Bigler Melina, Vaucher Malina, Wiederkehr Manuel, Brülisauer Sophia, Albrich Werner C, Dräger Sarah, Gisler Valentin, Akers Isabel, Mäusezahl Daniel
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Swiss Med Wkly. 2025 Jun 17;155:4333. doi: 10.57187/s.4333.
Is there a post-acute infection syndrome for Legionnaires' disease? Legionnaires' disease is a form of primarily community-acquired pneumonia caused by Legionella spp. bacteria. Legionnaires' disease and other forms of bacterial community-acquired pneumonia may lead to persistent health and wellbeing impairments. It remains unclear whether these are caused by the community-acquired pneumonia-causing pathogen or the pneumonia itself. We present the rationale and design of a matched cohort study to investigate the persistent health impacts of Legionnaires' disease and compare them with persistent manifestations of other bacterial (Legionella test-negative) community-acquired pneumonia. We also present baseline characteristics of the study cohorts.
Legionnaires' disease patients and Legionella test-negative community-acquired pneumonia patients with confirmed or clinically suspected bacterial aetiology were recruited from university and cantonal/regional hospitals and matched for sex, age, hospital type and date of diagnosis. Questionnaire-based interviews are conducted at baseline and 2, 6 and 12 months after the start of appropriate antibiotics. The questionnaires focus on patient-reported outcome measures and cover long-term symptoms, use of health services and health-related quality of life.
Between June 2023 and June 2024, 59 patients with Legionnaires' disease (59.3% male, median age 69 years [interquartile range [IQR]: 57-80]) and 60 patients with other bacterial (Legionella test-negative) community-acquired pneumonia (63.3% male, median age 69 years [IQR: 60-79]) were enrolled. Admission to the intensive care unit was required for 13.6 % of Legionnaires' disease patients and 8.3 % of other bacterial community-acquired pneumonia patients. Chronic kidney failure was more prevalent among Legionnaires' disease patients (15.3% vs 10.0%), while chronic obstructive pulmonary disease (20.0% vs 11.9%), malignancies (33.3% vs 13.6%) and an immunocompromised status (25.0% vs 13.6%) were more common in Legionella test-negative community-acquired pneumonia patients. Furthermore, Legionella test-negative community-acquired pneumonia patients reported lower baseline quality of life scores than Legionnaires' disease patients. Differences in pneumonia severity, comorbidities and self-reported quality of life scores will be accounted for in future analyses.
The LongLEGIO study will contribute to research on post-acute infection syndromes and provide the data for a more holistic assessment of the disease burden of Legionnaires' disease.
军团病是否存在急性感染后综合征？军团病是一种主要由军团菌属细菌引起的社区获得性肺炎。军团病和其他形式的细菌性社区获得性肺炎可能导致持续的健康和幸福受损。目前尚不清楚这些损害是由引起社区获得性肺炎的病原体还是肺炎本身导致的。我们介绍了一项匹配队列研究的基本原理和设计，以调查军团病对健康的持续影响，并将其与其他细菌性（嗜肺军团菌检测阴性）社区获得性肺炎的持续表现进行比较。我们还介绍了研究队列的基线特征。
从大学医院和州/地区医院招募确诊或临床疑似细菌性病因的军团病患者和嗜肺军团菌检测阴性的社区获得性肺炎患者，并根据性别、年龄、医院类型和诊断日期进行匹配。在开始使用适当抗生素后的基线、2个月、6个月和12个月进行基于问卷的访谈。问卷重点关注患者报告的结局指标，涵盖长期症状、医疗服务使用情况和与健康相关的生活质量。
在2023年6月至2024年6月期间，招募了59例军团病患者（男性占59.3%，中位年龄69岁[四分位间距[IQR]：57 - 80]）和60例其他细菌性（嗜肺军团菌检测阴性）社区获得性肺炎患者（男性占63.3%，中位年龄69岁[IQR：60 - 79]）。13.6%的军团病患者和8.3%的其他细菌性社区获得性肺炎患者需要入住重症监护病房。慢性肾衰竭在军团病患者中更为普遍（15.3%对10.0%），而慢性阻塞性肺疾病（20.0%对11.9%）、恶性肿瘤（33.3%对13.6%）和免疫功能低下状态（25.0%对13.6%）在嗜肺军团菌检测阴性的社区获得性肺炎患者中更为常见。此外，嗜肺军团菌检测阴性的社区获得性肺炎患者报告的基线生活质量得分低于军团病患者。肺炎严重程度、合并症和自我报告的生活质量得分的差异将在未来分析中予以考虑。
LongLEGIO研究将有助于急性感染后综合征的研究，并为更全面评估军团病的疾病负担提供数据。
