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Nosocomial legionellosis outbreak occurring in immunosuppressed patients in a cancer centre

Abstract number: o264

Gudiol  C., Carratala  J., Dominguez  M.A., Verdaguer  R., Fernandez-Sevilla  A., Gudiol  F.

Objective: 

There is scarce information regarding the impact of early diagnosis of nosocomial legionellosis by urine antigen testing and levofloxacin therapy on outcomes of immunosuppressed patients with this infection. We report a legionellosis outbreak due to Legionella pneumophila serogroup 1 occurring in a cancer center, in which these modalities of rapid diagnosis and treatment were used.

Methods: 

The outbreak involved 12 patients. Legionnaire´s disease was detected in the first patient, on Feb 24th 2005, and the outbreak lasted 4 weeks. After two more cases were diagnosed within 48 h, universal urine antigen testing (n = 155 patients) was indicated. Pulsed-field gel electrophoresis (PFGE) typing was performed in all isolates from sputum and water system samples. Superheating and flushing of water system were undertaken to control the outbreak.

Results: 

There were 6 males and 6 females, aged between 41 and 74 yrs. Seven patients had underlying hematologic disorders (lymphoma 4, acute leukemia 2, aplastic anemia 1) and 5 patients had solid tumors (lung cancer 3, disseminated cancer 1, pancreas cancer 1). All but one patients were receiving steroids and 6 patients other immunosuppressive drugs at the time or few days before the infection. Three patients had profound neutropenia and one of them had also invasive aspergillosis requiring ICU admission. Ten patients presented with pneumonia (multilobar 3, cavitated 1) while two patients were asymptomatic at the time when the urine antigen test was performed. Urine antigen test was positive in all 12 cases. L. pneumophila serogroup 1 was isolated from the sputum of 5 patients, and from water system samples. Only the first patient who was treated with clarithromycin died, whereas the remaining 11 patients who received levofloxacin survived. Overall mortality (<28 days) was 8.3%. PFGE typing demonstrated identical clonal patterns among isolates recovered from sputum and water samples. Superheating and flushing of water system successfully terminated the outbreak.

Conclusions: 

Early diagnosis of cases by universal urine antigen testing and early levofloxacin therapy were associated with outcomes much better than those classically reported in severely immunosupressed patients with legionellosis.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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