Pathogenicity of the family Legionellaceae

  • Marta Palusińska-Szysz
  • Monika Cendrowska-Pinkosz


The Legionellae are Gram-negative bacteria able to survive and replicate in a wide range of protozoan hosts in natural environments, but they also occur in man-made aquatic systems, which are the major source of infection. After transmission to humans via aerosols, Legionella spp. can cause pneumonia (Legionnaires’ disease) or influenza-like respiratory infections (Pontiac fever). In children, Legionnaires’ disease is uncommon and is mainly diagnosed in children with immunosuppression. The clinical picture of Legionella pneumonia does not allow differentiation from pneumonia caused by others pathogens. The key to diagnosis is performing appropriate microbiological testing. The clinical presentation and the natural course of Legionnaires’ disease in children are not clear due to an insufficient number of samples, but morbidity and mortality caused by this infection are extremely high. The mortality rate for legionellosis depends on the promptness of an appropriate antibiotic therapy. Fluoroquinolones are the most efficacious drugs against Legionella. A combination of these drugs with macrolides seems to be promising in the treatment of immunosuppressed patients and individuals with severe legionellosis. Although all Legionella species are considered potentially pathogenic for humans, Legionella pneumophila is the etiological agent responsible for most reported cases of community-acquired and nosocomial legionellosis.


Legionnaires’ disease Pontiac fever 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adeleke AA, Fields BS, Benson RF et al (2001) Legionella drozanski sp. nov., Legionella rowbothamii sp. nov. and Legionella fallonii sp. nov: tree unusual new Legionella species. Int J Syst Evol Microbiol 51: 1151–1160PubMedGoogle Scholar
  2. Adeleke AA, Pruckler JM, Benson RF et al (1996) Legionella-like amebal pathogens – phylogenetic status and possible role in respiratory disease. Emerg Infect Dis 2: 225–230PubMedGoogle Scholar
  3. Akyildiz B, Gümüs H, Kumandas S et al (2008) Guillain-Barre syndrome associated with Legionella infection. J Trop Pediatr 54: 275–277PubMedCrossRefGoogle Scholar
  4. Andereya S, Schneider U, Siebert C et al (2004) Reactive knee and ankle joint arthritis: abnormal manifestation of Legionella pneumophila. Rheumatol Int 24: 182–184PubMedCrossRefGoogle Scholar
  5. Bartlett JG (2008) Is activity against “atypical” pathogens necessary in the treatment protocols for community-acquired pneumonia? Issues with combination therapy. Clin Infect Dis 47(suppl 3): S232–S236PubMedCrossRefGoogle Scholar
  6. Bartram J, Chartier Y, Lee JV et al (2007) Legionella and the prevention of legionellosis. WHO Press World Health Organization, Geneva, SwitzerlandGoogle Scholar
  7. Benin AL, Benson RF, Arnold KL et al (2002) An outbreak of travel-associated Legionnaires’ disease and Pontiac fever: the need for enhanced surveillance of travel-associated legionellosis in the United States. J Infect Dis 185: 237–243PubMedCrossRefGoogle Scholar
  8. Borchardt J, Helbig JH, Lück PC (2008) Occurrence and distribution of sequence types among Legionella pneumophila strains isolated from patients in Germany: common features and differences to other regions of the world. Eur J Clin Microbiol Infect Dis 27: 29–36PubMedCrossRefGoogle Scholar
  9. Brady MT (1989) Nosocomial legionnaires’ disease in children’s hospital. J Pediatr 115: 46–50PubMedCrossRefGoogle Scholar
  10. Breiman RF, Butler JC (1998) Legionnaires’ disease: Clinical, epidemiological, and public health perspectives. Semin Respir Infect 13: 84–89PubMedGoogle Scholar
  11. Brenner DJ, Krieg NR, Staley JT et al (2005) Legionellales. In: Bergey’s Manual of Systematic Bacteriology, vol 2 (The Proteobacteria), part B (The Gammaproteobacteria), Springer, New York, p 210Google Scholar
