Successful pediatric ECMO in a rare case of septic shock due to a community-acquired Legionella infection

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

The causative agent of legionellosis is the Gram-negative intracellular bacteria Legionella spp. Its clinical presentation varies from a mild febrile illness called Pontiac fever to the severe and possible fatal pneumonia, Legionnaires’ disease. Immunocompromised patients, in particular, are affected. Only a small number of infected neonates are described in the literature. Most of them have been associated with water birth or the use of air humidifiers. In the last five years, a growing number of cases have been reported in Germany by the national institute of disease surveillance and prevention (Robert-Koch Institute). Here, we describe a fatal case report of pulmonary legionellosis with acute respiratory distress syndrome (ARDS), sepsis, associated cutaneous manifestation, and extracorporeal membrane oxygenation in a full-term neonate. Moreover, we present a review of the literature discussing the epidemiology, risk factors, clinical features, diagnostics, treatment options, and prevention for this rare condition in neonates.

Outcomes of severe Legionella pneumonia requiring extracorporeal membrane oxygenation (ECMO)

BACKGROUND

Legionella pneumonia with acute respiratory failure may necessitate extracorporeal membrane oxygenation (ECMO). The medical literature in this area is comprised primarily of case reports and small case series. Our goal was to summarize published data and contribute our institutional experience regarding survival in severe Legionella pneumonia requiring ECMO.

METHODS

A National Library of Medicine (PubMed) search was conducted, identifying reports of ECMO therapy in patients with severe Legionella pneumonia. Electronic health records of Montefiore Medical Center (Bronx, NY) captured all such patients treated at our institution during the 10-year period 2010-2019.

RESULTS

23 articles reported 73 patients. Survival to hospital discharge was 78.1%. In an attempt to avoid publication bias, we culled from the search four series (53 patients), reporting surviving and non-surviving patients. Survival in this group was 71.7%. Our institutional experience included 10 patients with survival rate 80%.

CONCLUSIONS

Review of clinical experience with ECMO for severe Legionella pneumonia yields a survival rate of over 70%. The similarity in survival rates among all published cases (78.1%), case series reporting surviving and non-surviving patients (71.7%), our institutional experience (80%), and recently reported Extracorporeal Life Support Organization (ELSO) registry data (71%) supports the veracity of this encouraging survival rate.