|Table of Contents|

Clinical analysis of 12 cases of hematological malignancies with legionella pneumonia

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 19
Page:
3648-3652
Research Field:
Publishing date:

Info

Title:
Clinical analysis of 12 cases of hematological malignancies with legionella pneumonia
Author(s):
YANG Erqing; MI Ruihua; CHEN Lin; WANG Lin; WEI Xudong
Department of Hematopathy，the Affiliated Cancer Hospital of Zhengzhou University，Henan Zhengzhou 450008，China.
Keywords:
hematological malignancies; legionella; pneumonia; treatment; prognosis
PACS:
R732
DOI:
10.3969/j.issn.1672-4992.2023.19.022
Abstract:
Objective:To enhance the understanding of legionella pneumonia in patients with hematological malignancies by analyzing the clinical characteristics and diagnostic outcomes.Methods:We retrospectively analyzed the clinical data included clinical characteristics，imaging manifestations，treatments，and outcomes of 12 patients with hematological malignancies complicated by legionella pneumonia admitted to the Hematology Department of our hospital from March 2021 to August 2022.Results:Of the 12 patients，4 were male and 8 were female，with a median age of 55(14~89) years old.There were 5 cases of acute myeloid leukemia（AML)，2 cases of acute lymphoblastic leukemia（ALL)，1 case of myelodysplastic syndrome（MDS)，1 case of T lymphoblastic leukemia/lymphoma（T-ALL/LBL)，and 3 cases of multiple myeloma（MM).The diagnoses were confirmed through bronchoalveolar lavage fluid，lung tissue biopsy，and blood next generation sequencing.Clinical symptoms included high fever（12/12)，cough（8/12)，sputum production（6/12)，dyspnea（5/12)，chills（3/12)，chest pain（3/12)，and respiratory failure（3/12).Laboratory tests showed that C-reactive protein was increased in all 12 cases，procalcitonin was significantly increased in 6 cases，serum potassium was decreased in 6 cases，and serum sodium was decreased in 8 cases.The imaging manifestations were rapidly progressive，showing nodular，cord or patchy high-density shadows，fused into patches or consolidation，accompanied by atelectasis，pleural effusion，pleural thickening.The majority of cases（11/12) occurred during the bone marrow suppression period following chemotherapy.Quinolones and macrolides were the preferred antibiotic choices，and 8 cases showed improvement and 4 cases resulted in death.Conclusion:Legionella pneumonia in patients with hematological malignancies is more commonly observed during the bone marrow suppression period following chemotherapy.The clinical and imaging manifestations are atypical，and the mortality rate is high.When pneumonia occurs with hypokalemia，hyponatremia，and ineffective treatment with broad-spectrum antibiotics and antifungal drugs，legionella pneumonia should be considered.Early identification of the pathogen and targeted treatment can improve the prognosis of patients.

References:

