Introduction
The first epidemic outbreak of Legionella pneumonia was recorded in 1976 in Philadelphia (USA), when 4400 congress participants of the American Legion veteran organization 221 (5%) developed severe pneumonia, 34 (15.4%) of them died. Six month later J.E. McDade and C.C. Shepard could have isolated the pathogen from lung tissue of deceased patients, it was called Legionella pneumophila in memory of the first victims (1). Legionella pneumophila is in the top of 3 most frequent causes of community-acquired pneumonia and associated with high morbidity, as shown by the high proportion of patients requiring intensive care unit (ICU) admission (2-4).
The genus Legionella forms a genetically related taxonomic structure, while the Legionellaceae family consists of only one genus and belongs to the g-subtype of proteobacteria. Legionella are gram-negative rods 0.5–0.7 µm in diameter and 2–5 µm in length (5).
Legionella pneumonia lack diagnostic specifity. Warm season, age over 40, male sex, smoking, presence of concomitant diseases, accompanied by a course of systemic hormonal and / or intensive immunosuppressive therapy are defined as the risk factors that have been associated with severity of legionella pneumonia (5). Legionella pneumonia is often misdiagnosed, that leads to under treatment of legionella accounted community acquired pneumonia (6). Mortality rate ranges from 8 to 40 %, in cases of legionella pneumonia admitted to the ICU mortality was around 33%, duration of symptoms before ICU admission longer than 5 days, and intubation were reported to be associated with increased mortality (7). Early initiation of appropriate therapy decreases the mortality rate to less than 5 %. Delay in initiation of appropriate antibiotics is associated with a worse prognosis (8). Diagnosis is based mainly on the isolation of the pathogen from sputum, bronchoalveolar lavage fluid, pleural fluid, and occasionally from blood cultures. L pneumophila serotype 1 accounts for about 90% of all Legionella pneumonia. Widespread use of rapid methods for the determination of soluble antigen of L. pneumophila serotype 1 in urine have led in recent years to a tangible decrease in mortality in this disease. The method allows to confirm the diagnosis within 1-2 hours. This method has advantages over others due to non-invasiveness and timing (9).
We present a case of clinical manifestation of legionellesis in immunocompromised patient with multiple myeloma.