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Legionella in two splenectomized patients. Coincidence or causal relationship?
O Gorelik1, Z Lazarovich, I Boldur
1Dept. of Internal Medicine "F", Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine,Tel Aviv University, Zerifin 70300, Israel. internal6@asaf.health.gov.il
Infection
|June 10, 2004
Summary
Splenectomized patients may develop severe Legionella pneumonia, even when Streptococcus pneumoniae is suspected. Early diagnosis and treatment are critical for survival in these high-risk individuals.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Splenectomy increases susceptibility to encapsulated bacteria like Streptococcus pneumoniae.
- Legionella species are increasingly recognized as causes of pneumonia in immunocompromised individuals.
Observation:
- Two splenectomized patients presented with pneumonia.
- One patient experienced multiorgan failure, with seropositivity for Legionella hackeliae and Legionella longbeachae.
- The second patient was seroreactive for Legionella micdadei.
Findings:
- Legionella species, particularly non-pneumophila strains, can cause severe pneumonia in asplenic patients.
- Legionella pneumonia may be misdiagnosed as Streptococcus pneumoniae pneumonia in this population.
- Splenectomy is identified as a potential predisposing factor for Legionella pneumonia.
Implications:
- Clinicians should consider Legionella in the differential diagnosis of pneumonia in splenectomized patients.
- Prompt empirical antibiotic therapy targeting Legionella is crucial for improving outcomes.
- Diagnostic challenges highlight the need for increased awareness and testing for Legionella in at-risk patients.