title: Serological evidence of Legionella species infection in acute exacerbation of COPD.
abstract: A prospective study was conducted to identify and characterize hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with serological evidence of infection with Legionella spp. (Lsp). Two-hundred and forty hospital admissions for AECOPD of 213 patients were included in the study. Paired sera were obtained for each of the admissions and were tested for 41 different serogroups of Lsp, using microimmunofluorescence-serology. Only a significant change in immunoglobulin-G and/or immunoglobulin-M antibody titres was considered diagnostic. In 40 admissions (16.7%) there was serological evidence of infection with Lsp (LspH). Legionella pneumophila 1 was identified in nine admissions, L. pneumophila 3-15 in 19 and nonpneumophila in 22. In 26 LspH (65%) there was serological evidence of infection with at least one other respiratory pathogen. Compared to the 200 admissions without Lsp (NLspH), the LspH patients were younger (p<0.05) and more hypoxaemic (p<0.04). None of the cases in the LspH group had an abrupt onset of disease, compared to 58 (29.0%) in the NLspH group (p<0.0001). The incidence of myalgia/arthralgia was 55% for LspH compared to 37% for NLspH (p<0.03). To conclude, serological evidence of infection with Legionella spp. is common among patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease. In most hospital admissions with serological evidence of infection with Legionella spp. an additional respiratory pathogen can be identified. Acute exacerbation develops gradually in these patients and is characterized clinically by more systemic manifestations than hospital admissions without serological evidence of infection with Legionella spp. The true interpretation and practical relevance of these findings should be determined in further studies.
authors.affiliation: The Pulmonary Unit, Soroka Medical Centre and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva. Israel. Lieberma@bgumail.bgu.ac.il
authors.forename: D
authors.initials: D
authors.lastname: Lieberman
authors.forename: D
authors.initials: D
authors.lastname: Lieberman
authors.forename: O
authors.initials: O
authors.lastname: Shmarkov
authors.forename: Y
authors.initials: Y
authors.lastname: Gelfer
authors.forename: M
authors.initials: M
authors.lastname: Ben-Yaakov
authors.forename: Z
authors.initials: Z
authors.lastname: Lazarovich
authors.forename: I
authors.initials: I
authors.lastname: Boldur
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000907:Antibodies, Bacterial / Q000032:analysis* / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005455:Fluorescent Antibody Technique; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D007875:Legionella / Q000145:classification* / Q000276:immunology* / Q000302:isolation & purification; D016952:Legionella pneumophila / Q000276:immunology / Q000302:isolation & purification; D007876:Legionellosis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D007877:Legionnaires' Disease / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000382:microbiology*; D012008:Recurrence; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D012720:Severity of Illness Index; D013147:Spirometry
chemical_list: D000907:Antibodies, Bacterial