Legionnaires Disease Presenting as Diarrhea: A Case Report

Dalal, Nimit; Athwal, Pal Satyajit Singh; Tharu, Biswaraj; Shah, Parth D.; Shah, Love

doi:10.7759/cureus.10593

Cited by 3 publications

(2 citation statements)

References 9 publications

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“… 8 There are also reports of cases in which the first presentation was with gastrointestinal symptoms. 9 The diagnosis of Legionella pneumonia is based on intrapulmonary and extrapulmonary clinical manifestations and CT imaging pattern of lung infiltrates, positive laboratory cultures of Legionella spp. in sputum, blood or pleural fluid (on special media); or fluorescent antibodies in respiratory secretions; or 4-fold increase or decrease in IgG titer by indirect fluorometric examination of blood (or IgG antibody titer ≥1:128).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Water-Contaminated Severe Legionella Pneumonia with Digestive Symptoms as the First Symptom: A Case Report and Review of the Literature

Fan

Shuai

et al. 2023

IDR

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Introduction Although Legionella is not the most common pathogen of community-acquired pneumonia, the epidemiological distribution of pneumonia pathogens has changed in recent years, with a gradual increase in some rare pathogens. For example, pneumonia that occurs after water source contamination is mostly caused by Legionella infection. This paper reports the diagnosis and treatment process of a patient after Legionella infection, who had misdiagnosis at the beginning, rapidly progressed to severe disease and combined with fungal infection. This article focuses on the timely and effective treatment of rapidly progressing Legionella pneumonia, in anticipation of a better understanding of the diagnosis and treatment of the disease. Case Presentation Here, we report a case of legionella infection with the nausea, vomiting as the first symptoms accompanied by weakness, chills, dizziness, abdominal discomfort in a 75-year-old female. The patient had a history of type 2 diabetes for 30 years, diabetic peripheral neuropathy for more than 20 years, arterial hypertension for 10 years, bone hyperplasia for more than 5 years, resection of right-sided thyroid cystadenoma in 1990. The patient had firstly been diagnosed with cholecystitis and gallbladder neck stones, diet abstinence, metronidazole, cefoperazone sulbactam, and rehydration were given. The patient responded poorly to these empiric treatments. The patient was given moxifloxacin in combination with azithromycin after the onset of respiratory symptoms, but the condition continued to deteriorate, and tigecycline was subsequently added. After the mechanical ventilation and the treatment plan adjusting, she improved significantly. Conclusion Immunocompromised patient combined with underlying diseases are more susceptible to infection in an environment contaminated with Legionella, and the rapid onset and atypical respiratory symptoms make it easy to misdiagnose the disease, thus delaying treatment and leading to further deterioration. Timely diagnosis, early mechanical ventilation and rational drug administration were fundamental to treat Legionella pneumonia.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Water-Contaminated Severe Legionella Pneumonia with Digestive Symptoms as the First Symptom: A Case Report and Review of the Literature

Fan

Shuai

et al. 2023

IDR

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“…Some patients with immune suppression such as due to a kidney transplant or with SLE developed pulmonary abscess and pleural empyema [ 105 , 106 ]. Gastrointestinal manifestations such as watery diarrhea and sudden abdominal pain can be the presenting symptoms in patients with LD [ 107 ]. L. pneumophila , along with other intracellular pathogens, shares the propensity to produce relative bradycardia in the presence of fever.…”

Section: Clinical Manifestationmentioning

confidence: 99%

Legionella pneumophila: The Journey from the Environment to the Blood

Iliadi

Staykova

Iliadis

et al. 2022

JCM

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An outbreak of a potentially fatal form of pneumonia in 1976 and in the annual convention of the American Legion was the first time that Legionella spp. was identified. Thereafter, the term Legionnaires’ disease (LD) was established. The infection in humans is transmitted by the inhalation of aerosols that contain the microorganisms that belong to the Legionellaceae family and the genus Legionella. The genus Legionella contains genetically heterogeneous species and serogroups. The Legionella pneumophila serogroup 1 (Lp1) is the most often detected strain in outbreaks of LD. The pathogenesis of LD infection initiates with the attachment of the bacterial cells to the host cells, and subsequent intracellular replication. Following invasion, Legionella spp. activates its virulence mechanisms: generation of specific compartments of Legionella-containing vacuole (LCV), and expression of genes that encode a type IV secretion system (T4SS) for the translocation of proteins. The ability of L. pneumophila to transmigrate across the lung’s epithelium barrier leads to bacteremia, spread, and invasion of many organs with subsequent manifestations, complications, and septic shock. The clinical manifestations of LD depend on the bacterial load in the aerosol, the virulence factors, and the immune status of the patient. The infection has two distinct forms: the non- pneumatic form or Pontiac fever, which is a milder febrile flu-like illness, and LD, a more severe form, which includes pneumonia. In addition, the extrapulmonary involvement of LD can include heart, brain, abdomen, and joints.

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An Insight into the Microbiology, Epidemiology, and Host Cell Biology of Legionella Pneumophila: A Review of Literature

Alrahimi

Aldahlawi

Hassoubah

et al. 2022

Biosci., Biotech. Res. Asia

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Legionnaires’ disease (LD) is a type of severe pneumonia that mainly caused by bacteria of the genus Legionella. LD bacteria reside in the water systems of facilities where lack of water exchange or flow plays a crucial role in enhancing bacterial growth. The under-recognition of the dangers of Legionella along with easing of Coronavirus disease 2019 (COVID-19) lockdown restrictions and global reopening, pose a potential increased risk of developing LD. Various Legionella species can lead to legionellosis infections, including LD and Pontiac fever. Legionellosis cases is generally found in natural or artificial aquatic environments such as cooling towers, hot water tanks, or air conditioning. The bacteria elude the host’s immune responses by various strategies, including releasing effector proteins. Thus, this review provides insight into the microbiology, epidemiology, and host cell biology of L. pneumophila, as well as an emphasis on the bacterial novel survival strategies of L. pneumophila. Also, suggests taking intensive actions towards closed buildings as a potential source of bacterial infection.

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Legionnaires Disease Presenting as Diarrhea: A Case Report

Cited by 3 publications

References 9 publications

Diagnosis and Treatment of Water-Contaminated Severe Legionella Pneumonia with Digestive Symptoms as the First Symptom: A Case Report and Review of the Literature

Diagnosis and Treatment of Water-Contaminated Severe Legionella Pneumonia with Digestive Symptoms as the First Symptom: A Case Report and Review of the Literature

Legionella pneumophila: The Journey from the Environment to the Blood

An Insight into the Microbiology, Epidemiology, and Host Cell Biology of Legionella Pneumophila: A Review of Literature

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