  12. Burnsed LJ, Hicks LA, Smithee LM et al (2007) A large travel-associated outbreak of legionellosis among hotel guests: utility of the urine antigen assay in confirming Pontiac fever. Clin Infect Dis 44: 222–228PubMedCrossRefGoogle Scholar
  13. Campins M, Ferrer A, Callis L et al (2000) Nosocomial Legionnaire’s disease in a children’s hospital. Pediatr Infect Dis J 19: 228–234PubMedCrossRefGoogle Scholar
  14. Casaulta Aebischer C, Matter L, Gaia V et al (1999) Diagnosis by polymerase chain reaction of pneumonia caused by Legionella pneumophila in an immunocompetent child. Infection 27: 280–282CrossRefGoogle Scholar
  15. Castor ML, Wagstrom EA, Danila RN et al (2005) An outbreak of Pontiac fever with respiratory distress among workers performing high-pressure cleaning at a sugar-beet processing plant. J Infect Dis 191: 1530–1537PubMedCrossRefGoogle Scholar
  16. Chaisson RE (1998) Bacterial pneumonia in patients with human immunodeficiency virus infection. Semin Respir Infect 4: 133–138Google Scholar
  17. Chown JW, Yu VL (1998) Legionella: a major opportunistic pathogen in transplant recipients. Semin Respir Infect 13: 132–139Google Scholar
  18. Cianciotto NP (2007) Iron acquisition by Legionella pneumophila. Biometals 20: 323–331PubMedCrossRefGoogle Scholar
  19. Cunha BA (2005a) Diagnostic significance of non-specific laboratory tests in infectious diseases. In: Gorbach SL, Bartlett JB, Blacklow NR (eds) Infectious diseases in medicine and surgery, 3rd edn. W. B. Saunders Co., Philadelphia, pp 158–165Google Scholar
  20. Cunha BA (2005b) Elevated serum transaminases in Mycoplasma pneumoniae pneumonia. Clin Microbiol Infect 11: 1051–1054PubMedCrossRefGoogle Scholar
  21. Cunha BA (2006a) The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect 12: 12–24PubMedCrossRefGoogle Scholar
  22. Cunha BA (2006b) Hypophosphatemia: diagnostic significance in Legionnaires’ disease. Am J Med 119: e5–e6PubMedCrossRefGoogle Scholar
  23. Cunha BA (2008a) Atypical pneumonias: current clinical concepts focusing on Legionnaires’ disease. Curr Opin Pulm Med 14: 183–194PubMedCrossRefGoogle Scholar
  24. Cunha BA (2008b) Severe Legionella pneumonia: rapid presumptive clinical diagnosis with Winthrop-University Hospital’s weighted point score system (modified). Heart Lung 37: 311–320PubMedCrossRefGoogle Scholar
  25. Cunha BA (2008c) Highly elevated serum ferritin levels as a diagnostic marker for Legionella pneumonia. Clin Infect Dis 46: 1789–1791PubMedCrossRefGoogle Scholar
  26. Del Pozo JL (2008) Update and actual trends on bacterial infections following liver transplantation. World J Gastroenterol 28: 4977–4983CrossRefGoogle Scholar
  27. Den Boer JW, Yzerman EP (2004) Diagnosis of Legionella infection in Legionnaires’ disease. Eur J Clin Microbiol Infect Dis 23: 871–878PubMedGoogle Scholar
  28. Den Boer JW, Yzerman EP, Schellekens J et al (2002) A large outbreak of Legionnaires’ disease at a Dutch flower show. Emerg Infect Dis 8: 37–43PubMedGoogle Scholar
  29. Dennis PJ, Lee JV (1988) Differences in aerosol survival between pathogenic and non-pathogenic strains of Legionella pneumophila serogroup 1. J Appl Bacteriol 65: 135–141PubMedGoogle Scholar
  30. Di Stefano F, Verna N, Di Gioacchino M (2007) Cavitary Legionella pneumonia in a patient with immunodeficiency due to Hyper-IgE syndrome. J Infect 54: e121–e123PubMedCrossRefGoogle Scholar
  31. Diederen BM (2008) Legionella spp. and Legionnaires’ disease. J Infect 56: 1–12PubMedCrossRefGoogle Scholar
  32. Dournon E, Bibb WF, Rjagopalan P et al (1988) Monoclonal antibody reactivity as a virulence marker for Legionella pneumophila serogroup 1 strains. J Infect Dis 157: 496–501PubMedGoogle Scholar
