Bronchoalveolar lavage findings in severe community-acquired pneumonia due to Legionella pneumophila serogroup 1

Trisolini, Rocco; Agli, Luigi Lazzari; Cancellieri, Alessandra; Procaccio, L; Candoli, Piero; Alifano, Marco; Patelli, Marco

doi:10.1016/j.rmed.2004.04.015

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…Bronchoalveolar lavage findings of patients upon presentation with severe LD indicated a marked intrapulmonal increase of activated T-cells, defined as co-expression of HLA-DR and CD25, in combination with severe peripheral blood lymphocytopenia (mean absolute count 0.33×10 9 /l) [24]. Together, these observations illustrate that recruitment of (activated) lymphocytes from the bloodstream to the lung tissue could possibly explain the observed lymphocytopenia in the acute phase of LD.…”

Section: Discussionmentioning

confidence: 72%

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Dynamics of Peripheral Blood Lymphocyte Subpopulations in the Acute and Subacute Phase of Legionnaires’ Disease

et al. 2013

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Study ObjectiveAbsolute lymphocytopenia is recognised as an important hallmark of the immune response to severe infection and observed in patients with Legionnaires’ disease. To explore the immune response, we studied the dynamics of peripheral blood lymphocyte subpopulations in the acute and subacute phase of LD.Methods and ResultsEDTA-anticoagulated blood was obtained from eight patients on the day the diagnosis was made through detection of L. pneumophila serogroup 1 antigen in urine. A second blood sample was obtained in the subacute phase. Multiparametric flow cytometry was used to calculate lymphocyte counts and values for B-cells, T-cells, NK cells, CD4+ and CD8+ T-cells. Expression of activation markers was analysed. The values obtained in the subacute phase were compared with an age and gender matched control group. Absolute lymphocyte count (×109/l, median and range) significantly increased from 0.8 (0.4–1.6) in the acute phase to 1.4 (0.8–3.4) in the subacute phase. B-cell count showed no significant change, while T-cell count (×106/l, median and range) significantly increased in the subacute phase (495 (182–1024) versus 979 (507–2708), p = 0.012) as a result of significant increases in both CD4+ and CD8+ T-cell counts (374 (146–629) versus 763 (400–1507), p = 0.012 and 119 (29–328) versus 224 (107–862), p = 0.012). In the subacute phase of LD, significant increases were observed in absolute counts of activated CD4+ T-cells, naïve CD4+ T-cells and memory CD4+ T-cells. In the CD8+ T-cell compartment, activated CD8+ T-cells, naïve CD8+ T-cell and memory CD8+ T-cells were significantly increased (p<0.05).ConclusionThe acute phase of LD is characterized by absolute lymphocytopenia, which recovers in the subacute phase with an increase in absolute T-cells and re-emergence of activated CD4+ and CD8+ T cells. These observations are in line with the suggested role for T-cell activation in the immune response to LD.

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Section: Discussionmentioning

confidence: 72%

“…Furthermore, LD is characterized by accumulation of activated T-cells in the lungs [24]. This could well be a reflection of early recruitment of activated T-cells at the site of the infection.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Peripheral Blood Lymphocyte Subpopulations in the Acute and Subacute Phase of Legionnaires’ Disease

et al. 2013

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“…At the same time, the clinical radiological findings became worse, with an unintentional challenge effect. (2) The BAL on the 22nd day, as some other authors have reported, still showed compatibility with ARDS Legionella , [10] while the following BAL showed eosinophilia (28%) compatible with an acute eosinophilic pneumonia [6], which histological exams confirmed (Figure 3). …”

Section: Discussionmentioning

confidence: 77%

Eosinophilic infiltrate in a patient with severe Legionella pneumonia as a levofloxacin-related complication: a case report

et al. 2010

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IntroductionLegionella pneumonia can appear with different levels of severity and it can often present with complications such as acute respiratory distress syndrome.Case presentationWe report the case of a 44-year-old Caucasian man with Legionella pneumonia with successive development of severe acute respiratory distress syndrome. During his stay in intensive care the clinical and radiological situation of the previously observed acute respiratory distress syndrome unexpectedly worsened due to acute pulmonary eosinophilic infiltrate of iatrogenic origin.ConclusionLevofloxacin treatment caused the occurrence of acute eosinophilic infiltrate. Diagnosis was possible following bronchoscopic examination using bronchoaspirate and transbronchial biopsy.

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“…The marked number of neutrophils in BALF is a major finding in patients with Legionella pneumonia [15]. As shown in Fig.…”

Section: Discussionmentioning

confidence: 79%

“…L. pneumophila pneumonia often progresses rapidly with severe systematic inflammation and is sometimes life-threatening [13], despite the strong activity fluoroquinolone and macrolide antibiotics have against Legionella species [14]. A variety of host cells, including macrophages and neutrophils, are involved in the immune response to L. pneumophila [15][16]. However, the accumulation of activated neutrophils can lead to the production of excessive NE, which causes lung tissue damage.…”

Section: Introductionmentioning

confidence: 99%

In vivo efficacy of sivelestat in combination with pazufloxacin againstLegionellapneumonia

Morinaga¹,

Yanagihara²,

Araki³

et al. 2010

Experimental Lung Research

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It is important to regulate excessive inflammation when we treat patients with severe infectious disease. Sivelestat sodium hydrate (sivelestat), a neutrophil elastase inhibitor, is used in the treatment of lung injury but its effect on pneumonia is unknown. We examined the efficacy of sivelestat in combination with a fluoroquinolone, in a Legionella pneumophila pneumonia mouse model. The combination therapy did not show a significant survival improvement compared to the treatment with fluoroquinolone alone, but reduced bacteria number and inflammatory cells in the early phase. The combination therapy can contribute to treatment of L. pneumophila pneumonia with protecting lungs.

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Bronchoalveolar lavage findings in severe community-acquired pneumonia due to Legionella pneumophila serogroup 1

Abstract: We suggest that the association of lymphoblasts with a marked neutrophilia in BAL fluid of patients with a clinical-radiological setting compatible with acute pneumonia should suggest L. pneumophila as a possible etiologic agent.

Cited by 13 publications

References 19 publications

Dynamics of Peripheral Blood Lymphocyte Subpopulations in the Acute and Subacute Phase of Legionnaires’ Disease

Dynamics of Peripheral Blood Lymphocyte Subpopulations in the Acute and Subacute Phase of Legionnaires’ Disease

Eosinophilic infiltrate in a patient with severe Legionella pneumonia as a levofloxacin-related complication: a case report

In vivo efficacy of sivelestat in combination with pazufloxacin againstLegionellapneumonia

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