Legionella pneumophila Serogroup 1 Septic Arthritis With Probable Endocarditis in an Immunodeficient Patient

Thurneysen, Claudio; Boggian, Katia

doi:10.1097/rhu.0000000000000128

Cited by 13 publications

(5 citation statements)

References 14 publications

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“…The pilot plant designed and developed could be a model for further investigations, especially in the light of the experimental protocols adapted for exposition, sampling, analysis, even in the presence of multiple contaminations [106][107][108][109][110][111][112][113][114]. The treatment system based on the action of the chlorine dioxide generator in the study shows an effective disinfectant action.…”

Section: Discussionmentioning

confidence: 99%

Disinfection of Water Systems in Accordance with Eu Directives on Health and Safety in Working Environments: Use of A Technologically Advanced ClO2 Generator

Lombardi¹,

Spica

Firenze

et al. 2020

BJSTR

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It is currently of great interest to develop prevention systems for the management of the risk of microbial contamination of water in buildings of various types in which work is done. In this regard, international organizations have drawn up reference guidelines and in the EU countries specific legislative provisions indicated in the EU directives must be observed. A pilot system, copying a building pipeline, was designed, and developed to test water treatments with a ClO 2 generator. Chemical and physical parameters were monitored in real time and the effectiveness of disinfection was tested on several microorganisms, focusing on Legionella. The scale plant reached steady state within 24 hours and maintained equilibrium, showing stability to chemical and physical parameters. Simulations showed disinfection efficacy for different contaminations (>1,000,000 CFU) under water system conditions. Escherichia coli counts and other indicators showed a 99.999% reduction within 15 minutes while Legionella and other environmental species showed a 99.999% reduction within 30 minutes. In addition, the system proved to be effective on complex microflora and other species and allowed to demonstrate adherence to the regulatory framework and legislative requirements (italian legislation's accepte of EU directives on health and safety at work D.lgs. [1]. And with particular reference to the European Directive [2] and European Parliament's Directive [3].The study model can be easily extended to simulate particular risk situations, verifying for each of them the effective compliance with current legislation. This pilot model can be a feasible support in validating or comparing alternative solutions and new technologies for disinfection of water.

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Section: Discussionmentioning

confidence: 99%

Disinfection of Water Systems in Accordance with Eu Directives on Health and Safety in Working Environments: Use of A Technologically Advanced ClO2 Generator

Lombardi¹,

Spica

Firenze

et al. 2020

BJSTR

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“…To date, ten cases of Legionella arthritis have been reported, including eight septic (12)(13)(14)(15)(16)(17)(18)(19) and two reactive (20,21) arthritis (Table 1). However, we present the first case of septic arthritis in native joint caused by L. micdadei, accompanied with S. aureus.…”

Section: Discussionmentioning

confidence: 99%

Arthritis caused by Legionella micdadei and Staphylococcus aureus: metagenomic next-generation sequencing provides a rapid and accurate access to diagnosis and surveillance

Huang

Miao

et al. 2019

Ann. Transl. Med.

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Legionella spp. is an important pulmonary pathogen but rarely causes extra-pulmonary infections.We report a case of joint infection caused by Legionella micdadei and Staphylococcus aureus in a 54-year-old male with medication history of oral steroid for systemic lupus erythematosus (SLE). He developed arthritis in his right metacarpophalangeal (MCP) joints without precursor pneumonia. In the joint aspirate, S. aureus was detected through culture. The existence of L. micdadei and S. aureus were indicated by metagenomic next-generation sequencing (mNGS) and confirmed by 16S rRNA sequence analysis. After oral levofloxacin treatment for 54 days, the patient's symptoms ameliorated and blood test results improved, which were consistent with the dynamic trend of reads numbers in mNGS data. Our case included, arthritis caused by Legionella spp. have been reported in 11 patients. However, our case is the first to report septic arthritis caused by L. micdadei in native joints and monitored by mNGS. This case demonstrated an application of mNGS for etiological diagnosis and semi-quantification in joint aspirate. mNGS may serve as a promising tool for rapid and accurate etiological diagnosis and surveillance, contributing to appropriate antimicrobial drug applications and timely medication adjustments when necessary.

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“…Extrapulmonary legionellosis is a very challenging diagnosis and might involve many different organs[15-18]. In patients with immunocompromising conditions, L. pneumophila can cause septic arthritis, endocarditis, myocarditis, myositis or cutaneous involvement, including panniculitis, exanthema, subcutaneous nodules, pustules or even abscesses.…”

Section: Discussionmentioning

confidence: 99%

FatalLegionella pneumophilaserogroup 1 pleural empyema: A case report

Maillet

Bonnet

Billard-Pomarès

et al. 2019

WJCCM

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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.

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Legionella pneumophila Serogroup 1 Septic Arthritis With Probable Endocarditis in an Immunodeficient Patient

Cited by 13 publications

References 14 publications

Disinfection of Water Systems in Accordance with Eu Directives on Health and Safety in Working Environments: Use of A Technologically Advanced ClO2 Generator

Disinfection of Water Systems in Accordance with Eu Directives on Health and Safety in Working Environments: Use of A Technologically Advanced ClO2 Generator

Arthritis caused by Legionella micdadei and Staphylococcus aureus: metagenomic next-generation sequencing provides a rapid and accurate access to diagnosis and surveillance

FatalLegionella pneumophilaserogroup 1 pleural empyema: A case report

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