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Legionella pneumophila in Patients with Pneumonia at a Referral Hospital, New Delhi, India, 2015–2020

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  • 1 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India;
  • 2 Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India;
  • 3 Pediatrics, All India Institute of Medical Sciences, New Delhi, India;
  • 4 Biostatistics, All India Institute of Medical Sciences, New Delhi, India;
  • 5 Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India

ABSTRACT

Legionnaires’ disease (LD) is an established cause of pneumonia, and the disease remains largely underdiagnosed. Even though LD has been reported from many parts of the world, only sporadic cases have been reported in India. During February 2015–January 2020, we enrolled 597 patients with radiographically confirmed pneumonia and tested respiratory secretions for Legionella spp. by using real-time PCR, and culture. A commercial urinary antigen test (UAT) was also used to detect the Legionella pneumophila (Lp) serogroup 1 antigen in urine. An LD case was defined as a patient with pneumonia and positive results for Legionella spp. infections determined by real-time PCR (from any respiratory specimen) or culture or UAT. Demographic data, risk factors, clinical, radiological, and outcome data of Lp-positive and Lp-negative patients were compared using logistic regression. Over the study period, 14 (2.3%) patients were positive for Legionella spp. infections by real-time PCR and UAT; eight (57%) were admitted to the intensive care unit, and four (28.6%) in-hospital deaths occurred. Bivariate analysis showed that renal disease, neurological conditions, confusion, leukocytosis, and requirement of oxygen support were more common in the Lp-positive group than in the Lp-negative group. However, multivariate analysis failed to confirm most of these differences; renal disease was the only independent variable remaining significant. All test methods have intrinsic limitations in identifying Legionella; therefore, more than one testing method should be used. Application of molecular assays including real-time PCR has great value because of its high sensitivity, specificity, and rapid diagnostic potency. Increased awareness and improved diagnostic testing could facilitate early detection of cases, pathogen-directed therapy, and improved outcomes for patients.

    • Supplementary Materials

Author Notes

Address correspondence to Rama Chaudhry, Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail: drramach@gmail.com

Authors’ addresses: K. Sreenath and Rama Chaudhry, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India, E-mails: sreenathk87@gmail.com and drramach@gmail.com. A. B. Dey, Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India, E-mail: abdey@hotmail.com. S. K. Kabra, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India, E-mail: skkabra@hotmail.com. Bhaskar Thakur, Division of Biostatistics and Epidemiology, Texas Tech Health Science Center, EI Paso, TX, E-mail: bhaskarstatistics@gmail.com. Randeep Guleria, Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India, E-mail: randeepguleria2002@gmail.com.

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