title: Legionellosis and biologic therapies.
abstract: BACKGROUND
  Biologic therapies are widely used in inflammatory diseases, and they are associated to an increased infection risk, especially to granulomatous and intracellular infections such as Legionella.
  
  
  RESULTS
  A review of the literature revealed 105 cases of Legionella pneumonia in patients taking biologic therapies. Sixty-four patients (65.3%) were treated with infliximab, 23 (23.5%) with adalimumab, 5 (5%) with etanercept and 3 (3%) with rituximab. Seventy-one per cent of the patients were treated for rheumatologic diseases and 16% for inflammatory bowel diseases. The majority of the patients received one or more concomitant immunosuppressive drugs, especially steroids (43%). Overall mortality was 19%. Legionella pneumonia might complicate therapy with biologic therapies, especially in patients being treated with infliximab or adalimumab given concomitantly with other immunosuppressive medications during their first 6 months of treatment.
  
  
  CONCLUSIONS
  Physicians should be aware of this potentially severe association. Early recognition and treatment would likely result in reduced morbidity and mortality.
authors: IDIBELL, Institute of Biomedical Research of Bellvitge Hospital, Infectious Diseases Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain; University of Queensland Centre for Clinical Research, Brisbane, Australia. Electronic address: martabodro@gmail.com.
authors: M
authors: M
authors: Bodro
authors: IDIBELL, Institute of Biomedical Research of Bellvitge Hospital, Infectious Diseases Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain.
authors: J
authors: J
authors: Carratalà
authors: University of Queensland Centre for Clinical Research, Brisbane, Australia.
authors: D L
authors: DL
authors: Paterson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D001685:Biological Factors / Q000009:adverse effects*; D001691:Biological Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D007876:Legionellosis / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000188:drug therapy
chemical_list: D000911:Antibodies, Monoclonal; D001685:Biological Factors
keywords: Biologic therapies; Immunocompromised patients; Infection; Legionella; Tumour necrosis factor alpha inhibitors