Cavitary Legionella Pneumonia in AIDS: When Intracellular Immunity Failure Leads to Rapid Intrapulmonary Cavitation

Introduction. Legionella is a frequent cause of bacterial pneumonia in patients with AIDS. While multiple organisms have been associated with cavitary pneumonia in this population, Legionella has not. Clinical Case. A middle-aged woman with HIV-AIDS and severely depressed CD-4 count presented with one month of progressively worsening productive cough and dyspnea. Serial imaging showed focal consolidations which multiplied and cavitated over the subsequent days. Legionella urine antigen was positive, and appropriate treatment was continued for 3 weeks total. The patient recovered quickly, and follow-up imaging 8 weeks later showed near-resolution of all lesions. Discussion. Cavitary pneumonia secondary to Legionella has been seldom described, traditionally in the context of immunosuppressive therapy. Patients with AIDS and severely depressed CD4 counts have significantly compromised cell-mediated immunity. This case highlights the importance of consideration for legionellosis in rapidly progressing cavitary pneumonia, especially in patients with severely compromised cell-mediated immunity, including those with HIV-AIDS.

Health Risk in Hot Springs: A Literature Review

Natural hot spring is one of the recreational water. The public used it for recreation, relaxation, and therapy. The water quality should meet standards, such as free from microorganisms to prevent the onset of health complaints. This paper aimed to identify the pathogenic microorganisms and recreational water illness in natural hot spring users from worldwide studies. Method: This systematic review analysis use PRISMA Protocol as a guide to provide this article and PEO Framework to specified the criteria. Various database used to find those article is NCBI, Google Scholar, and Science Direct. In total of 10 eligible articles to analyse from 2010 -2020. Discussion: The result showed that hot spring users experienced health complaints after using hot springs contaminated with pathogenic microorganisms. The microorganisms identified were Naegleria spp, Naegleria fowleri, Legionella pneumophila, Vittaforma corneae, Mycobacterium avium-intracellulare Complex (MAC), Pseudomonas aeruginosa, and Mycobacterium phocaicum. Recreation water illnesses identified were Primary Amebic Meningoencephalitis (PAM), Legionella pneumonia, Pseudomonas foliculitis, Pseudomonas mastitis, Microsporidial keratitis, Hot tub lung (HTL), and P. aeruginosa pneumonia. Besides the water quality, age, comorbid, and frequency of visiting hot springs were risk factors of recreational water illness. Conclusion: The onset of recreational water illness in users of hot springs was influenced by the quality of water microbiology and age.

It’s never too late- spontaneous rupture of spleen and life-threatening hypovolemic shock in a patient recuperating from legionnaire’s disease

Spontaneous non-traumatic rupture of the spleen in the setting of Legionnaires’ disease is very uncommon but a life-threatening condition. The splenic rupture can present within a few days after symptom onset with significant hypotension with drop in haemoglobin along with left side upper quadrant pain. Most of the cases described in the previous literature have presented within 0-11 (mean 4) days of the pneumonia but this case we are reporting presented after 3 weeks after being treated with Legionella pneumonia. The case also highlights an atypical presentation and emphasises the need to maintain a low threshold for diagnosis especially in resource constrained setting so that patient can be transferred at the earliest to a centre where appropriate corrective measures including surgery can be safely undertaken. Keywords: splenic rupture, pneumonia, hypovolemic shock

Legionella Pneumonia on Point-of-care Ultrasound in the Emergency Department: A Case Report

Introduction: Legionella is an uncommon, atypical organism that can cause community-acquired pneumonia. Commonly associated with high fevers, gastrointestinal symptoms, and hyponatremia, it can be easily overlooked, especially during the coronavirus disease of 2019 (COVID-19) pandemic. Legionella has specific antibiotic treatment that will improve outcome; thus, its recognition is important. Case Report: We present a case of Legionella pneumonia in a man presenting with shortness of breath and fever. The patient’s initial chest radiography was negative. With the use of point-of-care ultrasound (POCUS) the changes of atypical pneumonia could be seen. Ultimately Legionella was confirmed with urine antigen testing, and appropriate antibiotic treatment was started. Discussion: Given the increased awareness of COVID-19 it is important to consider a broad differential with respiratory illness. Legionella pneumonia on POCUS is consistent with atypical pneumonia descriptions on ultrasound. Point-of-care ultrasound can be used to diagnose atypical pneumonia, specifically caused by Legionella in our case. Conclusion: Legionella is evident on POCUS but is difficult to distinguish from other infections with POCUS alone. One should consider Legionella if POCUS is positive for signs of atypical infection.