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Isolation of Legionella maceachernii from an immunocompromised patient with severe underlying lung disease
W H Merrell1, A Moritz, H L Butt
1Newcastle Mater Misericordiae Hospital, Waratah, NSW.
Objective:
To present the first case in Australia in which Legionella maceachernii has been documented as a cause of infection.
Clinical Features:
A 71-year-old retired carpenter with underlying autoimmune disease and pulmonary fibrosis was admitted to hospital with increasing shortness of breath and fever, and pneumonia was diagnosed.
Intervention And Outcome:
He was treated with ampicillin then gentamicin and flucloxacillin and later imipenem but his condition deteriorated with progression of the pneumonia and abscess formation and he died 25 days after admission. Subsequently, L. maceachernii was isolated from three sputum samples collected before the patient died.
Conclusion:
There is a need for clinical awareness of the value of sputum culture in the diagnosis of infection due to Legionella spp. other than L. pneumophila.
Insights
This case report details the first documented infection caused by Legionella maceachernii in Australia. The patient
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Case Study
Background:
- Legionella species are known causes of pneumonia.
- Legionella pneumophila is the most common species identified in human infections.
- Other Legionella species are increasingly recognized as potential pathogens.
Observation:
- A 71-year-old male with autoimmune disease and pulmonary fibrosis presented with pneumonia.
- Despite broad-spectrum antibiotic treatment, the patient's condition worsened, leading to abscess formation and death.
- Legionella maceachernii was isolated from sputum samples post-mortem.
Findings:
- This case represents the first documentation of Legionella maceachernii infection in Australia.
- The patient's clinical presentation and treatment failure highlight the challenges in diagnosing and managing infections caused by less common Legionella species.
- Sputum culture proved crucial for identifying the causative agent.
Implications:
- Clinicians should consider Legionella species beyond L. pneumophila in the differential diagnosis of pneumonia, especially in immunocompromised patients.
- The diagnostic value of sputum culture for identifying atypical Legionella infections warrants emphasis.
- Increased awareness and diagnostic vigilance are necessary for Legionella spp. other than L. pneumophila.