Chow J W, Yu V L
VA Medical Center and Wayne State University School of Medicine, Detroit, MI, USA.
Semin Respir Infect. 1998 Jun;13(2):132-9.
Legionella have a predilection for infecting immunocompromised patients, and transplant recipients have the highest risk. Legionella spp have been the most common cause of nosocomial pneumonia among transplant recipients at selected medical centers. Diagnosis is dependent on the ability of the clinical microbiology laboratory to isolate the organism by culture; therefore, the disease is easily overlooked. The mode of transmission of Legionella pneumophila is likely aspiration in transplant recipients. Clinical manifestations are similar to that of other bacterial pneumonias, although diarrhea is often prominent. The quinolone antibiotics (especially ciprofloxacin) are the antibiotics of choice because, unlike the macrolides or rifampin, they do not interact with the immunosuppressive agents used to counter rejection. Prevention of nosocomial legionellosis involves disinfection of the hospital's potable water system. Effective disinfection methods include superheat and flush or copper-silver ionization; hyperchlorination is no longer recommended. Routine culture surveillance directed at the hospital water supply for Legionella is mandatory in hospitals caring for transplant patients.
军团菌倾向于感染免疫功能低下的患者，移植受者的风险最高。在一些特定的医疗中心，军团菌属是移植受者医院获得性肺炎最常见的病因。诊断依赖于临床微生物实验室通过培养分离出该病原体的能力；因此，这种疾病很容易被忽视。嗜肺军团菌在移植受者中的传播途径可能是误吸。其临床表现与其他细菌性肺炎相似，不过腹泻往往较为突出。喹诺酮类抗生素（尤其是环丙沙星）是首选抗生素，因为与大环内酯类或利福平不同，它们不会与用于抗排斥的免疫抑制剂相互作用。医院获得性军团菌病的预防涉及对医院饮用水系统进行消毒。有效的消毒方法包括过热冲洗或铜银离子化；不再推荐过度氯化。对于照料移植患者的医院，对医院供水系统进行军团菌的常规培养监测是强制性的。
