Kovatch A L, Jardine D S, Dowling J N, Yee R B, Pasculle A W
Pediatrics. 1984 Jun;73(6):811-5.
Two children with legionellosis complicating a relapse of acute lymphoblastic leukemia are reported. A 5-year-old boy with pneumonia had Legionella pneumophila cultured from a tracheal aspirate following a rapid deterioration in his respiratory status and intubation. This child had severe and irreversible granulocytopenia and died in spite of therapy with erythromycin and rifampin added five days later. Combination antimicrobial therapy is suggested for immunosuppressed children with legionellosis if resolution of neutropenia is not readily anticipated. Culture of Legionella sp from respiratory tract secretions or sputum, as reported for the first time in the pediatric literature, should be attempted in all children in whom this infection is suspected. A 13-year-old boy with pneumonia recovered in spite of therapy with antimicrobial agents not proven to be effective against the legionellae. Clinical improvement coincided with increase in absolute granulocyte count. A retrospective diagnosis was made when seroconversion to Legionella micdadei (less than 1:16 to 1:1,024) was determined during a survey of unselected sera from 255 hospitalized children. This is the first documented case of Pittsburgh pneumonia described in a child.
报告了两名患有军团菌病并伴有急性淋巴细胞白血病复发的儿童。一名5岁患肺炎男孩，在呼吸状况迅速恶化并插管后，气管吸出物培养出嗜肺军团菌。该患儿有严重且不可逆的粒细胞减少症，尽管在五天后加用了红霉素和利福平治疗仍死亡。对于免疫抑制且中性粒细胞减少症不太可能迅速缓解的军团菌病患儿，建议采用联合抗菌治疗。对于所有疑似感染军团菌的儿童，应尝试从呼吸道分泌物或痰液中培养嗜肺军团菌，这在儿科文献中尚属首次报道。一名13岁患肺炎男孩，尽管使用了未证实对军团菌有效的抗菌药物治疗，但仍康复。临床改善与绝对粒细胞计数增加同时出现。在对255名住院儿童的非选择性血清进行调查时，发现血清转化为米克戴德军团菌（从小于1:16至1:1024），从而做出回顾性诊断。这是首次记录在案的儿童匹兹堡肺炎病例。
