FatalLegionella pneumophilaserogroup 1 pleural empyema: A case report

Abstract

BACKGROUNDLegionella pneumophila (L. pneumophila) is a gram-negative intracellular bacillus composed of sixteen different serogroups. It is mostly known to cause pneumonia in individuals with known risk factors as immunocompromised status, tobacco use, chronic organ failure or age older than 50 years. Although parapneumonic pleural effusion is frequent in legionellosis, pleural empyema is very uncommon. In this study, we report a case of fatal pleural empyema caused by L. pneumophila serogroup 1 in an 81-year-old man with multiple risk factors.CASE SUMMARYAn 81-year-old man presented to the emergency with a 3 wk dyspnea, fever and left chest pain. His previous medical conditions were chronic lymphocytic leukemia, diabetes mellitus, chronic kidney failure, hypertension and hyperlipidemia, without tobacco use. Chest X-ray and comouted tomography-scan confirmed a large left pleural effusion, which puncture showed a citrine exudate with negative standard bacterial cultures. Despite intravenous cefotaxime antibiotherapy, patient’s worsening condition after 10 d led to thoracocentesis and evacuation of 2 liters of pus. The patient progressively developed severe hypoxemia and multiorgan failure occurred. The patient was treated by antibiotherapy with cefepime and amikacin and with adequate symptomatic shock treatment, but died of uncontrolled sepsis. The next day, cultures of the surgical pleural liquid samples yielded L. pneumophila serogroup 1, consistent with the diagnosis of pleural legionellosis.CONCLUSIONL. pneumophila should be considered in patients with multiple risk factors and undiagnosed pleural empyema unresponsive to conventional antibiotherapy.

Can mandatory monitoring in rental apartments effectively prevent legionellosis? A retrospective analysis of data from Regensburg with a review of the literature

“…But what is reasonably achievable with regard to the concentration of Legionella and given the paradoxical dose-response relationship? Preventive health measures have high priority, as the course of legionella pneumonia can be dramatic [ 31 ], [ 32 ], [ 33 ]. Although the goal must be to prevent all these cases, the relevance of legionella prevention is questionable in relation to other preventable deaths.…”

Emerging Pulmonary Infections in Clinical Practice

“…16 ). Parapneumonic pleural effusions are seen in approximately half of patients, but empyema is rare and likely carries a poor prognosis [ 49 ].

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