Wstrząs septyczny wywołany przez Legionella micdadei – opis przypadku

J. Kulesza¹, A. Wądrzyk²

Summary
Background. Legionella, a Gram-negative bacterium, is known to cause severe infections, although on rare occasions. We present a case of life-threatening sepsis that has not been described in Poland before. Case report. A 48-yr-old woman was admitted to hospital with a diagnosis of myocardial infarction which had not been confirmed. After several hours of observation, the patient developed profound shock with respiratory distress and renal failure, associated with production of a large amount of purulent sputum. Vigorous resuscitation with inotropic support and controlled ventilation was commenced, and initial administration of ampicillin/clavulonic acid was ineffective. A blood sample tested for anti-legionella antibodies was positive, and azithromycin was introduced. Concomitant Pseudomonas and Acinetobacter infection was treated with ciprofloxacin and imipenem. The patient was ventilated for 14 days, eventually recovering sufficiently to be discharged home after 29 days of hospitalisation. Discussion. An atypical clinical picture with dominating cardiac pain delayed proper diagnosis. We began to suspect Legionellosis because of high concentrations of aminotransferases, hypophosphatemia and the lack of response to initial antibiotic treatment. Legionnaires´ disease was confirmed by the high concentration of anti-legionella antibodies. Conclusion. Legionella micdadei may cause severe systemic infection. Since there are no clinical features unique to Legionnaires´ disease, accurate diagnosis may be delayed and difficult.

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