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Community-acquired pneumonia caused by Legionella dumoffii in a patient with hairy cell leukemia

Nicht nosokomiale Pneumonie durch Legionella dumoffii bei einem Patienten mit Haarzell-Leukämie

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Summary

A case of community-acquired pneumonia caused byLegionella dumoffii in a patient with hairy cell leukemia is described. Diagnosis was confirmed by isolation by culture of sputum and broncho-alveolar lavage specimens, positive direct fluorescent antibody stains, and antibody seroconversion from 1 : 16 (acute) to 1 : 4096 (six months). The blue white autofluorescence of theL. dumoffii colonies when viewed under ultraviolet light was particularly useful in preliminary identification. The patient recovered from his pneumonia after administration of erythromycin and rifampin. Legionella have been shown to multiply in monocytes and cell-mediated immunity appears to be the primary mechanism of host defense in man. Hairy cell leukemia is characterized by monocyte dysfunction and such patients have a predilection for infection by microbes that are controlled by cell-mediated defenses. We review other cases of community-acquiredL. dumoffii pneumonia as well as other cases of Legionella infection in patients with hairy cell leukemia.

Zusammenfassung

Bei einem Patienten mit Haarzell-Leukämie wurde eine nicht nosokomialeLegionella dumoffii — Pneumonie beobachtet. Die Diagnose wurde gesichert durch kulturellen Erregernachweis aus Sputum und Bronchoalveolar-Lavageflüssigkeit, eine positive direkte Antikörper-Fluoreszenz und einen Antikörperanstieg im Serum mit einem Titer von 1 : 16 im Akutstadium auf 1 : 4096 nach sechs Monaten. Für die vorläufige Erregeridentifizierung war die weiße Autofluoreszenz derL. dumoffii-Kulturen unter ultraviolettem Licht besonders hilfreich. Nach Behandlung mit Erythromycin und Rifampicin heilte die Pneumonie ab. Es wurde nachgewiesen, daß sich Legionella in Monozyten vermehrt. Beim Menschen ist die zellvermittelte Immunität offensichtlich der primäre Abwehrmechanismus. Bei Haarzell-Leukämie besteht typischerweise eine Monozytenfunktionsstörung. Die Patienten sind besonders anfällig für Infektionen durch Erreger, die unter der Kontrolle der zellvermittelten Abwehr stehen. Wir geben eine Übersicht über andere Fälle vonL. dumoffii Pneumonie und andere Fälle von Legionella-Infektionen bei Patienten mit Haarzell-Leukämie.

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Authors and Affiliations

  1. Infectious Disease and Special Pathogens Sections, VA Medical Center and the University of Pittsburgh, Pittsburgh, PA, USA

    G. D. Fang M. D., J. E. Stout M. S., V. L. Yu M. D., A. Goetz R. N., M. N. Ed., J. D. Rihs B. S. & R. M. Vickers B. S.

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  1. G. D. Fang M. D.
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  2. J. E. Stout M. S.
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  3. V. L. Yu M. D.
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  4. A. Goetz R. N., M. N. Ed.
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  5. J. D. Rihs B. S.
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  6. R. M. Vickers B. S.
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Fang, G.D., Stout, J.E., Yu, V.L. et al. Community-acquired pneumonia caused by Legionella dumoffii in a patient with hairy cell leukemia. Infection 18, 383–385 (1990). https://doi.org/10.1007/BF01646415

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