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[Pleural empyema caused by Legionella pneumophila]
Abstract:
Although pleural effusion is not uncommon in legionellosis, the development of empyema and the demonstration of the organism in pleural fluid are exceptional. We report four patients with pleural empyema with isolation of Legionella pneumophila in the pleural fluid culture. The patients were three males and one female, with ages ranging from 36 and 83 years. All had left pleuritic pain, fever and pleural effusion. The appearance of pleural effusion was purulent in two cases and serofibrinous in the other two. Initially, the diagnosis was only suspected in one patient. The other three received inadequate treatment, until the result of the culture of the pleural fluid in BCYE-alpha medium was known. After giving erythromycin therapy at high doses, the outcome was favorable in the four patients. It is concluded that, in the absence of another diagnosis, the presence of L. pneumophila should be systematically investigated in the pleural fluid although the disease is not clinically suspected.
Insights
Legionella pneumophila can cause pleural empyema, a rare complication of legionellosis. Prompt diagnosis via pleural fluid culture and erythromycin treatment led to favorable outcomes in four patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Microbiology
Context:
- Pleural effusion is a known complication of legionellosis.
- Empyema and isolation of Legionella in pleural fluid are exceptionally rare.
Purpose:
- To report cases of pleural empyema caused by Legionella pneumophila.
- To highlight the diagnostic and therapeutic approach for this rare condition.
Summary:
- Four patients (3 male, 1 female; ages 36-83) presented with empyema, fever, and pleuritic pain.
- Legionella pneumophila was isolated from pleural fluid cultures (BCYE-alpha medium).
- Diagnosis was challenging; three patients received inadequate initial treatment.
- High-dose erythromycin therapy resulted in favorable outcomes for all four patients.
Impact:
- Suggests systematic investigation of Legionella in unexplained pleural fluid infections.
- Emphasizes the importance of specific microbiological testing for rare pathogens.
- Demonstrates the efficacy of erythromycin in treating Legionella-associated empyema.