  33. Drenning SD, Stout JE, Joly JR et al (2001) Unexpected similarity of pulsed-field gel electrophoresis patterns of unrelated clinical isolates of Legionella pneumophila, serogroup 1. J Infect Dis 183: 628–632PubMedCrossRefGoogle Scholar
  34. Dubois J, St-Pierre C (2000) Comparative in vitro activity and post-antibiotic effect of gemifloxacin against Legionella spp. J Antimicrob Chemother 45(suppl): 41–46PubMedCrossRefGoogle Scholar
  35. Edelstein PH (2007) Urine antigen tests positive for Pontiac fever: implications for diagnosis and pathogenesis. Clin Infect Dis 44: 229–231PubMedCrossRefGoogle Scholar
  36. Eisenberg VH, Eidelman LA, Arbel R et al (1997) Legionnaires’ disease during pregnancy: a case presentation and review of the literature. Eur J Obstet Gynecol Reprod Biol 72: 15–18PubMedCrossRefGoogle Scholar
  37. Eitrem R, Forsgren A, Nilsson C (1987) Pneumonia and acute pancreatitis most probably caused by a Legionella longbeachae infection. Scand J Infect Dis 19: 381–382PubMedCrossRefGoogle Scholar
  38. Esposito AL, Gantz MN (1986) Legionnaires’ disease: the distance travelled since Philadelphia. Pediatr Infect Dis J 5: 163–166CrossRefGoogle Scholar
  39. Esposito S, Bosis S, Faelli N et al (2005) Role of atypical bacteria and azithromycin therapy for children with recurrent respiratory tract infections. Pediatr Infect Dis J 24: 438–444PubMedCrossRefGoogle Scholar
  40. Euzeby JP (2008) List of bacterial names with standing in nomenclature:
  41. Falguera M, Sacristan O, Nogues A et al (2001) Nonsevere community-acquired pneumonia. Correlation between cause and severity or comorbidity. Arch Intern Med 161: 1866–1872PubMedCrossRefGoogle Scholar
  42. Famiglietti RF, Bakerman PR, Saubolle MA et al (1997) Legionellosis in two immunocompetent infants. Pediatrics 99: 899–903PubMedCrossRefGoogle Scholar
  43. Fang GD, Yu VL, Vickers RM (1989) Disease due to the Legionellaceae (other than Legionella pneumophila): Historical, microbiological, clinical, and epidemiological review. Medicine 68: 116–132PubMedCrossRefGoogle Scholar
  44. Faris B, Faris C, Schousboe M et al (2005) Legionellosis from Legionella pneumophila serogroup 13. Emerg Infect Dis 11: 1405–1409PubMedGoogle Scholar
  45. Fields BS, Benson RF, Besser RE (2002) Legionella and Legionnaires’ disease: 25 years of investigation. Clin Microbiol Rev 15: 506–526PubMedCrossRefGoogle Scholar
  46. Fitzgeorge RB, Lever S, Baskerville A (1993) A comparison of the efficacy of azithromycin and clarithromycin in oral therapy of experimental airborne legionnaires’ disease. J Antimicrob Chemother 31(suppl E): 171–176PubMedGoogle Scholar
  47. Franzin L, Cabodi D, Scolfaro C et al (2004) Microbiological investigations on a nosocomial case of Legionella pneumophila pneumonia associated with water birth and review of neonatal cases. Infez Med 12: 69–75PubMedGoogle Scholar
  48. Franzin L, Scolfaro C, Cabodi D et al (2001) Legionella pneumophila pneumonia in a newborn after water birth: a new mode of transmission. Clin Infect Dis 33: 103–104CrossRefGoogle Scholar
  49. Fraser DW, Tsai TR, Orenstein W et al (1977) Legionnaires’ disease – description of an epidemic of pneumonia. N Engl J Med 297: 1189–1197PubMedGoogle Scholar
  50. Fry NK, Bangsborg JM, Bergmans A et al (2002) Designation of the European Working Group on Legionella Infections (EWGLI) amplified fragment length polymorphism types of Legionella pneumophila serogroup 1 and results of intercentre proficiency testing using a standard protocol. Eur J Clin Microbiol Infect Dis 21: 722–728PubMedCrossRefGoogle Scholar
  51. Fry NK, Rowbotham TJ, Saunders NA et al (1991) Direct amplification and sequencing of the 16S ribosomal DNA of an intracellular Legionella species recovered by amebal enrichment from the sputum of a patient with pneumonia. FEMS Microbiol Lett 83: 165–168CrossRefGoogle Scholar
