A Culture-Proven Case of Community-AcquiredLegionellaPneumonia Apparently Classified as Nosocomial: Diagnostic and Public Health Implications

Abstract

We report a case of Legionella pneumonia in a 78-year-old patient affected by cerebellar haemangioblastoma continuously hospitalised for 24 days prior to the onset of overt symptoms. According to the established case definition, this woman should have been definitely classified as a nosocomial case (patient spending all of the ten days in hospital before onset of symptoms). Water samples from the oncology ward were negative, notably the patient's room and the oxygen bubbler, and the revision of the case history induced us to verify possible contamination in water samples collected at home. We found that the clinical strain had identical rep-PCR fingerprint of L. pneumophila serogroup 1 isolated at home. The description of this culture-proven case of Legionnaires' disease has major clinical, legal, and public health consequences as the complexity of hospitalised patients poses limitations to the rule-of-thumb surveillance definition of nosocomial pneumonia based on 2–10-day incubation period.

Community‐acquired Legionnaires' disease in a renal transplant recipient with unclear incubation period: the importance of molecular typing

“…Such situations have been reported in outbreaks – from 16 days to 19 days in 22 cases (16%) – and time before illness onset exceeded 10 days . Turner et al described the LD case of a renal transplant recipient with a 12‐day incubation period between home exposure and the onset of pneumonia in hospital, and similarly, an LD case with a 24‐day incubation period has been reported . Oropharyngeal colonization at home may explain the Lp1 pneumonia in our patient, with rapid progression toward infection during hospital stay, because of immunosuppressant treatments.…”

Cutaneous legionellosis: case report and review of the medical literature

“…Therefore, very few were potentially hospital‐acquired infections (, CR). Because the individual reports did not disclose information regarding an epidemiologic investigation for hospital acquisition, and because some community‐acquired infections have been misclassified as hospital‐acquired , it is unclear whether any of these cases were nosocomial in origin.…”

Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella

“…70,75 Most patients are symptomatic within 2-10 days, however, incubation periods of up to 26 days have been described. 76 Complicating the diagnosis, especially early in infection, is a relative paucity of respiratory symptoms. Cough, when present, is frequently non-productive.…”