Atypical presentation of Legionella pneumonia among patients with underlying cancer: A fifteen-year review.
BACKGROUND
Immunocompromised patients, especially those receiving treatment with corticosteroids and cytotoxic chemotherapy are at increased risk for developing Legionella pneumonia.


OBJECTIVE
The aim of this study was to determine clinical and radiographic characteristics of pulmonary infection due to Legionella in persons undergoing treatment for cancer and stem cell transplant (SCT) recipients.


METHODS
Retrospective review of Legionella cases at MSKCC over a fifteen-year study period from January 1999 and December 2013. Cases were identified by review of microbiology records.


RESULTS
During the study period, 40 cases of Legionella infection were identified; nine among these were due to non-pneumophila species. Most cases occurred during the summer. The majority [8/9, (89%)] of patients with non-pneumophila infection had underlying hematologic malignancy, compared to 18/31 (58%) with Legionella pneumophila infections. Radiographic findings were varied-nodular infiltrates mimicking invasive fungal infection were seen only among patients with hematologic malignancy and hematopoietic stem cell transplant (SCT) recipients and were frequently associated with non-pneumophila infections (50% vs 16%; P = 0.0594). All cases of nodular Legionella pneumonia were found incidentally or had an indolent clinical course.


CONCLUSIONS
Legionella should be considered in the differential diagnosis of nodular lung lesions in immunocompromised patients, especially those with hematologic malignancy and SCT recipients. Most cases of nodular disease due to Legionella are associated with non-pneumophila infections.
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA. Electronic address: maria.a.del.castillo@gmail.com.
Maria
M
del Castillo
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Anabella
A
Lucca
Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Andrew
A
Plodkowski
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Yao-Ting
YT
Huang
Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Janice
J
Kaplan
Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Kathleen
K
Gilhuley
Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
N Esther
NE
Babady
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Susan K
SK
Seo
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
Mini
M
Kamboj
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007875:Legionella; D007876:Legionellosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D055815:Young Adult
Cancer; Immunocompromised; Legionella; Stem cell transplant