Legionellosis classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Legionellosis}} | {{Legionellosis}} | ||
{{CMG}} | {{CMG}}<nowiki> {{AE}]</nowiki>{{TarekNafee}} [[Ogechukwu Hannah Nnabude, MD]] | ||
==Overview== | ==Overview== | ||
[[Legionellosis]] may be classified into three clinically different diseases, all of which vary in disease presentation, organ system affected, and severity: [[Pneumonia|pulmonary infection]] [[(Legionnaires' disease)]], [[Extrapulmonary legionella|extrapulmonary]] infection, and [[Pontiac fever]], which has causes only mild disease. [[Legionellosis]] may also be classified based on the causative species. | |||
==Classification== | ==Classification== | ||
Legionellosis may be classified into three types based upon affected organ systems and clinical presentation: | |||
===Pulmonary Infection (Legionnaires' Disease)=== | |||
[[Legionnaires' disease]] may further be classified into: | |||
:* Community-acquired [[Legionnaires' disease]], which is most commonly caused by ''[[Legionella pneumophila|L. pneumophila]]'' <ref name="pmid18419436">{{cite journal| author=von Baum H, Ewig S, Marre R, Suttorp N, Gonschior S, Welte T | display-authors=etal| title=Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 9 | pages= 1356-64 | pmid=18419436 | doi=10.1086/586741 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419436 }} </ref> | |||
:* Healthcare associated [[Legionnaires' disease]] which is also most commonly caused by ''[[Legionella pneumophila|L. pneumophila]]'' <ref name="pmid3328895">{{cite journal| author=Kirby BD, Harris AA| title=Nosocomial Legionnaires' disease. | journal=Semin Respir Infect | year= 1987 | volume= 2 | issue= 4 | pages= 255-61 | pmid=3328895 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3328895 }} </ref> | |||
:* [[Pittsburgh pneumonia]] which is caused by ''[[Legionella micdadei|L. micdadei]]'' <ref name="pmid7014621">{{cite journal| author=Cordes LG, Myerowitz RL, Pasculle AW, Corcoran L, Thompson TA, Gorman GW | display-authors=etal| title=Legionella micdadei (Pittsburgh pneumonia agent): direct fluoresent-antibody examination of infected human lung tissue and characterization of clinical isolates. | journal=J Clin Microbiol | year= 1981 | volume= 13 | issue= 4 | pages= 720-2 | pmid=7014621 | doi=10.1128/jcm.13.4.720-722.1981 | pmc=273866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7014621 }} </ref> | |||
===Extrapulmonary Legionella Infection=== | |||
[[Legionella]] can [[skin infection]] [[soft tissue infection]], [[endocarditis]], [[wound infection]], [[joint infection]], and [[graft infection]]. | |||
:: | |||
:: | ===Pontiac Fever=== | ||
: | *Pontiac fever produces a mild, self-limiting, non-fatal illness without symptoms or radiologic findings of pneumonia. A comparison of Pontiac fever and Legionnaires' disease is as follows: | ||
:: | |||
:* | {| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" | ||
:* Legionella | | align="center" style="background:#f0f0f0;" |'''Characteristic''' | ||
| align="center" style="background:#f0f0f0;" |'''[[Legionnaires' disease]]''' | |||
| align="center" style="background:#f0f0f0;" |'''[[Pontiac fever]]''' | |||
|- | |||
| Cause||[[Legionella spp|Legionella species]]||[[Legionella spp.|Legionella species]] | |||
|- | |||
| Symptoms||[[Pneumonia]], [[cough]], [[fever]] <ref> Brady MF, Sundareshan V. Legionnaires' Disease. 2021 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28613558 </ref>.||[[Flu]]-like illness ([[fever]], chills, [[malaise]]) without [[pneumonia]] <ref name="pmid15029835">{{cite journal| author=Pancer K, Stypułkowska-Misiurewicz H| title=[Pontiac fever--non-pneumonic legionellosis]. | journal=Przegl Epidemiol | year= 2003 | volume= 57 | issue= 4 | pages= 607-12 | pmid=15029835 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15029835 }} </ref> | |||
|- | |||
| Radiographic evidence of pneumonia||Yes <ref name="pmid18043362">{{cite journal| author=Kim KW, Goo JM, Lee HJ, Lee HY, Park CM, Lee CH | display-authors=etal| title=Chest computed tomographic findings and clinical features of legionella pneumonia. | journal=J Comput Assist Tomogr | year= 2007 | volume= 31 | issue= 6 | pages= 950-5 | pmid=18043362 | doi=10.1097/RCT.0b013e31804b211d | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18043362 }} </ref> <ref name="pmid3328894">{{cite journal| author=Muder RR, Yu VL, Parry MF| title=The radiologic manifestations of Legionella pneumonia. | journal=Semin Respir Infect | year= 1987 | volume= 2 | issue= 4 | pages= 242-54 | pmid=3328894 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3328894 }} </ref>||No <ref name="pmid8855593">{{cite journal| author=Tolentino A, Ahkee S, Ramirez J| title=Hot tub legionellosis. | journal=J Ky Med Assoc | year= 1996 | volume= 94 | issue= 9 | pages= 393-4 | pmid=8855593 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8855593 }} </ref> | |||
|- | |||
| Incubation period||2-14 days after exposure||24-72 hours after exposure | |||
|- | |||
| Attack rate[1]||< 5%||> 90% | |||
|- | |||
| Isolation of organism||Possible||Never | |||
|- | |||
| Outcome||Hospitalization common<br>[[Case fatality rate|Case-fatality rate]]: 5-30% <ref name="pmid19275805">{{cite journal| author=Dominguez A, Alvarez J, Sabria M, Carmona G, Torner N, Oviedo M | display-authors=etal| title=Factors influencing the case-fatality rate of Legionnaires' disease. | journal=Int J Tuberc Lung Dis | year= 2009 | volume= 13 | issue= 3 | pages= 407-12 | pmid=19275805 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19275805 }} </ref>||Hospitalization uncommon<br>Case-fatality rate: 0% <ref name="pmid30061526">{{cite journal| author=Leoni E, Catalani F, Marini S, Dallolio L| title=Legionellosis Associated with Recreational Waters: A Systematic Review of Cases and Outbreaks in Swimming Pools, Spa Pools, and Similar Environments. | journal=Int J Environ Res Public Health | year= 2018 | volume= 15 | issue= 8 | pages= | pmid=30061526 | doi=10.3390/ijerph15081612 | pmc=6121464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30061526 }} </ref> | |||
|} | |||
==Microbiological Classification== | |||
Legionellosis may also be classified based on the infectious species responsible for the disease. Species of ''Legionella'' include: | |||
:*''[[Legionella pneumophila|L. pneumophila]]'' | |||
:*''[[Legionella spp|L. feeleii]]'' | |||
:*''[[Legionella spp|L. sainthelensi]]'' | |||
:*''[[Legionella micdadei|L. micdadei]]'' | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}}{{WS}} | |||
Latest revision as of 13:07, 31 March 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] {{AE}]Tarek Nafee, M.D. [2] Ogechukwu Hannah Nnabude, MD
Overview
Legionellosis may be classified into three clinically different diseases, all of which vary in disease presentation, organ system affected, and severity: pulmonary infection (Legionnaires' disease), extrapulmonary infection, and Pontiac fever, which has causes only mild disease. Legionellosis may also be classified based on the causative species.
