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Head BM, Trajtman A, Bernard K, Burdz T, Vélez L, Herrera M, Rueda ZV, Keynan Y. Legionella co-infection in HIV-associated pneumonia. Diagn Microbiol Infect Dis 2019; 95:71-76. [PMID: 31072645 DOI: 10.1016/j.diagmicrobio.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/04/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
Due to poor diagnostics and increased co-infections, HIV-associated Legionella infections are underreported. We aimed to retrospectively determine the frequency of Legionella infections in bronchoalveolar lavage (BAL) from HIV-associated pneumonia patients hospitalized in Medellin, Colombia, between February 2007 and April 2014. Although culture was negative, 17 BAL (36%) were positive for Legionella by quantitative polymerase chain reaction, most of which were in the Mycobacterium tuberculosis or Pneumocystis jirovecii co-infected patients, and included L. anisa (n = 6), L. bozemanae (n = 4), L. pneumophila (n = 3), and L. micdadei (n = 2). All L. bozemanae and L. micdadei associated with Pneumocystis, while all L. pneumophila associated with M. tuberculosis. Legionella probable cases had more complications and higher mortality rates (P = 0.02) and were rarely administered empirical anti-Legionella therapy while in hospital. Clinicians should be aware of the possible presence of Legionella in HIV and M. tuberculosis or P. jirovecii co-infected patients.
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Affiliation(s)
- Breanne M Head
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Adriana Trajtman
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Kathryn Bernard
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada; Special Bacteriology Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
| | - Tamara Burdz
- Special Bacteriology Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
| | - Lázaro Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Universidad de Antioquia, Medellín, Antioquia, Colombia.
| | - Mariana Herrera
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia.
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada; Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia; Department of Internal Medicine and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Head BM, Trajtman A, Rueda ZV, Vélez L, Keynan Y. Atypical bacterial pneumonia in the HIV-infected population. Pneumonia (Nathan) 2017; 9:12. [PMID: 28856082 PMCID: PMC5571654 DOI: 10.1186/s41479-017-0036-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/13/2017] [Indexed: 01/02/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected individuals are more susceptible to respiratory tract infections by other infectious agents (viruses, bacteria, parasites, and fungi) as their disease progresses to acquired immunodeficiency syndrome. Despite effective antiretroviral therapy, bacterial pneumonia (the most frequently occurring HIV-associated pulmonary illness) remains a common cause of morbidity and mortality in the HIV-infected population. Over the last few decades, studies have looked at the role of atypical bacterial pneumonia (i.e. pneumonia that causes an atypical clinical presentation or responds differently to typical therapeutics) in association with HIV infection. Due to the lack of available diagnostic strategies, the lack of consideration, and the declining immunity of the patient, HIV co-infections with atypical bacteria are currently believed to be underreported. Thus, following an extensive database search, this review aimed to highlight the current knowledge and gaps regarding atypical bacterial pneumonia in HIV. The authors discuss the prevalence of Chlamydophila pneumoniae, Mycoplasma pneumoniae, Coxiella burnetii, Legionella species and others in the HIV-infected population as well as their clinical presentation, methods of detection, and treatment. Further studies looking at the role of these microbes in association with HIV are required. Increased knowledge of these atypical bacteria will lead to a more rapid diagnosis of these infections, resulting in an improved quality of life for the HIV-infected population.
