Community-acquired Legionnaires' disease at a medical center in northern Taiwan
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
52
Journal Issue
3
Pages
465
Date Issued
2019-06-01
Author(s)
Abstract
© 2017 Background/purpose: Legionella pneumophila had been recognized as an important pathogen for community-acquired pneumonia. We aimed to investigate clinical features and outcomes of patients with Legionnaires' disease at a tertiary medical center in northern Taiwan. Methods: From June 2012 to February 2017, a retrospective review of adult community-acquired. Legionnaires' disease at a medical center was conducted. All Legionella infections were confirmed by positive urinary Legionella antigen assay, sera indirect immunofluorescence assay, or sputum culture for Legionella. Literature review of Legionnaires' disease from Medline and PubMED websites was performed. Results: A total of 32 cases of Legionnaires' disease were identified. Their mean age was 64.3 years, with male predominance (27 cases, 84.3%). The underlying diseases were varied and most were attributed to chronic disorders, such as diabetes mellitus (31%) and cigarette smoking (40.6%). The most common symptoms were cough (68%) and fever (59.3%). More than half of patients (18, 56.2%) with Legionnaires' disease could initially present with extrapulmonary manifestations. Sixteen (50%) patients had delay in initiation of appropriate antibiotic therapy. Patients without adequately initiation of appropriate antibiotic therapy had higher proportion (11 of 16, 68.7%) of intensive care unit admission than patients with adequate initiation (5 of 16, 31.2%). Our results inferred that a delay in treatment might result in worsening of disease severity and the need for more intensive management. Overall mortality rate was 21.8%. Development of vasopressor requirement is an independent risk factor associated with mortality. Conclusion: Legionnaires' disease in Taiwan frequently present with extrapulmonary manifestations. Patients with hemodynamic instability that need vasopressor therapy associated with mortality.
Subjects
Community-acquired pneumonia | Fluoroquinolone | Legionnaires' disease | Macrolide
Community-acquired pneumonia; Fluoroquinolone; Legionnaires' disease; Macrolide
Other Subjects
cotrimoxazole; hypertensive factor; ketolide; macrolide; quinolone derivative; tetracycline derivative; antiinfective agent; acute kidney failure; adult; antibiotic therapy; Article; artificial ventilation; chronic kidney failure; chronic obstructive lung disease; cigarette smoking; clinical article; clinical feature; community acquired pneumonia; comorbidity; coronary artery disease; coughing; diabetes mellitus; disease severity; double balloon enteroscopy; dyslipidemia; female; fever; gastrointestinal symptom; hospital mortality; human; hypertension; hyponatremia; hypotension; immunoassay; immunofluorescence; intensive care unit; Legionella; Legionella longbeachae; legionnaire disease; leukocyte count; liver cirrhosis; male; mean arterial pressure; middle aged; mortality rate; mortality risk; musculoskeletal disease; neurologic disease; observational study; retrospective study; sputum culture; Taiwan; therapy delay; thorax radiography; community acquired infection; hospitalization; isolation and purification; Legionella pneumophila; legionnaire disease; microbiology; risk factor; tertiary care center; time to treatment; Anti-Bacterial Agents; Community-Acquired Infections; Female; Hospital Mortality; Hospitalization; Humans; Legionella pneumophila; Legionnaires' Disease; Male; Middle Aged; Retrospective Studies; Risk Factors; Taiwan; Tertiary Care Centers; Time-to-Treatment
Publisher
ELSEVIER TAIWAN
Type
journal article