Journal List > Tuberc Respir Dis > v.68(2) > 1001514

TOOLS
Lyu, Song, Choi, Oh, Lee, Kim, Kim, Kim, and Shim: Comparative Study of Pneumonia Caused by Streptococcus pneumonia and Legionella pneumophila
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 68(2): 74-79.

Published online: 28 February 2010

DOI: https://doi.org/10.4046/trd.2010.68.2.74

Comparative Study of Pneumonia Caused by Streptococcus pneumonia and Legionella pneumophila

Jiwon Lyu, M.D.1, Jin Woo Song, M.D.1, Chang-Min Choi, M.D.1, Yeon-Mok Oh, M.D.1, Sang Do Lee, M.D.1, Woo Sung Kim, M.D.1, Dong Soon Kim, M.D.1, Mi-Na Kim, M.D.2, Tae Sun Shim, M.D.1

1Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Tae Sun Shim, M.D. Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3892, Fax: 82-2-3010-6968, shimts@amc.seoul.kr

Received 7 January 2010       Accepted 19 January 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

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

Figures and Tables

Table 1
Baseline characteristics of the patients
trd-68-74-i001

CAP: community-acquired pneumonia; HCAP: healthcare-associated pneumonia; HAP: hospital-acquired pneumonia; ICU: intensive care unit.

Table 2
Frequencies of symptoms and signs
trd-68-74-i002
Table 3
Laboratory findings at the time of admission
trd-68-74-i003
Table 4
Empirical antibiotic therapy
trd-68-74-i004

References

1. Chang FY, Yu VL. Fauci AS, Braundwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Legionella infection. Harrison's principles of internal medicine. 2008. 17th ed. New York: McGraw-Hill Co, Inc.;929–933.
2. Stout JE, Yu VL. Legionellosis. N Engl J Med. 1997. 337:682–687.
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. 31:353–357.
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. 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. 30:218–226.
6. Disease Web Statistics System [Internet]. 2010. Seoul: Korean Centers for Disease Control and Prevention;Available from: http://stat.cdc.go.kr.
7. Cunha BA. Atypical pneumonias: current clinical concepts focusing on Legionnaires' disease. Curr Opin Pulm Med. 2008. 14:183–194.
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. 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. 9:144–153.
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. 1998. 114:1588–1593.
11. Chan CH, Cohen M, Pang J. A prospective study of community-acquired pneumonia in Hong Kong. Chest. 1992. 101:442–446.
12. Fields BS, Benson RF, Besser RE. Legionella and Legionnaires' disease: 25 years of investigation. Clin Microbiol Rev. 2002. 15:506–526.
13. Den Boer JW, Yzerman EP. Diagnosis of Legionella infection in Legionnaires' disease. Eur J Clin Microbiol Infect Dis. 2004. 23:871–878.
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. 40:3232–3236.
15. Kim S, Sung H, Kim DJ, Kim MN. Clinical relevance of positive NOW™ Legionella urinary antigen test in a tertiary-care hospital in Korea. Korean J Lab Med. 2006. 26:93–97.
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. 59:388–390.
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. 9:137–144.
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. 50:409–414.
19. Miller AC. Early clinical differentiation between Legionnaires' disease and other sporadic pneumonias. Ann Intern Med. 1979. 90:526–528.
20. Helms CM, Viner JP, Sturm RH, Renner ED, Johnson W. Comparative features of Pneumococcal, Mycoplasma and Legionnaires' disease pneumonias. Ann Intern Med. 1979. 90:543–547.
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. 2:130–134.
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. 39:217–224.
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. 186:127–128.
TOOLS
Similar articles