Legionnaires’ Disease in Solid Organ Transplant Recipients - Université de Reims Champagne-Ardenne
Article Dans Une Revue Chest Année : 2023

Legionnaires’ Disease in Solid Organ Transplant Recipients

Guillaume Thizy
Adrien Flahault
Olivier Roux
  • Fonction : Auteur
Sophie Jarraud
David Lebeaux
Gabriela Gautier-Vargas
  • Fonction : Auteur
Paolo Malvezzi
  • Fonction : Auteur
Marlene Murris
  • Fonction : Auteur
Fanny Vuotto
  • Fonction : Auteur
Sophie Girerd
  • Fonction : Auteur
Nathalie Pansu
Teresa Antonini
  • Fonction : Auteur
Laure Elkrief
  • Fonction : Auteur
Benoit Barrou
Camille Besch
Mathieu Blot
  • Fonction : Auteur
Aude Boignard
  • Fonction : Auteur
Henri Brenier
  • Fonction : Auteur
Audrey Coilly
  • Fonction : Auteur
Kaminski Hannah
  • Fonction : Auteur
Pauline Housssel-Debry
Jerome Jouan
Boris Melloni
  • Fonction : Auteur
Christophe Pison
Cédric Rafat
  • Fonction : Auteur
Jean-Michel Rebibou
  • Fonction : Auteur
Betoul Schvartz
  • Fonction : Auteur
Fatouma Toure
  • Fonction : Auteur
Emilie Savoye
Florence Ader
  • Fonction : Auteur

Résumé

BACKGROUND: Legionnaires’ disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients (SOTRs). However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. RESEARCH QUESTION: What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in SOTRs? STUDY DESIGN AND METHODS: In this 10-year multicenter, retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU. RESULTS: One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% of patients (54/57), ground-glass opacity in 63% of patients (36/57), macronodules in 21% of patients (12/57), and cavitation in 8.8% of patients (5/57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P¼ .047), lymphopenia (P ¼ .014), respiratory symptoms (P¼ .010), and pleural effusion (P ¼ .039). The 30-day and 12-month mortality rates were 8% (8/101) and 20% (19/97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12- month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P ¼ .022). INTERPRETATION: LD is a late and severe complication occurring in SOTRs that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.
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Dates et versions

hal-04274669 , version 1 (08-11-2023)

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Guillaume Thizy, Adrien Flahault, Anne Scemla, Olivier Roux, Sophie Jarraud, et al.. Legionnaires’ Disease in Solid Organ Transplant Recipients. Chest, 2023, ⟨10.1016/j.chest.2023.09.033⟩. ⟨hal-04274669⟩
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