바로가기메뉴

본문 바로가기 주메뉴 바로가기

Tuberculosis & Respiratory Diseases

Article Contents

Prev Next
e-Submission

Vol.68 No.2
Citation Share

Comparative Study of Pneumonia Caused by Streptococcus pneumonia and Legionella pneumophila

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2010, v.68 no.2, pp.74-79









& (2010). Comparative Study of Pneumonia Caused by Streptococcus pneumonia and Legionella pneumophila. Tuberculosis & Respiratory Diseases, 68(2), 74-79.
  • Downloaded
  • Viewed
PDF Download

Abstract

Background: Legionella pneumophila has been recognized as an important cause of pneumonia. However, limited data are available in the literature regarding legionella pneumonia in Korea. The objective of this study was to compare epidemiological data and clinical presentation of legionella pneumonia and pneumococcal pneumonia. Methods: We retrospectively compared clinical, radiological, and laboratory data, antimicrobial treatment, and treatment outcomes between 28 cases of legionella pneumonia and 56 cases of pneumococcal pneumonia. Diagnoses of both legionella and pneumococcal pneumonia were based on commercial urinary antigen tests. Results: Legionella pneumonia patients included 23 men and 5 women, with a mean age of 61.6 years (range 36∼88). Fifteen were smokers and 26 had some underlying diseases. Legionella pneumonia occurred more frequently in healthcare-associated settings than pneumococcal pneumonia (42.9% vs 21.4%, respectively, p=0.040). There were no significant differences in clinical signs and symptoms. Compared to patients with pneumococcal pneumonia, patients with legionella pneumonia presented more frequently with anemia (39.3% vs 8.9%, p=0.001), increased C-reactive protein (57.1% vs 30.4%, p=0.018) and increased alkaline phosphatase (46.4% vs 16.1%, p=0.003). Also, legionella pneumonia patients more often showed pleural effusion on simple chest X-rays (50.0% vs 12.5%, p＜0.001). Conclusion: Legionella pneumonia and pneumococcal pneumonia can not be distinguished by clinical manifestations alone. However, legionella pneumonia occurred as a healthcare-associated pneumonia more frequently and was more often associated with anemia and increased CRP and alkaline phosphatase levels.

keywords
Legionella, Streptococcus pneumoniae, Pneumonia

Reference

1.

1. Chang FY, Yu VL. Legionella infection. In: Fauci AS,Braundwald E, Kasper DL, Hauser SL, Longo DL,Jameson JL, editors. Harrison's principles of internal medicine. 17th ed. New York: McGraw-Hill Co, Inc.;2008. p. 929-33.

2.

2. Stout JE, Yu VL. Legionellosis. N Engl J Med 1997;337:682-7.

3.

3. Seog W, Jung YJ, Park HW, Lee HK, Park MS, Park MY, et al. A case of community-acquired Legionnaires' disease in a renal transplant recipient. Korean J Infect Dis 1999;31:353-7.

4.

4. Kim MJ, Cheong HJ, Sohn JW, Shim HS, Park DW, Park SC, et al. A prospective multicenter study of the etiological analysis in adults with community-acquired pneumonia: Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi. Korean J Infect Dis 2001;33:24-31.

5.

5. Sohn JW, Cheong HJ, Woo HJ, Kim WJ, You SH, Park SC, et al. A molecular epidemiological study on a cluster of Legionella pneumonia occurred in a tertiary- care hospital. Korean J Infect Dis 1998;30:218-26.

6.

6. Disease Web Statistics System [Internet]. Seoul: Korean Centers for Disease Control and Prevention; 2010.Available from: http://stat.cdc.go.kr.

7.

7. Cunha BA. Atypical pneumonias: current clinical concepts focusing on Legionnaires' disease. Curr Opin Pulm Med 2008;14:183-94.

8.

8. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.

9.

9. Ngeow YF, Suwanjutha S, Chantarojanasriri T, Wang F,Saniel M, Alejandria M, et al. An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. Int J Infect Dis 2005;9:144-53.

10.

10. Ishida T, Hashimoto T, Arita M, Ito I, Osawa M. Etiology of community-acquired pneumonia in hospitalized patients: a 3 year prospective study in Japan. Chest 998;114:1588-93.

11.

11. Chan CH, Cohen M, Pang J. A prospective study of community-acquired pneumonia in Hong Kong. Chest 1992;101:442-6.

12.

12. Fields BS, Benson RF, Besser RE. Legionella and Legionnaires' disease: 25 years of investigation. Clin Microbiol Rev 2002;15:506-26.

13.

13. Den Boer JW, Yzerman EP. Diagnosis of Legionella infection in Legionnaires' disease. Eur J Clin Microbiol Infect Dis 2004;23:871-8.

14.

14. Yzerman EP, den Boer JW, Lettinga KD, Schellekens J, Dankert J, Peeters M, et al. Sensitivity of three urinary antigen tests associated with clinical severity in a large outbreak of Legionnaires' disease in The Netherlands.J Clin Microbiol 2002;40:3232-6.

15.

15. Kim S, Sung H, Kim DJ, Kim MN. Clinical relevance of positive NOWTM Legionella urinary antigen test in a tertiary-care hospital in Korea. Korean J Lab Med 2006;26:93-7.

16.

16. Ercis S, Ergin A, Sahin GO, Hascelik G, Uzun O.Validation of urinary antigen test for Streptococcus pneumoniae in patients with pneumococcal pneumonia.Jpn J Infect Dis 2006;59:388-90.

17.

17. Kang MS, Choi YS, Chong Y, Lee SY. Serum bactericidal and antimicrobial susceptibility test on Legionella pneumophila isolates from cooling tower water. Korean J Clin Pathol 1989;9:137-44.

18.

18. Song HS, Suh JH, Ahn JH, Yoon BI, Lee SJ, Lee MG,et al. The etiological role of Legionella pneumophila in patients with community-acquired pneumonia in Korea. Tuberc Respir Dis 2001;50:409-14.

19.

19. Miller AC. Early clinical differentiation between Legionnaires' disease and other sporadic pneumonias. Ann Intern Med 1979;90:526-8.

20.

20. Helms CM, Viner JP, Sturm RH, Renner ED, Johnson W. Comparative features of Pneumococcal, Mycoplasma and Legionnaires' disease pneumonias. Ann Intern Med 1979;90:543-7.

21.

21. Granados A, Podzamczer D, Gudiol F, Manresa F.Pneumonia due to Legionella pneumophila and pneumococcal pneumonia: similarities and differences on presentation. Eur Respir J 1989;2:130-4.

22.

22. Anna H, Martin J, Sverker B, Berndt EB, Agneta J,Helena L, et al. A community outbreak of Legionnaires' disease from an industrial cooling tower: assessment of clinical features and diagnostic procedures. Scand J Infect Dis 2007;39:217-24.

23.

23. Yu VL, Plouffe JF, Pastoris MC, Stout JE, Schousboe M,Widmer A, et al. Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis 2002;186:127-8.

Tuberculosis & Respiratory Diseases

e-Submission OA Policy