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Clinical features of patients with Legionnaires disease showing initial clinical improvement but radiological deterioration: A retrospective single-center analysis

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Abstract
Patients with Legionnaires disease occasionally experience initial clinical improvement but radiological progression. However, data on this issue are so far limited. The aim of this study was to investigate changes in chest radiograph findings in patients with Legionnaires disease who showed initial clinical improvement and to identify risk factors and outcomes in these patients.

All patients diagnosed with Legionnaires disease at a tertiary hospital in South Korea between March 2011 and May 2020 were retrospectively enrolled. Legionnaires disease was defined as abnormal chest radiographs accompanied by a positive finding on at least one of the following tests: urinary antigen test, sputum Legionella polymerase chain reaction, and sputum Legionella culture. Clinical improvement was defined as defervescence and decreased C-reactive protein level. Clinical and radiological records were reviewed on treatment days 7 and 14 and at discharge. We describe the characteristics of patients with clinical improvement but radiological deterioration on treatment for Legionnaires disease and compared them with patients with initial clinical improvement and stable or resolving chest radiograph findings.

Of 140 patients with Legionnaires disease, 33 (24%) showed initial clinical deterioration, while the remaining 107 (76%) showed initial clinical improvement on day 7. The latter 107 patients were analyzed in this study; 22 (21%) showed radiological progression despite the clinical improvement. Risk factors for these patients were a high pneumonia severity index score and the use of mechanical ventilation. Mortality did not significantly differ between those with initial clinical improvement but radiological deterioration and those with both initial clinical and radiological improvement (28% vs 12%, P = .49).

About one-fifth of patients with Legionnaires disease, especially those who had a high pneumonia severity index score and underwent mechanical ventilation, showed radiological deterioration despite of clinical improvement 1 week after appropriate treatment, while outcomes were not significantly worse in these patients. Therefore, our findings support that close monitoring without modification of antibiotics use is warranted in those who have clinical improvement regardless of radiologic findings.
Author(s)
김민재김성한김양수김진영김해인박성희서현지양은미이상오정용필정지원정혜민최상호
Issued Date
2021
Type
Article
Keyword
AgedFemaleHumansLegionellaLegionella pneumophila - isolation & purificationLegionnaires'Disease - diagnostic imagingLegionnaires'Disease - drug therapyMaleMiddle AgedPneumonia - diagnostic imagingRadiographyThoracicRetrospective Studies
DOI
10.1097/MD.0000000000028402
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8383
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2614232071&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Clinical%20features%20of%20patients%20with%20Legionnaires%20disease%20showing%20initial%20clinical%20improvement%20but%20radiological%20deterioration:%20A%20retrospective%20single-center%20analysis&offset=0&pcAvailability=true
Publisher
MEDICINE
Location
미국
Language
한국어
ISSN
0025-7974
Citation Volume
100
Citation Number
51
Citation Start Page
28402
Citation End Page
28402
Appears in Collections:
Medicine > Medicine
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