Classification
Legionellosis may be classified into three types based upon affected organ systems and clinical presentation:
Pulmonary Infection (Legionnaires' Disease)
Legionnaires' disease may further be classified into:
- Community-acquired Legionnaires' disease, which is most commonly caused by L. pneumophila [1]
- Healthcare associated Legionnaires' disease which is also most commonly caused by L. pneumophila [2]
- Pittsburgh pneumonia which is caused by L. micdadei [3]
Extrapulmonary Legionella Infection
Legionella can skin infection soft tissue infection, endocarditis, wound infection, joint infection, and graft infection.
Pontiac Fever
- Pontiac fever produces a mild, self-limiting, non-fatal illness without symptoms or radiologic findings of pneumonia. A comparison of Pontiac fever and Legionnaires' disease is as follows:
| Characteristic | Legionnaires' disease | Pontiac fever |
| Cause | Legionella species | Legionella species |
| Symptoms | Pneumonia, cough, fever [4]. | Flu-like illness (fever, chills, malaise) without pneumonia [5] |
| Radiographic evidence of pneumonia | Yes [6] [7] | No [8] |
| Incubation period | 2-14 days after exposure | 24-72 hours after exposure |
| Attack rate[1] | < 5% | > 90% |
| Isolation of organism | Possible | Never |
| Outcome | Hospitalization common Case-fatality rate: 5-30% [9] |
Hospitalization uncommon Case-fatality rate: 0% [10] |
Microbiological Classification
Legionellosis may also be classified based on the infectious species responsible for the disease. Species of Legionella include:
References
- ↑ von Baum H, Ewig S, Marre R, Suttorp N, Gonschior S, Welte T; et al. (2008). "Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia". Clin Infect Dis. 46 (9): 1356–64. doi:10.1086/586741. PMID 18419436.
- ↑ Kirby BD, Harris AA (1987). "Nosocomial Legionnaires' disease". Semin Respir Infect. 2 (4): 255–61. PMID 3328895.
- ↑ Cordes LG, Myerowitz RL, Pasculle AW, Corcoran L, Thompson TA, Gorman GW; et al. (1981). "Legionella micdadei (Pittsburgh pneumonia agent): direct fluoresent-antibody examination of infected human lung tissue and characterization of clinical isolates". J Clin Microbiol. 13 (4): 720–2. doi:10.1128/jcm.13.4.720-722.1981. PMC 273866. PMID 7014621.
- ↑ Brady MF, Sundareshan V. Legionnaires' Disease. 2021 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28613558
- ↑ Pancer K, Stypułkowska-Misiurewicz H (2003). "[Pontiac fever--non-pneumonic legionellosis]". Przegl Epidemiol. 57 (4): 607–12. PMID 15029835.
- ↑ Kim KW, Goo JM, Lee HJ, Lee HY, Park CM, Lee CH; et al. (2007). "Chest computed tomographic findings and clinical features of legionella pneumonia". J Comput Assist Tomogr. 31 (6): 950–5. doi:10.1097/RCT.0b013e31804b211d. PMID 18043362.
- ↑ Muder RR, Yu VL, Parry MF (1987). "The radiologic manifestations of Legionella pneumonia". Semin Respir Infect. 2 (4): 242–54. PMID 3328894.
- ↑ Tolentino A, Ahkee S, Ramirez J (1996). "Hot tub legionellosis". J Ky Med Assoc. 94 (9): 393–4. PMID 8855593.
- ↑ Dominguez A, Alvarez J, Sabria M, Carmona G, Torner N, Oviedo M; et al. (2009). "Factors influencing the case-fatality rate of Legionnaires' disease". Int J Tuberc Lung Dis. 13 (3): 407–12. PMID 19275805.
- ↑ Leoni E, Catalani F, Marini S, Dallolio L (2018). "Legionellosis Associated with Recreational Waters: A Systematic Review of Cases and Outbreaks in Swimming Pools, Spa Pools, and Similar Environments". Int J Environ Res Public Health. 15 (8). doi:10.3390/ijerph15081612. PMC 6121464. PMID 30061526.