  52. Furugen M, Koide M, Baba M et al (2008) Legionella pneumonia caused by Legionella pneumophila serogroup 2: second case report in Japan. J Infect Chemother 14: 161–165PubMedCrossRefGoogle Scholar
  53. Gaillac N, Floccard B, Ould T et al (2006) Legionella pneumophila pneumonia during pregnancy: a case report. J Infect 52: e163–e164PubMedCrossRefGoogle Scholar
  54. Garcia-Vidal C, Carratala J (2006) Current clinical management of Legionnaires’ disease. Expert Rev Anti Infect Ther 4: 995–1004PubMedCrossRefGoogle Scholar
  55. Garrido RM, Parra FJ, Frances LA et al (2005) Antimicrobial chemotherapy for Legionnaires’ disease: levofloxacin versus macrolides. Clin Infect Dis 40: 800–806CrossRefGoogle Scholar
  56. Gonzalez IA, Martin JM (2007) Legionella pneumophila serogroup 1 pneumonia recurrence postbone marrow transplantation. Pediatr Infect Dis J 26: 961–963PubMedCrossRefGoogle Scholar
  57. Granados A, Podzamczer D, Gudiol F et al (1989) Pneumonia due to Legionella pneumophila and pneumococcal pneumonia: similarities and differences on presentation. Eur Respir J 2: 130–134PubMedGoogle Scholar
  58. Greenberg D (2005) Legionnaires’ disease in children: is it an emerging or an under-diagnosed disease? ASM 45th General Meeting, Washington D.C., Poster G-820Google Scholar
  59. Greenberg D, Chiou CC, Famigilleti R et al (2006) Problem pathogens: paediatric legionellosis-implications for improved diagnosis. Lancet Infect Dis 6: 529–535PubMedCrossRefGoogle Scholar
  60. Guillouzouic A, Bemer P, Gay-Andrieu F et al (2008) Fatal coinfection with Legionella serogroup 8 and Aspergillus fumigatus. Diagn Microbiol Infect Dis 60: 193–195PubMedCrossRefGoogle Scholar
  61. Gupta SK, Imperiale TF, Sarosi GA (2001) Evaluation of the Winthrop-University Hospital. Criteria to identify Legionella pneumonia. Chest 120: 1064–171PubMedCrossRefGoogle Scholar
  62. Gutierrez F, Masia M, Rodriguez JC et al (2005) Community-acquired pneumonia of mixed etiology, prevalence and outcome. Eur J Clin Microbiol Infect Dis 24: 377–383PubMedCrossRefGoogle Scholar
  63. Gutierrez Rodero F, Ortizdela Tabla V, Martinez C et al (1995) Legionnaires’ disease in patients infected with human immunodeficiency virus. Clin Infect Dis 21: 712–713PubMedGoogle Scholar
  64. Guyot S, Goy JJ, Gersbach P et al (2007) Legionella pneumophila aortitis in a heart transplant recipient. Transpl Infect Dis 9: 58–59PubMedCrossRefGoogle Scholar
  65. Haeuptle J, Zaborsky R, Fiumefreddo R et al (2009) Prognostic value of procalcitonin in Legionella pneumonia. Eur J Clin Microbiol Infect Dis 28: 55–60PubMedCrossRefGoogle Scholar
  66. Haluk E, Aynur Y, Oznur K et al (2006) Rhabdomyolysis-induced acute renal failure associated with legionnaires’ disease. Scan J Urol Nephrol 40: 345–346CrossRefGoogle Scholar
  67. Harrison TG, Doshi N, Fry NK et al (2007) Comparison of clinical and environmental isolates of Legionella pneumophila obtained in the UK over 19 years. Clin Microbiol Infect 13: 78–85PubMedCrossRefGoogle Scholar
  68. Harrison TG, Fry NK, Afshar B et al (2006) Typing of Legionella pneumophila and its role in elucidating the epidemiology of Legionnaires’ disease. In: Cianciotto NP, Kwaik Y, Edelstein PS et al (eds) Legionella: state of the art 30 years after its recognition. Washington, D. C.: American Society for Microbiology, 94–99Google Scholar
  69. Helbig JH, Bernander S, Castellanii Pastoris M et al (2002) Pan-European study on culture-proven Legionnaires’ disease: distribution of Legionella pneumophila serogroups and monoclonal subgroups. Eur J Clin Microbiol Infect Dis 21: 710–716PubMedCrossRefGoogle Scholar
  70. Holmberg RE, Pavia AT, Montgomery D et al (1993) Nosocomial Legionella pneumonia in the neonate. Pediatrics 92: 450–453PubMedGoogle Scholar
  71. Horbach I, Fehrenbach FJ (1990) Legionellosis in heart transplant recipients. Infection 18: 361–363PubMedCrossRefGoogle Scholar
