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Sporadic and epidemic community legionellosis: two faces of the same illness

¹ Infectious Diseases Unit, Germans Trias i Pujol University Hospital, Badalona, ² Internal Medicine Department, and ³ Microbiology Laboratory, Mataró Hospital, Mataró, Barcelona, Spain.

CORRESPONDENCE: N. Sopena, Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol. C/ Canyet s/n., 08916 Badalona, Barcelona, Spain. Fax: 34 934978843. E-mail: nsopena.germanstrias{at}gencat.net

Keywords: Community-acquired pneumonia, Legionella, Legionella pneumophila, legionnaires' disease, outbreak, urinary antigen

Received: June 13, 2006
Accepted September 9, 2006

The present study compares the risk factors, presentation and outcome of community-acquired Legionella pneumophila pneumonia in 138 sporadic-case patients (1994–2004) and 113 outbreak-case patients (2002) treated in two hospitals in Catalonia (Spain) since urinary antigen assays were adopted.

Univariate and multivariate analysis were performed to compare epidemiological and clinical features, blood chemistry values, radiological findings and outcome of sporadic and epidemic legionnaires' disease.

Univariate analysis showed that male sex, chronic lung disease, HIV infection and immunosuppressive therapy prevailed in sporadic cases. Presentation with respiratory symptoms, confusion and blood chemistry alterations, such as hyponatraemia, aspartate aminotransferase and blood urea nitrogen elevation, and partial pressure of oxygen P_O2 <7.98 KPa (60 mmHg) were also more frequent in sporadic cases, while headache prevailed in outbreak cases. Sporadic cases had a greater delay in treatment, were more severe and had a worse outcome than epidemic cases. Multivariate analysis showed significant differences in sex, chronic lung disease, HIV infection and headache.

The clinical and outcome differences between the two groups may be explained by the detection of milder forms of legionnaires' disease, the earlier treatment and the lower severity of underlying disease in the outbreak cases.

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				P. Vanhems, S. Pires-Cronenberger, and C. Lasset Sporadic and epidemic community legionellosis: two faces of the same illness Eur. Respir. J., October 1, 2007; 30(4): 813 - 813. [Full Text] [PDF]