We searched Medline with the following keywords: “Legionella”, “children”, “infant”, “neonates”, “infection”, and “Legionnaires' disease”. All case reports and case series were reviewed to identify other reports of paediatric legionellosis. Inclusion criteria were based on diagnostic tests for Legionnaires' disease. A case was included if at least one of the following diagnostic methods was positive: culture of respiratory secretions, direct fluorescent antibody assay, urine antigen, or
ReviewProblem pathogens: paediatric legionellosis—implications for improved diagnosis
Introduction
Legionnaires' disease is considered a rare cause of community-acquired pneumonia in children. Seroepidemiological studies in children have shown variable results with raised titres of legionella antibody ranging from 2% to 52%.1, 2 A prospective study found raised titres for Legionella pneumophila in 52% of children without clinical signs for infection.3 The authors concluded that “L pneumophila is not a common cause of acute respiratory disease in early childhood in the study area but that children are frequently exposed to the organism.”3 Diagnosis based only on serological tests for which the sensitivity and specificity is uncertain is a major drawback for these earlier studies in children. We reviewed the literature of paediatric legionellosis. However, we adopted rigorous criteria for the diagnosis of legionellosis in the cases to be included in this review. The evolutionary course of discovery of Legionnaires' disease in children seems to parallel that of adults. We suggest an approach that might uncover occult cases of Legionnaires' disease in children to allow earlier treatment and, possibly, prevention.
Section snippets
Paediatric cases of legionella infection
We identified 76 cases of legionella infection in children that fulfilled our inclusion criteria.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56 Diagnosis was made with legionella culture methodology in 45 (59%) of these cases; culture was the only diagnostic method that was positive in 23 (30%) cases. Seroconversion and direct
Discussion
Legionnaires' disease in adults is now an established and frequent cause of both community-acquired and hospital-acquired pneumonia.57, 58 However, from the 1980s to the early 1990s, Legionnaires' disease was considered a rare and exotic disease usually identified with sporadic outbreaks. As diagnostic methods improved and were more commonly used, cases of Legionnaires' disease increased.59
Pneumonia is a common infection in children, but few reliable clinical or radiological features exist that
Search strategy and selection criteria
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Epidemiology and direct health care costs of hospitalised legionellosis in New Zealand, 2000–2020
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2020, Clinical Infection in PracticeCitation Excerpt :The most common reported source in the literature has been from water-birth via a heated birthing pool [3–5]. Mortality is reported as 33% in children, rising to 50% in those under 1 year of age [6]. We believe that this is the first reported case of a UK neonate being infected with legionella via a nursery cold mist humidifier filled from a residential water supply.
Bartonella, Legionella, Mycoplasma, and Ureaplasma
2020, Pediatric Transplant and Oncology Infectious DiseasesControlling Legionella pneumophila in water systems at reduced hot water temperatures with copper and silver ionization
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2019, The Lancet Respiratory Medicine