  72. Howden BP, Stuart RL, Tallis G et al (2003) Treatment and outcome of 104 hospitalized patients with Legionnaires’ disease. Intern Med J 33: 484–488PubMedCrossRefGoogle Scholar
  73. Imai N, Yagi N, Konishi T et al (2008) Legionnaires’ disease with hypoperfusion in the cerebellum and frontal lobe on single photon emission computed tomography. Intern Med 47: 1263–1266PubMedCrossRefGoogle Scholar
  74. Jacobson KL, Miceli MH, Tarrand JJ et al (2008) Legionella pneumonia in cancer patients. Medicine 87: 152–159PubMedCrossRefGoogle Scholar
  75. Jeon TJ, Jeon KW (2004) Gene switching in Amoeba proteus caused by endosymbiotic bacteria. J Cell Sci 117: 535–543PubMedCrossRefGoogle Scholar
  76. Johnson JT, Yu VL, Best MG (1985) Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet 2: 298–300PubMedCrossRefGoogle Scholar
  77. Joly JR, McKinney RM, Tobin JO et al (1986) Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. J Clin Microbiol 23: 768–771PubMedGoogle Scholar
  78. Joseph CA (2004) Legionnaires’ disease in Europe 2000–2002. Epidemiol Infect 132: 417–424PubMedCrossRefGoogle Scholar
  79. Joseph CA, Watson JM, Harrison TG et al (1994) Nosocomial Legionnaires’ disease in England and Wales, 1980–92. Epidemiol Infect 112: 329–345PubMedCrossRefGoogle Scholar
  80. Karim A, Ahmed S, Rossoff LJ (2002) Legionnaires’ disease associated with acute encephalitis and arrhythmia. Crit Care Med 30: 1028–1029PubMedCrossRefGoogle Scholar
  81. Kim KW, Goo JM, Lee HJ et al (2007) Chest computed tomographic findings and clinical features of Legionella pneumonia. J Comput Assist Tomogr 31: 950–955PubMedCrossRefGoogle Scholar
  82. König C, Hebestreit H, Valenza G et al (2005) Legionella waltersii – a novel cause of pneumonia?. Acta Paediatr 94: 1505–1507PubMedCrossRefGoogle Scholar
  83. Kümpers P, Tiede A, Kirschner P et al (2008) Legionnaires’ disease in immunocompromised patients: a case report of Legionella longbeachae pneumonia and review of the literature. J Med Microbiol 57: 384–387PubMedCrossRefGoogle Scholar
  84. La Scola B, Birtles RJ, Greub G et al (2004) Legionella drancourtii sp. nov., a strictly intracellular amoebal pathogen. Int J Syst Evol Microbiol 54: 699–703PubMedCrossRefGoogle Scholar
  85. La Scola B, Maltezou H (2004) Legionella and Q fever community acquired pneumonia in children. Pediatr Respir Rev 5(suppl A): S171–S177CrossRefGoogle Scholar
  86. Langtry HD, Balfour JA (1998) Azithromycin. A review of its use in paediatric infectious diseases. Drugs 56: 273–297PubMedCrossRefGoogle Scholar
  87. Lepine LA, Jernigan DB, Butler JC et al (1998) A recurrent outbreak of nosocomial Legionnaire’s disease detected by urinary antigen testing: evidence for long-term colonization of a hospital plumbing system. Infect Control Hosp Epidemiol 19: 905–910PubMedGoogle Scholar
  88. Lettinga KD, Verbon A, Nieuwkerk PT et al (2002a) Health-related quality of life and posttraumatic stress disorder among survivors of an outbreak of legionnaires’ disease. Clin Infect Dis 35: 11–17PubMedCrossRefGoogle Scholar
  89. Lettinga KD, Verbon A, Weverling GJ et al (2002b) Legionnaires’ disease at a Dutch flower show: prognostic factors and impact of therapy. Emerg Infect Dis 8: 1448–1454PubMedGoogle Scholar
  90. Levy I, Rubin LG (1998) Legionella pneumonia in neonates: a literature review. J Perinatol 18: 287–290PubMedGoogle Scholar
  91. Levy PY, Teysseire N, Etienne J et al (2003) A nosocomial outbreak of Legionella pneumophila caused by contaminated transesophageal echocardiography probes. Infect Control Hosp Epiemiol 24: 619–622CrossRefGoogle Scholar
  92. Lück PC, Dinger E, Helbig JH et al (1994) Analysis of Legionella pneumophila strains associated with nosocomial pneumonia in a neonatal intensive care unit. Eur J Clin Microbiol Infect Dis 13: 565–571PubMedCrossRefGoogle Scholar
