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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
Community-acquired pneumonia is common in winter (34%) but two-thirds of patients with CAP contract the virus in other seasons. 7
|
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 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
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
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
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