团病患者（18 例，56.2%）最初可出现肺外表现。16 例（50%）患者抗生素治疗开始延迟。未及时开始适当抗生素治疗的患者入住重症监护病房的比例（16 例中有 11 例，68.7%）高于及时开始治疗的患者（16 例中有 5 例，31.2%）。结果表明，治疗延迟可能导致疾病严重程度恶化，需要更强化的治疗。总的死亡率为 21.8%。需要血管加压药治疗是与死亡率相关的独立危险因素。
台湾的军团病常表现为肺外表现。血流动力学不稳定且需要血管加压药治疗的患者与死亡率相关。
