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Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center
Legionnaires' disease (LD) can be fatal among high‐risk transplant recipients. To understand the epidemiology of LD, we reviewed 15‐year longitudinal data from a center in Seattle, Washington that cares for both solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We...
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| Published in: | Transplant infectious disease 2017-10, Vol.19 (5), p.n/a |
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| container_issue | 5 |
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| container_title | Transplant infectious disease |
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| creator | Sivagnanam, Shobini Podczervinski, Sara Butler‐Wu, Susan M. Hawkins, Vivian Stednick, Zach Helbert, Lois A. Glover, William A. Whimbey, Estella Duchin, Jeffrey Cheng, Guang‐Shing Pergam, Steven A. |
| description | Legionnaires' disease (LD) can be fatal among high‐risk transplant recipients. To understand the epidemiology of LD, we reviewed 15‐year longitudinal data from a center in Seattle, Washington that cares for both solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We identified all laboratory‐confirmed LD and extracted data on species, diagnostic modalities, clinical presentation, management, and outcomes from medical records. Among 32 patients with LD, transplant recipients made up the majority of diagnoses (22, 69%; SOT 10, HCT 12). Approximately 0.8% of transplant recipients who underwent Legionella‐specific testing were positive. Non‐pneumophila Legionella species (LNLP), which are not detected by urinary antigen test, accounted for half the cases, led by Legionella micdadei (32%). The severity and outcome between Legionella pneumophila and LNLP infections were similar (attributed mortality, 36% vs 27%); all LNLP deaths occurred in transplant recipients with L. micdadei. The clinical and radiological features mimicked other opportunistic pathogens; 32% (n=7) were not on empiric treatment at the time of diagnosis. These data add to the emerging literature describing the importance of LD and highlight the need for both routine Legionella testing on transplant recipients with pulmonary findings and empiric Legionella‐active antibiotic therapy. |
| doi_str_mv | 10.1111/tid.12745 |
| format | article |
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To understand the epidemiology of LD, we reviewed 15‐year longitudinal data from a center in Seattle, Washington that cares for both solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We identified all laboratory‐confirmed LD and extracted data on species, diagnostic modalities, clinical presentation, management, and outcomes from medical records. Among 32 patients with LD, transplant recipients made up the majority of diagnoses (22, 69%; SOT 10, HCT 12). Approximately 0.8% of transplant recipients who underwent Legionella‐specific testing were positive. Non‐pneumophila Legionella species (LNLP), which are not detected by urinary antigen test, accounted for half the cases, led by Legionella micdadei (32%). The severity and outcome between Legionella pneumophila and LNLP infections were similar (attributed mortality, 36% vs 27%); all LNLP deaths occurred in transplant recipients with L. micdadei. The clinical and radiological features mimicked other opportunistic pathogens; 32% (n=7) were not on empiric treatment at the time of diagnosis. These data add to the emerging literature describing the importance of LD and highlight the need for both routine Legionella testing on transplant recipients with pulmonary findings and empiric Legionella‐active antibiotic therapy.</description><identifier>ISSN: 1398-2273</identifier><identifier>EISSN: 1399-3062</identifier><identifier>DOI: 10.1111/tid.12745</identifier><identifier>PMID: 28696077</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Aged ; Antibiotics ; Antigens, Bacterial - urine ; Diagnostic systems ; Epidemiology ; Female ; Health risk assessment ; Hematopoietic Stem Cell Transplantation - adverse effects ; Humans ; immunocompromised ; Legionella ; Legionella - isolation & purification ; Legionella micdadei ; Legionnaires disease ; Legionnaires' Disease - complications ; Legionnaires' Disease - epidemiology ; Legionnaires' disease bacterium ; Lung transplantation ; Male ; Medical records ; Middle Aged ; Opportunist infection ; Organ Transplantation - adverse effects ; pneumonia ; Retrospective Studies ; Tertiary Care Centers ; Time Factors ; transplantation ; Washington - epidemiology</subject><ispartof>Transplant infectious disease, 2017-10, Vol.19 (5), p.n/a</ispartof><rights>2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4195-380bb9d0000adb61888d1f5e6e28922a02c47e78e2984522f33f064967ad4d513</citedby><cites>FETCH-LOGICAL-c4195-380bb9d0000adb61888d1f5e6e28922a02c47e78e2984522f33f064967ad4d513</cites><orcidid>0000-0003-1028-7087</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftid.12745$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftid.12745$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28696077$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sivagnanam, Shobini</creatorcontrib><creatorcontrib>Podczervinski, Sara</creatorcontrib><creatorcontrib>Butler‐Wu, Susan M.