The Different Clinical Courses of Legionnaires' Disease in Newborns from the Same Maternity Hospital

Abstract

In children, the incidence of Legionnaires' disease (LD) is unknown, hospital-acquired LD is associated with clinical risk factors and environmental risk, and children with cell-mediated immune deficiency are at high risk of infection. Both newborns were born in the same delivery room; stayed in the same hospital room where they were cared for, bathed, and breastfed; were male; were born on time, with normal birth weight, and with high Apgar score at birth; and survived this severe infection (L. pneumophila, serogroup 2-15) but with different clinical courses. In neonate 1, bleeding in the brain, thrombosis of deep pelvic veins, and necrosis of the lungs, which left behind cystic and cavernous changes in the lungs, were found, while neonate 2 suffered from pneumonia alone. The only difference in risk factors for LD between these two newborns is the number of days of illness until the start of azithromycin treatment (sixth versus the third day of illness). We suggest that a change in the guidelines for diagnosing and treating community-acquired pneumonia and hospital-acquired pneumonia in newborns is needed in terms of mandatory routine testing for Legionella pneumophila. Early initiation of macrolide therapy is crucial for the outcome of LD in the newborn.

Keywords: cysts; legionnaires’ disease; macrolides; neonate; quinolones.

Figure 1

Ultrasound finding of blood vessels: The thrombosis of the femoral vein and iliac vein, on the right side, in newborn 1. The right femoral vein, right side, has a reduced diameter, long with 9 mm, lumen up to 50%, with a pre-obstructive dilatation of the blood vessel of about 5 mm. The right iliac external vein is from the level v. femoral along about 20 mm long filled with heteroechoic contents, more hyperechoic contents, corresponding to the thrombosis. A. femoris and a. iliaca external are preserved flow.

Figure 2

Ultrasound finding of the brain: The brain edema and on the right periventricular hyperechogenicity, the degree I, in newborn 1. Chambers easily asymmetric, VPRD = 2.2 mm, VPRL = 1.3 mm. Circular hyperechoic changes on both sides, around the tops of the lateral chambers. Right periventricular, hematoma with signs of resorption, 4 mm in diameter. Pronounced and diffuse hyperechogenicity in the parenchyma. Circulation in the a. pericalosa shows orderly velocities with low resistance RI = 0.53.

Figure 3

MSCT and X-ray of thoracic in neonate 1 indicate extensive, confluence, zones of lung parenchyma consolidation, on both sides, with signs of necrosis and formed thick wall cavities. The multislice computed tomography (MSCT) of the thoracic on the 17th day of hospitalization and X-ray of the thoracic on the 39th day of hospitalization shows cystic formations in the lungs. The MSCT finding on 17th day: The examination was performed natively and postcontrast, with axial sections 0.8 mm thick, with subsequent reconstructions in MPR and VRT. On both sides, diffuse in the lung parenchyma, large confluent zones of lung parenchyma consolidation can be seen, with hypodense zones of necrosis (density about 30 HU). Within the described consolidation zones, numerous thick-walled caverns can be seen, some of which communicate with each other, up to 13 mm in diameter. The anterior segments of the upper and lower lobes and the medial lingula segment of the right lung, as well as the anterior segment of the lower left lobe, are enveloped in aerations with smaller circular zones of consolidation. In the pleural cavities, on both sides, no free fluid is observed. The trachea, main, lobar, and segmental bronchi are preserved lumen and arborization. No significant mediastinal lymphadenopathy was observed. No pathological changes were seen in the bone structures of the chest wall shown. No pathological changes were seen in the sections through the upper abdomen. The X-ray finding on 39th day of hospitalization: Bilateral, diffuse in the pulmonary parenchyma of multiple oval cavitation zones with different wall thicknesses, which probably correspond to legionnaires’ disease. On the right are possible aero-liquid levels. Right hemidiaphragm of obscure contours.

Figure 4

X-ray of thoracic in neonate 2 on the 33rd day of hospitalization: On the right, in the upper and medial lung fields, the transparency of the lung parenchyma is inhomogeneously reduced. On the left, the lower lung field is in superposition with heart shadow. The hemidiaphragms of clear contours.