  93. Lück PC, Schneider T, Wagner J et al (2008) Community-acquired Legionnaires’ disease caused by Legionella pneumophila serogroup 10 linked to the private home. J Med Microbiol 57: 240–243PubMedCrossRefGoogle Scholar
  94. Lüttichau HR, Uldum SA et al (1997) An outbreak of Pontiac fever among children following use of a whirlpool. Clin Infect Dis 26: 1374–1378CrossRefGoogle Scholar
  95. Maltezou H, La Scola B, Astra H et al (2004) Mycoplasma pneumoniae and Legionella pneumophila in community-acquired lower respiratory tract infections among hospitalized children: diagnosis by real time PCR. Scand J Infect Dis 36: 639–642PubMedGoogle Scholar
  96. Marston B, Lipman HB, Brieman RF (1994) Surveillance for legionnaires’ disease. Risk factors for morbidity and mortality. Arch Intern Med 154: 2417–2422PubMedCrossRefGoogle Scholar
  97. Marston BJ, Plouffe JF, File TJ et al (1997) Incidence of community-acquired pneumonia requiring hospitalizations: results of a population-based active surveillance study in Ohio. The Community-Based Pneumonia Incidence Study Group. Arch Intern Med 157: 1709–1718PubMedCrossRefGoogle Scholar
  98. Masia M, Gutierrez F, Padilla S et al (2007) Clinical characterization of pneumonia caused by atypical pathogens combining classic and novel predictors. Clin Microbiol Infect 13: 153–161PubMedCrossRefGoogle Scholar
  99. Mathys W, Deng MC, Meyer J et al (1999) Fatal nosocomial Legionnaires’ disease after heart transplantation: clinical course, epidemiology and prevention strategies for the highly compromised host. J Hosp Infect 43: 242–246PubMedCrossRefGoogle Scholar
  100. McClelland MR, Vaszar LT, Kagawa F (2004) Pneumonia and osteomyelitis due to Legionella longbeachae in a woman with systemic lupus erythematosus. Clin Infect Dis 38: 102–106CrossRefGoogle Scholar
  101. McNally C, Hackman B, Fields BS et al (2000) Potential importance of Legionella species as etiologies in community acquired pneumonia (CAP). Diagn Microbiol Infect Dis 38: 79–82PubMedCrossRefGoogle Scholar
  102. Miller ML, Hayden R, Gaur A (2007) Legionella bozemanii pulmonary abscess in a pediatric allogeneic stem cell transplant recipient. Pediatr Infect Dis J 26: 760–762PubMedCrossRefGoogle Scholar
  103. Mrozińska M (2005) Legionellosis in three children – cases report. Przegl Epidemiol 59: 851–857PubMedGoogle Scholar
  104. Muder RR, Yu VL (2002) Infection due to Legionella species other than L. pneumophila. Clin Infect Dis 35: 990–998PubMedCrossRefGoogle Scholar
  105. Nagai T, Sobajima H, Iwasa M (2000) A fatal newborn case of Legionella pneumophila pneumonia occurring after water birth in a bathtub with an all day circulating system. IASR 13: 190–191Google Scholar
  106. Neil K, Berkelman R (2008) Increasing incidence of legionellosis in the United States, 1990–2005: changing epidemiologic trends. Clin Infect Dis 47: 591–599PubMedCrossRefGoogle Scholar
  107. O’Connor BA, Carman J, Eckert K et al (2007) Does using potting mix make you sick? Results from a Legionella longbeachae case-control study in South Australia. Epidemiol Infect 135: 34–39PubMedCrossRefGoogle Scholar
  108. Orenstein WA, Overturf GD, Leedom JM et al (1981) The frequency of Legionella infection prospectively determined in children hospitalized with pneumonia. J Pediatr 99: 403–406PubMedCrossRefGoogle Scholar
  109. Pai P, Kumar S, Bell GM et al (1996) Rapidly progressive crescentic glomerulonephritis and Legionnaires’ disease. Clin Nephrol 45: 209–210PubMedGoogle Scholar
  110. Paradkar PN, De Domenico I, Durchfort N et al (2008) Iron depletion limits intracellular bacterial growth in macrophages. Blood 112: 866–874PubMedCrossRefGoogle Scholar
  111. Park M, Yun ST, Kim MS et al (2004) Phylogenetic characterization of Legionella-like endosymbiotic X-bacteria in Amoeba proteus: a proposal for “Candidatus Legionella jeonii” sp. nov. Environ Microbiol 6: 1252–1263PubMedCrossRefGoogle Scholar
