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

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

Definition

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

Incubation

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

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

Complications

• Legionellosis
  • DIC (bleeding)
  • Rhabdomyolysis (Muscle)
  • Mental confusion / neuropathy

Diagnosis

• 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 represents 70% of the 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, Hyponatraemia (less than 130), thrombocytopenia, liver enzyme proliferation

Wrong diagnosis (Differential diagnoses)

• Antisynthetase syndrome
• Meningitis (Meningitis)
• Flu
• pneumonia of other reasons
• Opportunistic infections, others
• Pleurisy
• Systemic lupus erythematosus (SLE)

Treatment

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

Literature

• Simonsen S, 2015
• Wikipedia

Opportunistic infections, BINDEVEVSSYKDOMMER.no

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