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Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system

BACKGROUND: Because of a limited number of reports, we aimed to investigate the clinical characteristics of patients with Legionella pneumonia due to non-Legionella pneumophila serogroup 1 and the diagnostic usefulness of the six-point scoring system for such patients compared with patients with pne...

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Autores principales: Ito, Akihiro, Ishida, Tadashi, Washio, Yasuyoshi, Yamazaki, Akio, Tachibana, Hiromasa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732474/
https://www.ncbi.nlm.nih.gov/pubmed/29246145
http://dx.doi.org/10.1186/s12890-017-0559-3
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author Ito, Akihiro
Ishida, Tadashi
Washio, Yasuyoshi
Yamazaki, Akio
Tachibana, Hiromasa
author_facet Ito, Akihiro
Ishida, Tadashi
Washio, Yasuyoshi
Yamazaki, Akio
Tachibana, Hiromasa
author_sort Ito, Akihiro
collection PubMed
description BACKGROUND: Because of a limited number of reports, we aimed to investigate the clinical characteristics of patients with Legionella pneumonia due to non-Legionella pneumophila serogroup 1 and the diagnostic usefulness of the six-point scoring system for such patients compared with patients with pneumonia caused by L. pneumophila serogroup 1. METHODS: We retrospectively analysed patients diagnosed with Legionella pneumonia due to non-L. pneumophila serogroup 1 between March 2001 and June 2016. We examined the clinical characteristics, including symptoms, laboratory findings, radiologic findings, pneumonia severity, initial treatment and prognosis. We also calculated scores using the six-point scoring system in these patients. Furthermore, we compared the clinical characteristics and six-point scores between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients among hospitalized community-acquired pneumonia patients enrolled prospectively between October 2010 and July 2016. RESULTS: Eleven patients had pneumonia due to non-L. pneumophila serogroup 1; their median age was 66 years and 8 patients (72.7%) were male. The most common pathogen was L. pneumophila serogroup 3 (6/11), followed by L. pneumophila serogroup 9 (3/11), L. pneumophila serogroup 6 (1/11) and L. longbeachae (1/11). Non-specific symptoms, such as fever and cough, were common. Six patients (54.5%) had liver enzyme elevation, but no patient developed hyponatraemia at <130 mEq/L. Nine patients (81.8%) showed lobar pneumonia and 7 patients (63.6%) manifested with consolidation and ground-glass opacity. Patients with mild to moderate severity comprised 10 (90.9%) by CURB-65 and 5 (45.5%) by the Pneumonia Severity Index. Of all patients, 4 were admitted to the intensive care unit and 3 died despite appropriate empiric therapy. The clinical characteristics were not significantly different between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients (n = 23). At a cut-off value of ≥ 2 points, the sensitivity of the six-point scoring system was 54.5% (6/11) for non-L. pneumophila serogroup 1 patients and 95.7% (22/23) for L. pneumophila serogroup 1 patients. CONCLUSIONS: Cases of non-L. pneumophila serogroup 1 pneumonia varied in severity from mild to severe and the clinical characteristics were often non-specific. The six-point scoring system was not useful in predicting such Legionella pneumonia cases. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12890-017-0559-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-57324742017-12-21 Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system Ito, Akihiro Ishida, Tadashi Washio, Yasuyoshi Yamazaki, Akio Tachibana, Hiromasa BMC Pulm Med Research Article BACKGROUND: Because of a limited number of reports, we aimed to investigate the clinical characteristics of patients with Legionella pneumonia due to non-Legionella pneumophila serogroup 1 and the diagnostic usefulness of the six-point scoring system for such patients compared with patients with pneumonia caused by L. pneumophila serogroup 1. METHODS: We retrospectively analysed patients diagnosed with Legionella pneumonia due to non-L. pneumophila serogroup 1 between March 2001 and June 2016. We examined the clinical characteristics, including symptoms, laboratory findings, radiologic findings, pneumonia severity, initial treatment and prognosis. We also calculated scores using the six-point scoring system in these patients. Furthermore, we compared the clinical characteristics and six-point scores between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients among hospitalized community-acquired pneumonia patients enrolled prospectively between October 2010 and July 2016. RESULTS: Eleven patients had pneumonia due to non-L. pneumophila serogroup 1; their median age was 66 years and 8 patients (72.7%) were male. The most common pathogen was L. pneumophila serogroup 3 (6/11), followed by L. pneumophila serogroup 9 (3/11), L. pneumophila serogroup 6 (1/11) and L. longbeachae (1/11). Non-specific symptoms, such as fever and cough, were common. Six patients (54.5%) had liver enzyme elevation, but no patient developed hyponatraemia at <130 mEq/L. Nine patients (81.8%) showed lobar pneumonia and 7 patients (63.6%) manifested with consolidation and ground-glass opacity. Patients with mild to moderate severity comprised 10 (90.9%) by CURB-65 and 5 (45.5%) by the Pneumonia Severity Index. Of all patients, 4 were admitted to the intensive care unit and 3 died despite appropriate empiric therapy. The clinical characteristics were not significantly different between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients (n = 23). At a cut-off value of ≥ 2 points, the sensitivity of the six-point scoring system was 54.5% (6/11) for non-L. pneumophila serogroup 1 patients and 95.7% (22/23) for L. pneumophila serogroup 1 patients. CONCLUSIONS: Cases of non-L. pneumophila serogroup 1 pneumonia varied in severity from mild to severe and the clinical characteristics were often non-specific. The six-point scoring system was not useful in predicting such Legionella pneumonia cases. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12890-017-0559-3) contains supplementary material, which is available to authorized users. BioMed Central 2017-12-16 /pmc/articles/PMC5732474/ /pubmed/29246145 http://dx.doi.org/10.1186/s12890-017-0559-3 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ito, Akihiro
Ishida, Tadashi
Washio, Yasuyoshi
Yamazaki, Akio
Tachibana, Hiromasa
Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system
title Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system
title_full Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system
title_fullStr Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system
title_full_unstemmed Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system
title_short Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system
title_sort legionella pneumonia due to non-legionella pneumophila serogroup 1: usefulness of the six-point scoring system
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732474/
https://www.ncbi.nlm.nih.gov/pubmed/29246145
http://dx.doi.org/10.1186/s12890-017-0559-3
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