Host-related risk factors and clinical features of community-acquired legionnaires disease due to the Paris and Lorraine endemic strains, 1998-2007, France.
BACKGROUND
In France, Legionnaires disease is mainly caused by Legionella pneumophila. Here, we investigated possible host factors associated with susceptibility to community-acquired Legionnaires disease caused by the endemic Paris and Lorraine strains.


METHODS
We conducted a double-nested exploratory case-control study with use of data from the French national surveillance network of incident Legionnaires disease cases notified from 1998 through 2007. Patients with community-acquired Legionnaires disease and an L. pneumophila serogroup 1 isolate were eligible. Case patients were patients infected by the Paris or Lorraine strain, and control patients were those infected by sporadic strains. Epidemiological and clinical factors associated with infection with the Paris and Lorraine strains were assessed by calculating adjusted odds ratios (aOR) in multivariate logistic regression models.


RESULTS
We studied 1090 patients infected by sporadic strains (n = 920), the Paris strain (n = 80), or the Lorraine strain (n = 90). Infection with the Paris strain was significantly associated with female sex (aOR, 1.98; 95% confidence interval [CI], 1.19-3.28), steroid therapy (aOR, 3.16; 95% CI, 1.76-5.68), and a history of cancer or hematologic malignancies (aOR, 2.08; 95% CI, 1.15-3.76). In addition, the mortality rate was higher among patients infected with the Paris strain than in the control group (38% vs. 25.5%). The Lorraine strain was associated with smoking (aOR, 1.82; 95% CI, 1.14-2.91) and reduced mortality (9.9%). .


CONCLUSIONS
Several host characteristics were associated with the risk of infection by endemic strains of L. pneumophila serogroup 1. These findings may help to guide preventive measures. Factors predisposing patients to infection by specific strains need to be explored further.
Ginevra
Christophe
C
Faculté Laennec, Université de Lyon, Lyon, France. christophe.ginevra@univ-lyon1.fr
Duclos
Antoine
A
Vanhems
Philippe
P
Campèse
Christine
C
Forey
Françoise
F
Lina
Gerard
G
Che
Didier
D
Etienne
Jerome
J
Jarraud
Sophie
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005602:France / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D016952:Legionella pneumophila / Q000145:classification* / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
D013256:Steroids