</creatorcontrib><creatorcontrib>Hawkins, Vivian</creatorcontrib><creatorcontrib>Stednick, Zach</creatorcontrib><creatorcontrib>Helbert, Lois A.</creatorcontrib><creatorcontrib>Glover, William A.</creatorcontrib><creatorcontrib>Whimbey, Estella</creatorcontrib><creatorcontrib>Duchin, Jeffrey</creatorcontrib><creatorcontrib>Cheng, Guang‐Shing</creatorcontrib><creatorcontrib>Pergam, Steven A.</creatorcontrib><title>Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center</title><title>Transplant infectious disease</title><addtitle>Transpl Infect Dis</addtitle><description>Legionnaires' disease (LD) can be fatal among high‐risk transplant recipients. To understand the epidemiology of LD, we reviewed 15‐year longitudinal data from a center in Seattle, Washington that cares for both solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We identified all laboratory‐confirmed LD and extracted data on species, diagnostic modalities, clinical presentation, management, and outcomes from medical records. Among 32 patients with LD, transplant recipients made up the majority of diagnoses (22, 69%; SOT 10, HCT 12). Approximately 0.8% of transplant recipients who underwent Legionella‐specific testing were positive. Non‐pneumophila Legionella species (LNLP), which are not detected by urinary antigen test, accounted for half the cases, led by Legionella micdadei (32%). The severity and outcome between Legionella pneumophila and LNLP infections were similar (attributed mortality, 36% vs 27%); all LNLP deaths occurred in transplant recipients with L. micdadei. The clinical and radiological features mimicked other opportunistic pathogens; 32% (n=7) were not on empiric treatment at the time of diagnosis. These data add to the emerging literature describing the importance of LD and highlight the need for both routine Legionella testing on transplant recipients with pulmonary findings and empiric Legionella‐active antibiotic therapy.</description><subject>Aged</subject><subject>Antibiotics</subject><subject>Antigens, Bacterial - urine</subject><subject>Diagnostic systems</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Humans</subject><subject>immunocompromised</subject><subject>Legionella</subject><subject>Legionella - isolation & purification</subject><subject>Legionella micdadei</subject><subject>Legionnaires disease</subject><subject>Legionnaires' Disease - complications</subject><subject>Legionnaires' Disease - epidemiology</subject><subject>Legionnaires' disease bacterium</subject><subject>Lung transplantation</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Opportunist infection</subject><subject>Organ Transplantation - adverse effects</subject><subject>pneumonia</subject><subject>Retrospective Studies</subject><subject>Tertiary Care Centers</subject><subject>Time Factors</subject><subject>transplantation</subject><subject>Washington - epidemiology</subject><issn>1398-2273</issn><issn>1399-3062</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp1kc1O3DAUhS1U1KG0C16gstQFZRGwHcc_3SEKBWkkNtN15IlvkEeZJLUdqtnxCH1GnqQXZmCBxNnYsr575HMPIUecnXLUWQ7-lAstqz1ywEtri5Ip8eH5bgohdDkjn1JaMca1lfYjmQmjrGJaH5D1HO7C0PcuREjH1IcELgENPc3R9WnsXJ9phCaMAfqcftBzyqvHh38bcBHfcxzSCE0O90BTnvzmadLRDDEHFzdItBCj62iD0xA_k_3WdQm-7M5D8vvqcnFxXcxvf91cnM-LRnJbFaVhy6X1DOX8UnFjjOdtBQqEsUI4JhqpQRsQ1shKiLYsW6akVdp56SteHpLvW98xDn8mSLleh9RAh2lgmFLNLW5CcV0pRL-9QVfDFHv8HVJSWZQUSJ1sqQYDJ0xVjzGsMWHNWf3UQY0d1M8dIPt15zgt1-BfyZelI3C2Bf6GDjbvO9WLm59by__sqpC5</recordid><startdate>201710</startdate><enddate>201710</enddate><creator>Sivagnanam, Shobini</creator><creator>Podczervinski, Sara</creator><creator>Butler‐Wu, Susan M.</creator><creator>Hawkins, Vivian</creator><creator>Stednick, Zach</creator><creator>Helbert, Lois A.</creator><creator>Glover, William A.</creator><creator>Whimbey, Estella</creator><creator>Duchin, Jeffrey</creator><creator>Cheng, Guang‐Shing</creator><creator>Pergam, Steven A.