［1］CUNHA BA，BURILLO A，BOUZA E.Legionnaires' disease［J］.Lancet，2016,387(10016):376-385.
［2］中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)［J］.中华结核和呼吸杂志,2016,39(4):253-279. Chinese Respiratory Society.Chinese guidelines for the diagnosis and treatment of adult community-acquired pneumonia（2016 edition)［J］.Chinese Journal of Tuberculosis and Respiratory Diseases，2016，39(4):253-279.
［3］沈悌，赵永强，周道斌,等.血液病诊断及疗效标准［M］.4版.北京：科学出版社,2018:97-290. SHEN T，ZHAO YQ，ZHOU DB，et al.Diagnosis and therapeutic efficacy criteria for hematological diseases［M］.4th ed.Beijing：Science Press，2018:97-290.
［4］梁思聪，陈愉.军团菌肺炎的诊治策略［J］.中国实用内科杂志,2020,40(5):357-361. LIANG SC，CHEN Y.Diagnosis and treatment strategies of legionnaires' disease［J］.Chinese Journal of Practical Internal Medicine，2020，40(5):357-361.
［5］段智梅，魏腾陈，王凯飞,等.军团菌肺炎临床分析并文献复习［J］.解放军医学院学报,2022,43(3):284-290. DUAN ZM，WEI TC，WANG KF，et al.Clinical analysis and literature review of legionnaires' disease［J］.Academic Journal of Chinese Pla Medical School，2022，43(3):284-290.
［6］黄雨萱，郑贤惠，朱翠明,等.嗜肺军团菌致病性与效应蛋白的研究进展［J］.中国感染控制杂志,2019,18(12):1184-1190. HUANG YX，ZHENG XH，ZHU CM，et al.Research progress on pathogenicity and effector proteins of legionella pneumophila［J］.Chinese Journal of Infection Control，2019，18(12):1184-1190.
［7］LANTERNIER F，ADER F，PILMIS B，et al.Legionnaire's disease in compromised hosts［J］.Infect Dis Clin North Am，2017,31(1):123-135.
［8］LANTERNIER F，TUBACH F，RAVAUD P，et al.Incidence and risk factors of legionella pneumophila pneumonia during anti-tumor necrosis factor therapy：A prospective French study［J］.Chest，2013,144(3):990-998.
［9］TUBACH F，RAVAUD P，SALMON-CRON D，et al.Emergence of legionella pneumophila pneumonia in patients receiving tumor necrosis factor-alpha antagonists［J］.Clin Infect Dis，2006,43(10):e95-100.
［10］ARINUMA Y，NOGI S，ISHIKAWA Y，et al.Fatal complication of legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient［J］.Intern Med，2015,54(9):1125-1130.
［11］GOЁB V，ARDIZZONE M，ARNAUD L，et al.Recommendations for using TNFα antagonists and french clinical practice guidelines endorsed by the French National Authority for Health［J］.Joint Bone Spine，2013,80(6):574-581.
［12］NIELSEN H，BANGSBORG J，RECHNITZER C，et al.Defective monocyte function in legionnaires' disease complicating hairy cell leukaemia［J］.Acta Med Scand，1986,220(4):381-383.
［13］NUNNINK JC，GALLAGHER JG，YATES JW.Legionnaires' disease in patients with cancer［J］.Med Pediatr Oncol，1986,14(2):81-85.
［14］JACOBSON KL，MICELI MH，TARRAND J，et al.Legionella pneumonia in cancer patients［J］.Medicine（Baltimore)，2008,87(3):152-159.
［15］HAN XY，IHEGWORD A，EVANS SE，et al.Microbiological and clinical studies of legionellosis in 33 patients with cancer［J］.J Clin Microbiol，2015,53(7):2180-2187.
［16］PIERRE DM，BARON J，YU VL，et al.Diagnostic testing for legionnaires' disease［J］.Ann Clin Microbiol Antimicrob，2017,16(1):59-64.
［17］《中华传染病杂志》编辑委员会.中国宏基因组学第二代测序技术检测感染病原体的临床应用专家共识［J］.中华传染病杂志,2020,38(11):681-689. Editorial Board of Chinese Journal of Infectiois Diseases.Expert consensus on the clinical application of second-generation sequencing technology for detecting infectious pathogens in China［J］.Chinese Journal of Infectious Diseases，2020,38(11):681-689.
［18］刘幸，刘向芳，陈洁,等.艾滋病合并军团菌肺炎1例［J］.中国感染与化疗杂志,2022,22(1):88-90. LIU X，LIU XF，CHEN J，et al.A case of AIDS complicated with legionella pneumonia［J］.Chinese Journal of Infection and Chemotherapy，2022,22(1):88-90.
［19］姜世源.军团菌肺炎的抗生素选择及药学监护［J］.中国处方药,2022,20(5):138-139. JIANG SY.Antibiotic selection and pharmaceutical care for legionella pneumonia［J］.Journal of China Prescription Drug，2022,20(5):138-139.
［20］POUDEROUX C，GINEVRA C，DESCOURS G，et al.Slowly or nonresolving legionnaires' disease：case series and literature review［J］.Clin Infect Dis，2020,70(9):1933-1940.
［21］LARRU B，GERBER JS，OTA KV.Medical treatment failure and complete left pneumonectomy after legionella pneumophila pneumonia in a bone marrow transplant recipient［J］.Pediatr Infect Dis J，2012,31(9):979-981.

Memo

Memo:
National Natural Science Foundation of China（No.82170151）;国家自然科学基金面上项目（编号：82170151）；河南省医学科技攻关计划联合共建项目（编号：LHGJ20210185）
Last Update: 2023-08-31