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Affiliation(s)
- Breanne M. Head
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Adriana Trajtman
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Zulma V. Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Lázaro Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Universidad de Antioquia UdeA, Medellin, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Palusińska-Szysz M, Cendrowska-Pinkosz M. Pathogenicity of the family Legionellaceae. Arch Immunol Ther Exp (Warsz) 2009; 57:279-90. [DOI: 10.1007/s00005-009-0035-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 01/30/2009] [Indexed: 10/20/2022]
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Sandkovsky U, Sandkovsky G, Suh J, Smith B, Sharp V, Polsky B. Legionella pneumonia and HIV: case reports and review of the literature. AIDS Patient Care STDS 2008; 22:473-81. [PMID: 18462074 DOI: 10.1089/apc.2007.0111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although Legionnaires' disease occurs more commonly in patients with some degree of immunosuppression (diabetes, chronic lung disease, end stage renal disease, cancer, etc.), it has been infrequently described in patients infected with human immunodeficiency virus (HIV) and AIDS. Some studies suggest that pneumonia caused by Legionella tends to present with more severe clinical features and complications in the HIV-infected population. The use of antibiotic prophylaxis or the association of severe pneumonia with other pathogens may account for under diagnosis of the disease. We diagnosed five cases of Legionella pneumonia in patients with HIV infection at our institution during a 1-year period. The cases seen ranged in severity, regardless of the CD4(+) counts of the patients. Based on our observations, it seems impossible to discern whether HIV infection is an additional risk factor for Legionnaires' disease. We describe those five cases and review the available literature.
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Affiliation(s)
- Uriel Sandkovsky
- Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Gabriel Sandkovsky
- Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Jin Suh
- Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center New York, New York
- Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center New York, New York
- Center for Comprehensive Care, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Barbara Smith
- Department of Infection Control, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Victoria Sharp
- Center for Comprehensive Care, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Bruce Polsky
- Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center New York, New York
- Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center New York, New York
- Department of Infection Control, St. Luke's-Roosevelt Hospital Center New York, New York
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Benito Hernández N, Moreno Camacho A, Gatell Artigas JM. [Infectious pulmonary complications in HIV-infected patients in the high by active antiretroviral therapy era in Spain]. Med Clin (Barc) 2005; 125:548-55. [PMID: 16266640 DOI: 10.1157/13080461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary complications in HIV-infected patients are at present a first-rate problem. They are the main cause of hospital admission of these patients in our country. Most HIV-patients have a pulmonary complication during the evolution of the infection. The main etiologic diagnosis is bacterial pneumonia, especially pneumococcal pneumonia; the second most frequent cause is Pneumocystis jiroveci (previously named P. carinii) pneumonia and the third cause is mycobacteriosis, particularly Mycobacterium tuberculosis. From early studies, important changes in the epidemiology of HIV-related pulmonary complications have occurred. General prescription of P. jiroveci primary prophylaxis is probably one of the main causes, and, more recently, the use of highly active antiretroviral therapy may also be an underlying explanation. In this review, epidemiology, diagnosis and outcome of HIV-related pulmonary complications in our country are update.
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Pedro-Botet ML, Sabrià M, Sopena N, García-Núñez M, Dominguez MJ, Reynaga E, Rey-Joly C. Legionnaires disease and HIV infection. Chest 2003; 124:543-7. [PMID: 12907540 DOI: 10.1378/chest.124.2.543] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To compare the outcome of Legionnaires disease (LD) in patients with and without HIV infection. DESIGN Retrospective review of clinical charts. SETTING Six hundred-bed university hospital. PATIENTS We studied the clinical findings of 64 patients without HIV and 15 patients with HIV. Patients with a serologic diagnosis only were not included. Patients with previous immunosuppressive therapy or transplant recipients were excluded from the former group. In the HIV group, the mean CD4 cell count was 347.5/ microL, plasma viral load was undetectable in 50% of the patients, and only one patient (7%) was receiving cotrimoxazole as prophylaxis against Pneumocystis carinii at the time of pneumonia. No differences were observed in the two groups with respect to community or nosocomial acquisition, delay in the initiation of appropriate treatment, the use of macrolides or fluoroquinolones, and Fine score in cases of community-acquired LD. RESULTS Univariate analysis showed that time to apyrexia was longer, and respiratory symptoms, bilateral infiltrates in chest radiograph, hyponatremia, increase in aspartate aminotransferase and creatine phosphokinase (CK), and respiratory failure were more frequent in the HIV group. Mortality was greater in patients with HIV, achieving a statistically significant value of 20%; however, multivariate analysis only confirmed these differences with respect to the increase in CK. CONCLUSIONS LD has a more severe clinical presentation and worse evolution in patients with HIV.