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1028-7087</orcidid></search><sort><creationdate>201710</creationdate><title>Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center</title><author>Sivagnanam, Shobini ; Podczervinski, Sara ; Butler‐Wu, Susan M. ; Hawkins, Vivian ; Stednick, Zach ; Helbert, Lois A. ; Glover, William A. ; Whimbey, Estella ; Duchin, Jeffrey ; Cheng, Guang‐Shing ; Pergam, Steven A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4195-380bb9d0000adb61888d1f5e6e28922a02c47e78e2984522f33f064967ad4d513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Antibiotics</topic><topic>Antigens, Bacterial - urine</topic><topic>Diagnostic systems</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Hematopoietic Stem Cell Transplantation - adverse effects</topic><topic>Humans</topic><topic>immunocompromised</topic><topic>Legionella</topic><topic>Legionella - isolation & purification</topic><topic>Legionella micdadei</topic><topic>Legionnaires disease</topic><topic>Legionnaires' Disease - complications</topic><topic>Legionnaires' Disease - epidemiology</topic><topic>Legionnaires' disease bacterium</topic><topic>Lung transplantation</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Opportunist infection</topic><topic>Organ Transplantation - adverse effects</topic><topic>pneumonia</topic><topic>Retrospective Studies</topic><topic>Tertiary Care Centers</topic><topic>Time Factors</topic><topic>transplantation</topic><topic>Washington - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sivagnanam, Shobini</creatorcontrib><creatorcontrib>Podczervinski, Sara</creatorcontrib><creatorcontrib>Butler‐Wu, Susan M.</creatorcontrib><creatorcontrib>Hawkins, Vivian</creatorcontrib><creatorcontrib>Stednick, Zach</creatorcontrib><creatorcontrib>Helbert, Lois A.</creatorcontrib><creatorcontrib>Glover, William A.</creatorcontrib><creatorcontrib>Whimbey, Estella</creatorcontrib><creatorcontrib>Duchin, Jeffrey</creatorcontrib><creatorcontrib>Cheng, Guang‐Shing</creatorcontrib><creatorcontrib>Pergam, Steven A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant infectious disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sivagnanam, Shobini</au><au>Podczervinski, Sara</au><au>Butler‐Wu, Susan M.</au><au>Hawkins, Vivian</au><au>Stednick, Zach</au><au>Helbert, Lois A.</au><au>Glover, William A.</au><au>Whimbey, Estella</au><au>Duchin, Jeffrey</au><au>Cheng, Guang‐Shing</au><au>Pergam, Steven A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center</atitle><jtitle>Transplant infectious disease</jtitle><addtitle>Transpl Infect Dis</addtitle><date>2017-10</date><risdate>2017</risdate><volume>19</volume><issue>5</issue><epage>n/a</epage><issn>1398-2273</issn><eissn>1399-3062</eissn><notes>Funding information</notes><notes>This work was supported by the Joseph Thornton Tweddle Research Entry Scholarship through the Royal Australasian College of Physicians Foundation to S.S.</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Legionnaires' disease (LD) can be fatal among high‐risk transplant recipients. To understand the epidemiology of LD, we reviewed 15‐year longitudinal data from a center in Seattle, Washington that cares for both solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We identified all laboratory‐confirmed LD and extracted data on species, diagnostic modalities, clinical presentation, management, and outcomes from medical records. Among 32 patients with LD, transplant recipients made up the majority of diagnoses (22, 69%; SOT 10, HCT 12). Approximately 0.8% of transplant recipients who underwent Legionella‐specific testing were positive. Non‐pneumophila Legionella species (LNLP), which are not detected by urinary antigen test, accounted for half the cases, led by Legionella micdadei (32%). The severity and outcome between Legionella pneumophila and LNLP infections were similar (attributed mortality, 36% vs 27%); all LNLP deaths occurred in transplant recipients with L. micdadei. The clinical and radiological features mimicked other opportunistic pathogens; 32% (n=7) were not on empiric treatment at the time of diagnosis. These data add to the emerging literature describing the importance of LD and highlight the need for both routine Legionella testing on transplant recipients with pulmonary findings and empiric Legionella‐active antibiotic therapy.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28696077</pmid><doi>10.1111/tid.12745</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1028-7087</orcidid></addata></record> |
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| subjects | Aged Antibiotics Antigens, Bacterial - urine Diagnostic systems Epidemiology Female Health risk assessment Hematopoietic Stem Cell Transplantation - adverse effects Humans immunocompromised Legionella Legionella - isolation & purification Legionella micdadei Legionnaires disease Legionnaires' Disease - complications Legionnaires' Disease - epidemiology Legionnaires' disease bacterium Lung transplantation Male Medical records Middle Aged Opportunist infection Organ Transplantation - adverse effects pneumonia Retrospective Studies Tertiary Care Centers Time Factors transplantation Washington - epidemiology |
| title | Legionnaires' disease in transplant recipients: A 15‐year retrospective study in a tertiary referral center |
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