  112. Pedro-Botet ML, Sabria M, Sopena N et al (2003) Legionnaires’ disease and HIV infection. Chest 124: 543–547PubMedCrossRefGoogle Scholar
  113. Phares CR, Wangroonngsarb P, Chantra S et al (2007) Epidemiology of severe pneumonia caused by Legionella longbeachae, Mycoplasma pneumonia, and Chlamydia pneumonia: 1-year, population-based surveillance for severe pneumonia in Thailand. Clin Infect Dis 45: 147–155CrossRefGoogle Scholar
  114. Poupard M, Campese C, Bernillon P et al (2007) Factors associated with mortality in Legionnaires’ disease, France, 2002–2004. Med Mal Infect 37: 325–330PubMedGoogle Scholar
  115. Qin X, Abe PM, Weissman SJ et al (2002) Extrapulmonary Legionella micdadei infection in a previously healthy child. Pediatr Infect Dis J 21: 1174–1176PubMedCrossRefGoogle Scholar
  116. Quagliano PV, Das Narla L (1993) Legionella pneumonia causing multiple cavitating pulmonary nodules in a 7-month-old infant. AJR Am J Roentgenol 161: 367–368PubMedGoogle Scholar
  117. Redd SC, Schuster DM, Quan J et al (1988) Legionellosis in cardiac transplant recipients: results of a nationwide survey. J Infect Dis 158: 651–653PubMedGoogle Scholar
  118. Ricketts KD, Joseph CA (2007) Legionnaires’ disease in Europe 2005–2006. Euro Surveill 12: E7–E8PubMedGoogle Scholar
  119. Roig J, Aguilar X, Ruiz J et al (1991) Comparative study of Legionella pneumophila and other nosocomial-acquired pneumonias. Chest 99: 344–350PubMedCrossRefGoogle Scholar
  120. Roig J, Rello J (2003) Legionnaires’ disease: a rational approach to therapy. J Antimicrob Chemother 51: 1119–1129PubMedCrossRefGoogle Scholar
  121. Rowbotham TJ (1993) Legionella-like amoebal pathogens. In: Barbaree JM, Breiman RF, Dofour AP (eds) Legionella – current status and emerging perspectives. ASM Press, Washington, pp 137–140Google Scholar
  122. Ryan ME, Feldman S, Pruitt B et al (1979) Legionnaires’ disease in a child with cancer. Pediatrics 64: 951–953PubMedGoogle Scholar
  123. Sabria M, Campins M (2003) Legionnaires’ disease: update on epidemiology and management options. Am J Respir Med 2: 235–243PubMedGoogle Scholar
  124. Sabria M, Pedro-Botet ML, Gomez J et al (2005) Fluoroquinolones vs macrolides in the treatment of Legionnaires disease. Chest 128: 1401–1405PubMedCrossRefGoogle Scholar
  125. Sakai F, Tokuda H, Goto H et al (2007) Computed tomographic features of Legionella pneumophila pneumonia in 38 cases. J Comput Assist Tomogr 31: 125–131PubMedCrossRefGoogle Scholar
  126. Sandkovsky U, Sandkovsky G, Suh J et al (2008) Legionella pneumonia and HIV: case reports and review of the literature. AIDS Patient Care STDS 22: 473–481PubMedCrossRefGoogle Scholar
  127. Saunders NA, Harrison TG, Haththotuwa A et al (1990) A method for typing strains of Legionella pneumophila serogroup 1 by analysis of restriction fragment length polymorphisms. J Med Microbiol 31: 45–55PubMedCrossRefGoogle Scholar
  128. Scaturro M, Losardo M, De Ponte G et al (2005) Comparison of the free molecular methods used for subtyping of Legionella pneumophila strains isolated during an epidemic of Legionellosis in Rome. J Clin Microbiol 43: 5348–5350PubMedCrossRefGoogle Scholar
  129. Shelburne SA, Kielhofner MA, Tiwari PS (2004) Cerebellar involvement in legionellosis. South Med J 97: 61–64PubMedCrossRefGoogle Scholar
  130. Shimura C, Saraya T, Wada H et al (2008) Pathological evidence of rhabdomyolysis-induced acute tubulointerstitial nephritis accompanying Legionella pneumonia pneumonia. J Clin Pathol 61: 1062–1063PubMedCrossRefGoogle Scholar
  131. Singh N, Gayowski T, Wagener M et al (1996) Pulmonary infections in liver transplant recipients receiving tacrolimus. Changing pattern of microbial etiologies. Transplantation 61: 396–401Google Scholar
