Maria del Castillo1, Anabella Lucca2, Andrew Plodkowski3, Yao-Ting Huang2, Janice Kaplan4, Kathleen Gilhuley5, N Esther Babady5, Susan K Seo2, Mini Kamboj6. 1. Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA. Electronic address: maria.a.del.castillo@gmail.com. 2. Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA. 3. Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA. 4. Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA. 5. Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA. 6. Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Abstract
BACKGROUND: Immunocompromised patients, especially those receiving treatment with corticosteroids and cytotoxic chemotherapy are at increased risk for developing Legionella pneumonia. OBJECTIVE: The aim of this study was to determine clinical and radiographic characteristics of pulmonary infection due to Legionella in persons undergoing treatment for cancer and stem cell transplant (SCT) recipients. METHODS: Retrospective review of Legionella cases at MSKCC over a fifteen-year study period from January 1999 and December 2013. Cases were identified by review of microbiology records. RESULTS: During the study period, 40 cases of Legionella infection were identified; nine among these were due to non-pneumophila species. Most cases occurred during the summer. The majority [8/9, (89%)] of patients with non-pneumophila infection had underlying hematologic malignancy, compared to 18/31 (58%) with Legionella pneumophila infections. Radiographic findings were varied-nodular infiltrates mimicking invasive fungal infection were seen only among patients with hematologic malignancy and hematopoietic stem cell transplant (SCT) recipients and were frequently associated with non-pneumophila infections (50% vs 16%; P = 0.0594). All cases of nodular Legionella pneumonia were found incidentally or had an indolent clinical course. CONCLUSIONS: Legionella should be considered in the differential diagnosis of nodular lung lesions in immunocompromised patients, especially those with hematologic malignancy and SCT recipients. Most cases of nodular disease due to Legionella are associated with non-pneumophila infections.
BACKGROUND: Immunocompromised patients, especially those receiving treatment with corticosteroids and cytotoxic chemotherapy are at increased risk for developing Legionella pneumonia. OBJECTIVE: The aim of this study was to determine clinical and radiographic characteristics of pulmonary infection due to Legionella in persons undergoing treatment for cancer and stem cell transplant (SCT) recipients. METHODS: Retrospective review of Legionella cases at MSKCC over a fifteen-year study period from January 1999 and December 2013. Cases were identified by review of microbiology records. RESULTS: During the study period, 40 cases of Legionella infection were identified; nine among these were due to non-pneumophila species. Most cases occurred during the summer. The majority [8/9, (89%)] of patients with non-pneumophila infection had underlying hematologic malignancy, compared to 18/31 (58%) with Legionella pneumophila infections. Radiographic findings were varied-nodular infiltrates mimicking invasive fungal infection were seen only among patients with hematologic malignancy and hematopoietic stem cell transplant (SCT) recipients and were frequently associated with non-pneumophila infections (50% vs 16%; P = 0.0594). All cases of nodular Legionella pneumonia were found incidentally or had an indolent clinical course. CONCLUSIONS:Legionella should be considered in the differential diagnosis of nodular lung lesions in immunocompromised patients, especially those with hematologic malignancy and SCT recipients. Most cases of nodular disease due to Legionella are associated with non-pneumophila infections.
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