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Problem pathogens: paediatric legionellosis--implications for improved diagnosis.

David Greenberg1, Christine C Chiou, Ronald Famigilleti

  • 1Soroka University Medical Center, Beer-Sheeva, Israel.

The Lancet. Infectious Diseases
|July 28, 2006
PubMed
Summary

Legionnaires' disease, though rare, causes severe pneumonia in children. Early anti-legionella treatment significantly lowers mortality, highlighting the need for awareness and testing in unresponsive pneumonia cases.

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Area of Science:

  • Pediatric Infectious Diseases
  • Respiratory Medicine
  • Microbiology

Background:

  • Legionnaires' disease is a known cause of adult pneumonia but considered rare in children.
  • Prompt diagnosis and appropriate treatment are crucial for managing severe pediatric respiratory infections.

Purpose of the Study:

  • To review and analyze the epidemiology, clinical features, and treatment outcomes of Legionnaires' disease in children.
  • To assess the mortality rates and identify risk factors associated with Legionnaires' disease in pediatric patients.
  • To emphasize the importance of considering Legionnaires' disease in pediatric pneumonia, especially in unresponsive cases.

Main Methods:

  • Systematic review of medical literature for reported cases of Legionnaires' disease in children.

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  • Analysis of epidemiological data, including age, acquisition source, and underlying conditions.
  • Evaluation of clinical presentation, diagnostic methods, treatment strategies, and patient outcomes, including mortality.

    • Main Results:

    • 76 pediatric cases of Legionnaires' disease were identified, with 56% diagnosed via culture.
    • Community-acquired infections accounted for 46%, and 51.5% of patients were under 2 years old.
    • A high mortality rate of 33% was observed, particularly in infants and immunocompromised children; however, appropriate anti-legionella therapy reduced mortality from 70% to 23%.

    Conclusions:

    • Legionnaires' disease can present severely in children, with no unique clinical features to distinguish it from other pneumonias.
    • Awareness is critical, as empirical antibiotic therapies for pediatric pneumonia are often ineffective against Legionella.
    • Prompt consideration of Legionnaires' disease and specific diagnostic testing are vital for improving outcomes in severe pediatric pneumonia unresponsive to standard treatment.