Legionella-Induced Autoimmune Hemolytic Anemia: A Delayed and Unexpected Complication

Durrance, Richard Jesse; Gracas, Fabiano Das; Sivamurthy, Shetra; Singh, Bhupinder B.

doi:10.14740/jh487

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…LP is frequently associated with hyponatremia [23], which may in turn be associated with the syndrome of inappropriate antidiuretic hormone secretion [27]. There is some anecdotal evidence associating hemolytic anemia to legionellosis, but the underlying mechanism is unknown [28,29]. However, in our study, the bilirubin levels in both LP and psittacosis patients were found to be in the normal range, suggesting no evidence of hemolytic anemia.…”

Section: Discussioncontrasting

confidence: 43%

Comparative analysis of clinical presentation of community-acquired pneumonia induced by Chlamydia psittaci and Legionella Diagnosed through Metagenomic Next-Generation Sequencing

Zeng

et al. 2020

Preprint

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Background Legionella and Chlamydia psittaci cause atypical community-acquired pneumonia, which mimic each other. Our aim was to compare the clinical characteristics of Legionella pneumonia (LP) and psittacosis and assess whether metagenomic next-generation sequencing (mNGS) is an effective method for early diagnosis. Methods We conducted a retrospective study and compared seventeen patients with Chlamydia psittaci pneumonia and nine patients with LP, diagnosed by mNGS. This study was carried out in the First Affiliated Hospital of Wenzhou Medical University, China, from July 2018 to May 2020. mNGS was carried out from bronchial alveolar lavage fluid (BALF) and/or lung tissues. Results 76.5% of psittacosis cases and 0% of legionellosis cases had an avian exposure history (p < 0.001). Compared with LP patients, psittacosis patients had significantly higher hemoglobin (118.9 ± 20.2 vs. 93.2 ± 23.2 g/L, p = 0.007), serum sodium (138.9 ± 5.4 vs. 133.9 ± 6.5 mmol/L, p = 0.047), and higher proportion of elevated aspartate aminotransferase levels (88.2 vs. 44.4%, p = 0.028). Other clinical parameters were similar in psittacosis and LP patients: normal or slightly elevated leucocytes (10.5 vs. 9.5 × 109/L, p > 0.05), neutrophils (9.4 vs. 8.3 × 109/L, p > 0.05), and procalcitonin (0.8 vs 5.1 ng/mL, p > 0.05); highly increased C-reactive protein levels (205.1 vs. 234.9 mg/L, p > 0.05); and decreased lymphocytes (0.7 vs. 0.6 × 109/L, p > 0.05). Extra-pulmonary manifestations and mortality (11.8% in psittacosis vs. 22.2% in LP group, p = 0.591) were also similar in both the groups. mNGS detected Chlamydia psittaci in 17/17 BALF samples, and Legionella in 8/8 BALF samples and 1/1 lung tissue sample. Conclusions Apart from sharing many features with legionellosis, psittacosis is a vital differential diagnosis for LP, especially in patients with avian exposure history. mNGS is a sensitive and promising method for early diagnosis of both psittacosis and LP.

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Section: Discussioncontrasting

confidence: 43%

Comparative analysis of clinical presentation of community-acquired pneumonia induced by Chlamydia psittaci and Legionella Diagnosed through Metagenomic Next-Generation Sequencing

Zeng

et al. 2020

Preprint

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“…While Mycoplasma species are frequently associated with CAS, there is a lower association with Legionella. There are only five case reports published at the time of this submission of an AIHA associated with Legionella, and only one published associated with cold agglutinin [6][7][8]. This raises the possibility of underdiagnosis of AIHA secondary to Legionella.…”

Section: Discussionmentioning

confidence: 94%

A Rare Case of Cold Agglutinin Syndrome Associated With Legionella Pneumonia

Shakfeh,

Shotande,

Mateja

2023

Cureus

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Cold agglutinin syndrome (CAS) is a rare subset of autoimmune hemolytic anemia (AIHA) and can be classified as either primary or secondary. Secondary cold agglutinin disease has been associated with both viral and bacterial pathogens with the most common bacterial pathogen being Mycoplasma pneumoniae . Legionella pneumonia is a well-known causative agent for community-acquired pneumonia that can lead to a severe disease requiring hospitalization that is rarely associated with AIHA. We highlight the importance of recognizing Legionella pneumonia as a causative pathogen for CAS.

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Positive direct antiglobulin test in COVID-19 patients: Decision-making process

Cabo

Brochier

Saussoy

et al. 2021

Transfusion Clinique et Biologique

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In this unprecedented crisis of severe acute respiratory syndrome coronavirus 2 and its associated coronavirus disease 2019 (COVID-19), polymerase chain reaction and then serological testing platforms have been massively developed to face the important screening demand. Polymerase chain reaction and serological testing platforms are not the only actors impacted by the crisis, transfusion services are facing important difficulties. A positive direct antiglobulin test is frequently observed for patients encountering COVID-19. Patients with severe symptoms may develop anaemia and become good candidates for blood transfusions. The interpretation of a positive direct antiglobulin test for patients recently transfused and suffering from COVID-19 is complex. The differentiation between COVID-19 induced antibodies and possible associated transfusion alloantibodies is therefore crucial. In this context, the elution technique incorporated in an appropriate decision-making process plays its full role. This intricate topic is presented through a case report followed by literature review and finally decision-making process for COVID-19 patients necessitating red blood cells administration.

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Legionella-Induced Autoimmune Hemolytic Anemia: A Delayed and Unexpected Complication

Cited by 5 publications

References 8 publications

Comparative analysis of clinical presentation of community-acquired pneumonia induced by Chlamydia psittaci and Legionella Diagnosed through Metagenomic Next-Generation Sequencing

Comparative analysis of clinical presentation of community-acquired pneumonia induced by Chlamydia psittaci and Legionella Diagnosed through Metagenomic Next-Generation Sequencing

A Rare Case of Cold Agglutinin Syndrome Associated With Legionella Pneumonia

Positive direct antiglobulin test in COVID-19 patients: Decision-making process

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