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Simultaneous infection with Legionella pneumophila and Pittsburgh pneumonia agent. Clinical features and
Abstract:
Nosocomial pneumonia caused simultaneously by two organisms, Legionella pneumophila and the Pittsburgh pneumonia agent, was documented in seven patients in one institution. In all seven cases, both organisms were demonstrated by isolation from culture or visualization by direct immunofluorescence. Four patients died as a result of pneumonia, including two who received erythromycin therapy. The hospital water distribution system appeared to be the reservoir for both L. pneumophila and Pittsburgh pneumonia agent. These seven cases constituted 26.9 percent and 17.9 percent of the cases of Pittsburgh pneumonia agent and Legionnaires' disease, respectively, at one institution. Given this relatively high incidence of dual infection, it is likely that the mode of transmission for both organisms is identical. Dual infection may account for some cases of antibody response to more than one Legionella species. Historical parallels of the discovery of L. pneumophila and Pittsburgh pneumonia agent are reviewed.
Insights
Dual nosocomial pneumonia caused by Legionella pneumophila and Pittsburgh pneumonia agent occurred in seven patients. The hospital water system was the likely reservoir for both pathogens, suggesting identical transmission routes.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- Nosocomial pneumonia can be caused by various pathogens, including Legionella species.
- The Pittsburgh pneumonia agent (PPA) is an uncommon cause of pneumonia.
- Simultaneous infections with multiple respiratory pathogens can complicate diagnosis and treatment.
Purpose of the Study:
- To report on cases of simultaneous nosocomial pneumonia caused by Legionella pneumophila and the Pittsburgh pneumonia agent.
- To investigate the potential reservoir and transmission routes for both pathogens.
- To assess the clinical outcomes and implications of dual infections.
Main Methods:
- Case documentation of seven patients with dual infections.
- Isolation of pathogens by culture.
- Visualization of pathogens by direct immunofluorescence.
- Epidemiological investigation of the hospital water distribution system.
Main Results:
- Seven cases of dual Legionella pneumophila and Pittsburgh pneumonia agent infection were identified.
- Both pathogens were confirmed by culture and/or direct immunofluorescence.
- The hospital water system was implicated as the reservoir for both organisms.
- Four patients died from pneumonia, with two receiving erythromycin therapy.
- Dual infections represented a significant proportion of PPA and Legionnaires' disease cases at the institution.
Conclusions:
- The hospital water system is a likely common reservoir for Legionella pneumophila and the Pittsburgh pneumonia agent.
- Identical transmission routes are probable for both pathogens, leading to dual infections.
- Dual infections may influence serological responses and complicate the understanding of Legionella species infections.