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What’s causing your patient’s Community-Acquired Pneumonia?
What’s causing your patient’s Community-Acquired Pneumonia?
Legionella and S. pneumoniae
are often overlooked.
are often overlooked.
Legionnaires’ disease and COVID-19 present with similar initial symptoms, including a dry cough, fever, and muscle aches.1,2 When diagnosing pneumonia clinicians may be inclined to test repeatedly for COVID-19 before suspecting Legionnaires' disease.2,3
Although Legionnaires’ disease is a common cause of community-acquired pneumonia (CAP)4, the majority of Legionnaires’ disease cases go undiagnosed.5 The British Thoracic Society (BTS) guidelines recommend that all patients hospitalized with community-acquired pneumonia, without a known etiology, be tested for Legionella and S. pneumoniae infection.2,6
Seasonality, knowledge of Legionnaires’ disease and geographical regions are all factors that should be considered during the differential diagnosis of CAP.7,8
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Seasonal variations of CAP and when they occur.
Community-acquired pneumonia is common in winter (34%) but two-thirds of patients with CAP contract the virus in other seasons. 7
Seasonal distribution of Streptococcus pneumoniae and Legionella pneumophila7
|
Winter |
Spring |
Summer |
Autumn |
Overall |
|
|---|---|---|---|---|---|
|
Streptococcus pneumoniae |
21% |
16.5% |
13.6% |
12.9% |
P < 0.001 |
|
Legionella pneumophila |
0.6% |
1.7% |
3.6% |
4.2% |
P < 0.001 |
Rapid diagnosis is a powerful tool for effective clinical management.
Rapid diagnostic testing can play a central role in optimizing management of patients and diseases, allowing patients to be diagnosed faster and more precisely than ever before. According to the European Centre for Disease Prevention and Control (ECDC) and the European Legionnaires’ Disease Surveillance Network (ELDSNet), the urinary antigen test is the most commonly used primary method and is an essential tool for diagnosis during the acute phase of the infection.9
Find out more about BinaxNOW Rapid Tests for Legionella and S. pneumo
Rapid diagnosis is a powerful tool for effective clinical management.
Rapid diagnostic testing can play a central role in optimizing management of patients and diseases, allowing patients to be diagnosed faster and more precisely than ever before. According to the European Centre for Disease Prevention and Control (ECDC) and the European Legionnaires’ Disease Surveillance Network (ELDSNet), the urinary antigen test is the most commonly used primary method and is an essential tool for diagnosis during the acute phase of the infection.9
Find out more about BinaxNOW Rapid Tests for Legionella and S. pneumo
Proper diagnosis can increase the likelihood of appropriate and timely antibiotic treatment.4
Some antibiotics effective against Legionella species are also effective in treating the typical bacterial causes of CAP.10
In keeping with antimicrobial stewardship guidelines, it is recommended to administer double-drug therapy rather than monotherapy. Moreover, monotherapy with an additional respiratory quinolone or doxycycline is considered to be the optimal cost-effective therapy.8
In order to increase survival rates, it is essential that the correct diagnosis is promptly reported since Legionella infections do not respond to β-lactam-based antibiotics since these do not penetrate and act within infected cells.9
Stay up to date with the latest information on CAP
Stay up to date with the latest information on CAP
Stay up to date with the latest information on CAP
References
- Wiltshire Council, Legionella control covid-19 guidance for businesses, https://www.wiltshire.gov.uk/article/5392/Legionella-and-COVID-19, last accessed 11.11.2022.
- Cassell K, Davis JL, Berkelman R. Legionnaires' disease in the time of COVID-19. Pneumonia (Nathan). 2021 Jan 6;13(1):2. doi: 10.1186/s41479-020-00080-5. PMID: 33407911; PMCID: PMC7787226.
- Rota MC, Caporali MG, Scaturro M, Girolamo A, Andrianou X, Ricci ML. Legionella pneumophila and SARS-COV-2 co-infection: the importance of laboratory diagnosis. Letter. Ann Ist Super Sanita. 2021 Jul-Sep;57(3):199-200. doi: 10.4415/ANN_21_03_01.
- Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K, et al. Epidemiology and clinical management of Legionnaires’ disease. Lancet Infect Dis. 2014;14(10):1011–21. Available from: https://www.sciencedirect.com/science/article/pii/S1473309914707133.
- Spiegelman J, Pedutem T, Francisco MJ. Legionnaires' Disease Cases at a Large Community Hospital-Common and Underdiagnosed. Int J Environ Res Public Health. 2020 Jan 3;17(1):332. doi: 10.3390/ijerph17010332.
- BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA; Pneumonia Guidelines Committee of the BTS Standards of Care Committee.Thorax. 2009 Oct;64 Suppl 3:iii1-55. doi: 10.1136/thx.2009.121434.
- Cilloniz C, Ewig S, Gabarrus A, Ferrer M, Puig de la Bella Casa J, Mensa J, Torres A. Seasonality of pathogens causing community-acquired pneumonia. Respirology. 2017 May;22(4):778-785. doi: 10.1111/resp.12978. Epub 2017 Jan 17. PMID: 28093834.
- Cunha CB, Cunha BA. Antimicrobial Therapy for Legionnaire's Disease: Antibiotic Stewardship Implications. Infect Dis Clin North Am. 2017 Mar;31(1):179-191. doi: 10.1016/j.idc.2016.10.013. PMID: 28159174.
- European Centre for Disease Prevention and Control. European Legionnaires’ Disease Surveillance Network (ELDSNet) – Operating procedures for the surveillance of travel-associated Legionnaires’ disease in the EU/EEA. Stockholm: ECDC; 2017. Stockholm: ECDC; 2017.
- Cunha CB, Cunha BA. Antimicrobial Therapy for Legionnaire's Disease: Antibiotic Stewardship Implications. Infect Dis Clin North Am. 2017 Mar;31(1):179-191. doi: 10.1016/j.idc.2016.10.013. PMID: 28159174 Review.
