Legionella and rheumatic disease 4/5 (1)

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Lego Ella

Legionellosis when treated with immunosuppressant with TNF inhibitor. Wuerz TZ, 2012. Open

Legionellosis (Legionella pneumophilia (90%), Legionary Disease, ICD-10: A48.1


Bacterial infection that causes Legionellosis / Legionnaires' disease or Pontiac fever.

  • Initially, the infection can be reminiscent of systemic rheumatic diseases with lethargy, headaches, muscle pain and impaired lung and kidney function.
  • In case of a weakened immune system such as during immunosuppressive, anti-rheumatic treatment, after organ transplantation or by the wood HIV infection, legionellosis can be especially severe


It lasts 10-20 days between infection and outbreaks of symptoms


  • Fever
  • Frost attacks (fever chilliness)
  • Muscle pain, headaches, exhaustion
  • Headache
  • Cough (dry cough or with a little expectorate)
  • Pain in the lung areas (thoracic)
  • Legionnaires' disease
    • Dry cough and pneumonia
    • Abdominal pain and diarrhea
    • Renal inflammation (glomerulonephritis)
    • Renal impairment
    • Ataxia (uncoordinated movements)
    • Serious disease course
  • Pontiac fever
    • Influenza-like
    • Muscle pain
    • Duration 2-XNUM days


  • Legionellosis


  • Lung CT
    • Infiltrates at the bottom of both lungs (Bilateral basal infiltrates)
    • Pleural fluid
  • Urine antigen test is easy to perform, but only detects serotype-1. which accounts for 70% of cases
  • Legionella detection (PCR investigations and cultivation) in urine and saliva (BAL fluid)
  • PCR after BAL, or from urine / serum also possible. Cultivation from airways nevertheless important
  • Antibodies in serum should be checked with 3-6 weekly intervals
  • Leukocytosis, Hyponatremia (less than 130), thrombocytopenia, hepatic enzyme proliferation

 Wrong diagnosis (Differential diagnoses)


  • Quinolones (ciprofloxacin, levofloxacin and more)
  • Macrolides (azithromycin, clarithromycin)


Opportunistic infections, BINDEVEVSSYKDOMMER.no

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