Severe Neonatal Legionella Pneumonia: Full Recovery After Extracorporeal Life Support

Abstract

Legionella pneumophila is responsible for hospital or community-acquired pneumonia. Neonatal legionellosis is associated with rapidly severe clinical course and high mortality rates. We describe a case of hospital-acquired Legionella pneumonia in a newborn with undiagnosed tracheoesophageal fistula and acute respiratory failure requiring venovenous extracorporeal membrane oxygenation support before fistula repair. Standardized multiplex polymerase chain reaction assay allowed early diagnosis. Extracorporeal life support associated with appropriate antibiotic therapy, surfactant, and steroid therapy was effective in achieving complete recovery. This is the first report of successful neonatal extracorporeal life support for respiratory failure secondary to L pneumophila.

Legionellosis following water birth in a hot tub in a Canadian neonate

“…Legionella infections have the potential to cause severe lung injury through destruction of surfactant mediated by phospholipase A secretion. 8 Disease is often multilobar and may become cavitary, as in our patient. [2][3][4] Progression to respiratory failure is common (67% among six outbreak cases with abnormal chest imaging 3 ) and infants may end up requiring high-frequency oscillatory ventilation, inhaled nitric oxide or even extracorporeal life support.…”

Severe Pneumonia in Neonates Associated with Legionella pneumophila: Case Report and Review of the Literature

“…Of these, 29 fulfilled the research items of “ Legionella , pneumonia and neonate” (104) as well as “Legionnaires’ disease and neonate” (87) in the title or abstract. The additional search with the keyword “ECMO” identified five reports [ 6 , 7 , 8 , 9 , 10 , 11 ], all already included in our search. Three papers did not fulfill our search criteria.…”

“…In 13 patients (29%), an underlying disease was described, including prematurity [ 3 , 5 , 15 , 21 ], immunodeficiency [ 22 , 23 ], congenital heart disease [ 14 , 18 ], and transesophageal fistula [ 8 ].…”

“…is a rare cause of neonatal pneumonia, but the high mortality rate of 50% in children younger than one year is still being discussed in the literature [ 29 ]. Three cases of successful application of ECMO in neonates affected with severe Legionnaires´ disease are reported in the literature [ 8 , 20 , 23 ]. Dorfmann et al [ 20 ] recommend the use of ECLS early in the course of infection to improve outcomes in this subset of patients.…”

Legionnaire’s Disease in an Immunocompetent Host: An Unlikely Diagnosis

“…5 In fact, the current pediatric literature consists mainly of case reports in immunocompromised children as well as neonates. 6,7 The diagnosis of Legionnaire's disease should prompt thorough history taking in order to identify other potential cases as part of a localized outbreak as well as to identify the potential source of infection. In cases where no community source is identified, physicians should also consider potential in-home sources such as improperly cleaned air humidifiers.…”