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Affiliation(s)
- Maria Luisa Pedro-Botet
- Infectious Disease Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma, Badalona, Spain.
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Fields BS, Benson RF, Besser RE. Legionella and Legionnaires' disease: 25 years of investigation. Clin Microbiol Rev 2002; 15:506-26. [PMID: 12097254 PMCID: PMC118082 DOI: 10.1128/cmr.15.3.506-526.2002] [Citation(s) in RCA: 1089] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There is still a low level of clinical awareness regarding Legionnaires' disease 25 years after it was first detected. The causative agents, legionellae, are freshwater bacteria with a fascinating ecology. These bacteria are intracellular pathogens of freshwater protozoa and utilize a similar mechanism to infect human phagocytic cells. There have been major advances in delineating the pathogenesis of legionellae through the identification of genes which allow the organism to bypass the endocytic pathways of both protozoan and human cells. Other bacteria that may share this novel infectious process are Coxiella burnetti and Brucella spp. More than 40 species and numerous serogroups of legionellae have been identified. Most diagnostic tests are directed at the species that causes most of the reported human cases of legionellosis, L. pneumophila serogroup 1. For this reason, information on the incidence of human respiratory disease attributable to other species and serogroups of legionellae is lacking. Improvements in diagnostic tests such as the urine antigen assay have inadvertently caused a decrease in the use of culture to detect infection, resulting in incomplete surveillance for legionellosis. Large, focal outbreaks of Legionnaires' disease continue to occur worldwide, and there is a critical need for surveillance for travel-related legionellosis in the United States. There is optimism that newly developed guidelines and water treatment practices can greatly reduce the incidence of this preventable illness.
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Affiliation(s)
- Barry S Fields
- Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Sabria M, Yu VL. Hospital-acquired legionellosis: solutions for a preventable infection. THE LANCET. INFECTIOUS DISEASES 2002; 2:368-73. [PMID: 12144900 DOI: 10.1016/s1473-3099(02)00291-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hospital-acquired Legionnaires' disease has been reported from many hospitals since the first outbreak in 1976. Although cooling towers were linked to the cases of Legionnaires' disease in the years after its discovery, potable water has been the environmental source for almost all reported hospital outbreaks. Microaspiration is the major mode of transmission in hospital-acquired Legionnaires' disease; showering is not a mode of transmission. Since the clinical manifestations are non-specific, and specialised laboratory testing is required, hospital-acquired legionellosis is easily underdiagnosed. Discovery of a single case of hospital-acquired Legionnaires' disease is an important sentinel of additional undiscovered cases. Routine environmental culture of the hospital water supply for legionella has proven to be an important strategy in prevention. Documentation of legionella colonisation in the water supply would increase physician index of suspicion for Legionnaires' disease and the necessity for in-house legionella test methods would be obvious. Legionella is a common commensal of large-building water supplies. Preventive maintenance is commonly recommended; unfortunately, this measure is ineffective in minimising legionella colonisation of building water supplies. Copper-silver ionisation systems have emerged as the most successful long-term disinfection method for hospital water disinfection systems. There is a need for public-health agencies to educate the public and media that discovery of cases identifies those hospitals as providers of superior care, and that such hospitals are not negligent.
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Affiliation(s)
- Miguel Sabria
- Hospital Universitario Germans Trias I Pujol and the Autonomous University of Barcelona, Badalona, Spain
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Abstract
The number of HIV-infected persons who travel to the developing world is increasing. Pleasure, business, other work, and illness or death in families brings these special travelers to all corners of the world.1,2 Health care providers should ask patients who are seeking advice whether they are HIV-infected or at risk so that these travelers can be adequately protected and prepared. In most instances international travel is feasible, but in some cases itineraries may be modified or additional recommendations may be given to make trips safer and more enjoyable. This paper reviews the health problems that persons with HIV infection may face during international travel, and their prevention.
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