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Legionnaires’ Disease in Solid Organ Transplant Recipients
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Edité par CCSD ; American College of Chest Physicians -
International audience. BACKGROUND: Legionnaires’ disease (LD) is a rare, life-threatening opportunistic bacterialinfection that poses a significant risk to patients with impaired cell-mediated immunity suchas solid organ transplant recipients (SOTRs). However, the epidemiologic features, clinicalpresentation, and outcomes of LD in this population are poorly described.RESEARCH QUESTION: What are the clinical manifestations, radiologic presentation, riskfactors for severity, treatment, and outcome of LD in SOTRs?STUDY DESIGN AND METHODS: In this 10-year multicenter, retrospective cohort study inFrance, where LD notification is mandatory, patients were identified by hospital dischargedatabases. Diagnosis of LD relied on positive culture findings from any respiratory sample,positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU.RESULTS: One hundred one patients from 51 transplantation centers were eligible; 64 patients(63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97).Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophilaserogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% ofpatients (54/57), ground-glass opacity in 63% of patients (36/57), macronodules in 21% of patients (12/57), and cavitation in 8.8% of patients (5/57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findingsat presentation (P¼ .047), lymphopenia (P ¼ .014), respiratory symptoms (P¼ .010), and pleuraleffusion (P ¼ .039). The 30-day and 12-month mortality rates were 8% (8/101) and 20% (19/97),respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P ¼ .022).INTERPRETATION: LD is a late and severe complication occurring in SOTRs that may presentas pulmonary nodules on which diabetes impacts its long-term prognosis.
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