  132. Singh N, Stout J, Yu VL (2002) Legionnaires’ disease in a transplant recipient acquired from the patient’s home: implications for management. Transplantation 74: 755–756PubMedCrossRefGoogle Scholar
  133. Sopena N, Force L, Pedro-Botet ML et al (2007) Sporadic and epidemic community legionellosis: two faces of the same illness. Eur Respir J 29: 138–142PubMedCrossRefGoogle Scholar
  134. Sopena N, Martinez-Vazquez C, Rodriguez-Suarez JR et al (1998) Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias. Chest 113: 1195–2000PubMedCrossRefGoogle Scholar
  135. Stout JE, Yu VL (1997) Legionellosis. N Engl J Med 337: 682–687PubMedCrossRefGoogle Scholar
  136. Sugihara E, Dambara T, Aiba M et al (2007) Clinical characteristics of 8 sporadic cases of community-acquired Legionella pneumonia in advanced age. Intern Med 46: 461–465PubMedCrossRefGoogle Scholar
  137. Takunaga Y, Concepcion W, Berquist WE et al (1992) Graft involvement by Legionella in a liver transplant recipient. Arch Surg 127: 475–477Google Scholar
  138. Tewari K, Wold SM, Asrat T (1997) Septic shock associated with Legionella pneumonia: case report. Am J Obstet Gynecol 176: 706–707PubMedCrossRefGoogle Scholar
  139. Tossa P, Deloge-Abarkan M, Zmirou-Navier D et al (2006) Pontiac fever: an operational definition for epidemiological studies. BMC Public Health 6: 112PubMedCrossRefGoogle Scholar
  140. Trübel HK, Meyer HG, Jahn B et al (2002) Complicated nosocomial pneumonia due to Legionella pneumophila in immunocompromised child. Scand J Infect Dis 34: 219–221PubMedCrossRefGoogle Scholar
  141. Venezia RA, Hanley EM, Urquhart K et al (1994) Nosocomial legionellosis associated with aspiration of nasogastric feedings diluted in tap water. Infect Control Hosp Epidemiol 15: 529–533PubMedCrossRefGoogle Scholar
  142. Vergis EN, Akbas E, Yu VL (2000) Legionella as a cause of severe pneumonia. Semin Respir Crit Care Med 21: 295–304PubMedGoogle Scholar
  143. Vimercati A, Greco P, Bettocchi S et al (2000) Legionnaire’s disease complicating pregnancy: a case report with intrauterine fetal demise. J Perinat Med 28: 147–150PubMedCrossRefGoogle Scholar
  144. Von Baum H, Ewig S, Marre R et al (2008) Community-acquired Legionella pneumonia: new insights for the German competence network for community-acquired pneumonia. Clin Infect Dis 46: 1356–1364PubMedCrossRefGoogle Scholar
  145. Watkins ID, Tobin JO, Dennis PJ et al (1985) Legionella pneumophila serogroup 1 subgrouping by monoclonal antibodies – an epidemiological tool. J Hyg 95: 211–216CrossRefGoogle Scholar
  146. Watson AM, Boyce TG, Wylam ME (2004) Legionella pneumonia: infection during immunosuppressive therapy for idiopathic pulmonary hemosiderosis. Pediatr Infect Dis J 23: 82–84PubMedCrossRefGoogle Scholar
  147. Wondergem MJ, Voskuyl AE, van Agtmael MA (2004) A case of Legionellosis during treatment with a TNF-a antagonist. Scand J Infect Dis 36: 310–311PubMedCrossRefGoogle Scholar
  148. Woodhead M (2002) Community-acquired pneumonia in Europe: causative pathogens and resistance patterns. Eur Respir J Suppl 36: 20s–27sPubMedCrossRefGoogle Scholar
  149. Yoo BK, Triller DM, Yong CS (2004) Gemifloxacin: a new fluoroquinolone approved for treatment of respiratory infections. Ann Pharmacother 38: 1226–1235PubMedCrossRefGoogle Scholar
  150. Yu VL, Plouffe JF, Castellanii-Pastoris M et al (2002) Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis 186: 127–128PubMedCrossRefGoogle Scholar

Copyright information

© L. Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland 2009

Authors and Affiliations

  • Marta Palusińska-Szysz
    • 1
  • Monika Cendrowska-Pinkosz
    • 2
  1. 1.Department of Genetics and MicrobiologyMaria Curie-Skłodowska UniversityLublinPoland
  2. 2.Department of Anatomy, Department of AllergologyMedical UniversityLublinPoland

Personalised recommendations