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Recurrent infection due to Legionella pneumophila in a patient with AIDS
J N Morley1, L C Smith, A L Baltch
1Department of Medicine, Stratton Veterans Affairs Medical Center, Albany, New York.
Abstract:
We report a patient with AIDS who presented with community-acquired cavitary Legionella pneumophila pneumonia. The patient recovered after an extended course of treatment with macrolide antibiotics. He returned to the hospital 4 months later with a febrile illness. Chest radiograms appeared normal. Cultures of blood yielded L. pneumophila. The isolate from blood was indistinguishable from the isolate from sputum taken during the first infection, as shown by restriction-endonuclease analysis and pulsed-field gel electrophoresis. These data suggest that the second infection represented reactivation of a persistent focus of infection that was not apparent when the patient had pneumonia.
Insights
A patient with AIDS experienced Legionella pneumophila pneumonia, which recurred months later. Genetic analysis confirmed the second infection was a reactivation, not a new exposure.
Area of Science:
- Infectious Diseases
- Microbiology
- Immunology
Background:
- * AIDS patients are susceptible to opportunistic infections.
- * Legionella pneumophila can cause severe pneumonia.
- * Macrolide antibiotics are a common treatment for Legionella.
Observation:
- * A patient with AIDS presented with cavitary Legionella pneumonia.
- * The patient initially recovered after macrolide treatment.
- * Four months later, the patient had a febrile illness with L. pneumophila detected in blood cultures.
Findings:
- * Genetic analysis (restriction-endonuclease and pulsed-field gel electrophoresis) showed the blood isolate was indistinguishable from the initial sputum isolate.
- * This indicates the second infection was a reactivation of a persistent focus.
- * The persistent focus was not evident on chest imaging during the initial pneumonia.
Implications:
- * Persistent Legionella infections can occur in immunocompromised individuals.
- * Reactivation of Legionella may present without obvious pulmonary findings.
- * This highlights the importance of considering reactivation in recurrent febrile illnesses in AIDS patients.