Cutaneous legionellosis: case report and review of the medical literature

Padrnos, Leslie; Blair, Janis E.; Kusne, Shimon; DiCaudo, David J.; Mıkhael, Joseph

doi:10.1111/tid.12201

Cited by 27 publications

(26 citation statements)

References 29 publications

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“…46 While commonly seen in typical pneumonias, 47 this form of transmission is poorly documented for legionellosis. Transmission of rare forms of legionellosis, most commonly occurring in immuno-compromised patients, can occur via direct skin contact 48 or exposure during medical operations, 49 along with systemic infection transmission.…”

Section: Introductionmentioning

confidence: 99%

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Prussin

Schwake

Marr

2017

Building and Environment

101

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Legionella is a genus of pathogenic Gram-negative bacteria responsible for a serious disease known as legionellosis, which is transmitted via inhalation of this pathogen in aerosol form. There are two forms of legionellosis: Legionnaires' disease, which causes pneumonia-like symptoms, and Pontiac fever, which causes influenza-like symptoms. Legionella can be aerosolized from various water sources in the built environment including showers, faucets, hot tubs/swimming pools, cooling towers, and fountains. Incidence of the disease is higher in the summertime, possibly because of increased use of cooling towers for air conditioning systems and differences in water chemistry when outdoor temperatures are higher. Although there have been decades of research related to Legionella transmission, many knowledge gaps remain. While conventional wisdom suggests that showering is an important source of exposure in buildings, existing measurements do not provide strong support for this idea. There has been limited research on the potential for Legionella transmission through heating, ventilation, and air conditioning (HVAC) systems. Epidemiological data suggest a large proportion of legionellosis cases go unreported, as most people who are infected do not seek medical attention. Additionally, controlled laboratory studies examining water-to-air transfer and source tracking are still needed. Herein, we discuss ten questions that spotlight current knowledge about Legionella transmission in the built environment, engineering controls that might prevent future disease outbreaks, and future research that is needed to advance understanding of transmission and control of legionellosis.

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Section: Introductionmentioning

confidence: 99%

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Prussin

Schwake

Marr

2017

Building and Environment

101

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“…micdadei (n=3). restricted to case reports, [8][9][10][11] outbreaks, [12][13][14] and studies on cancer patients, [15][16][17] or to those 18 that include only a small subset of transplant recipients. Notable exceptions include a study on SOT recipients 19 and an older study from our center on HCT recipients.…”

Section: Management and Outcomementioning

confidence: 99%

Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center

Sivagnanam

Podczervinski

Butler-Wu

et al. 2017

Transplant Infectious Dis

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Legionnaires' disease (LD) can be fatal among high-risk transplant recipients. To understand the epidemiology of LD, we reviewed 15-year longitudinal data from a center in Seattle, Washington that cares for both solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We identified all laboratory-confirmed LD and extracted data on species, diagnostic modalities, clinical presentation, management, and outcomes from medical records. Among 32 patients with LD, transplant recipients made up the majority of diagnoses (22, 69%; SOT 10, HCT 12). Approximately 0.8% of transplant recipients who underwent Legionella-specific testing were positive. Non-pneumophila Legionella species (LNLP), which are not detected by urinary antigen test, accounted for half the cases, led by Legionella micdadei (32%). The severity and outcome between Legionella pneumophila and LNLP infections were similar (attributed mortality, 36% vs 27%); all LNLP deaths occurred in transplant recipients with L. micdadei. The clinical and radiological features mimicked other opportunistic pathogens; 32% (n=7) were not on empiric treatment at the time of diagnosis. These data add to the emerging literature describing the importance of LD and highlight the need for both routine Legionella testing on transplant recipients with pulmonary findings and empiric Legionella-active antibiotic therapy.

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“…To the Editor I read with interest the report by Padrnos et al (1), regarding a case of cutaneous legionellosis associated with allogeneic stem cell transplant. Despite 14 days of azithromycin therapy, the 27-year-old woman succumbed to this illness.…”

mentioning

confidence: 99%

Reducing the risk of legionellosis in stem cell transplant recipients

Cervia

2015

Transplant Infectious Dis

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Cutaneous legionellosis: case report and review of the medical literature

Cited by 27 publications

References 29 publications

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center

Reducing the risk of legionellosis in stem cell transplant recipients

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