TABLE 1.

Microbiological and clinical features of 33 cancer patients with legionellosis

Case no., age (yr)/sex; culture sourcea	Cancer type, HSCT status; baseline WBC, baseline ANC (× 109 cells/liter)b	Presentation	Best match % (no./total no.) to species/strain, GenBank accession no.; serogroup	Treatment; outcome, notec
15 cases with L. pneumophila subsp. pneumophila
24, 51/F; BAL fluid	Lung; 3.8, 2,4	Pneumonia, resp. failured	100 (1,475/1,475) to strains Paris, Lorraine, and Phily-1; 1e	FEP, AZM, VAN; death @ 5 days
6, 64/F; BAL fluid	AML; 3.1, 0.26	Pneumonia, neutropenic fever	99.6 (1,401/1,406) to strains Paris, Lorraine, and Phily-1; 1	LVX, MXF, AZM; recovered
28, 75/M; BAL fluid	AML, allo-HSCT; 7.0, 6.5	Pneumonia, resp. failure	100 (1,478/1,478) to strains Paris, Lorraine, and Phily-1; 1	MEM, MXF, VAN; recovered, urine antigen (+)
32, 74/F; BAL fluid	Myeloma, auto-HSCT; 5.0, 3.0	Pneumonia	100 (1,443/1,443) to strains Paris, Lorraine, and Phily-1; 1	CIP, CRO, AZM; recovered, urine antigen (−)
15, 55/F; BAL fluid	AML; 0.1, 0	Pneumonia, neutropenic fever	100 (1,451/1,451) to strains Paris, Lorraine, and Phily-1; 6	TZB, LZD, CIP; recovered
16, 66/M; BAL fluid	Thyroid; 7.3, 4.42	Pneumonia, resp. failure	99.8 (1,449/1,451) to strains Paris, Lorraine, and Phily-1; 6	AZM, CIP; recovered, infected in Florida
4, 60/F; BAL fluid	Breast; 0.8, 0.4	Pneumonia, resp. failure, neutropenic fever	100 (1,444/1,444) to strains Paris, Lorraine, and Phily-1; not serogrouped	VAN, MEM, AZM, SXT; death @ 18 days, infected in Puerto Rico
21, 61/M; BAL fluid	Large-cell lymphoma; 0.1, 0	Pneumonia, resp. failure, shock, neutropenic fever	100 (1,450/1,450) to strains Paris, Lorraine, and Phily-1; 3	MEM, VAN, LVX; recovered, direct DFA of BAL fluid (+)
14, 56/M; BAL fluid	Acute promyelocytic leukemia; 34.7-leukemic, 0	Pneumonia, resp. failure, neutropenic fever	99.9 (1,452/1,454) to strain Corby, CP000675; 1	CIP, MEM, VAN; death @ 16 days
29, 58/M, BAL fluid	Multiple myeloma; 4.1, 2.4	Pneumonia	100 (1,477/1,477) to strain Corby, CP000675; 1	FEP, LZD, MXF; recovered
22, 60/M; BAL fluid	CLL; 2.7, 1.56	Pneumonia	100 (1,434/1,434) to strain Corby, CP000675; 5	VAN, FEP, LVX; recovered
17, 56/F; BAL fluid	Myeloma, auto-HSCT; 3.1, 1.66	Pneumonia, neutropenic fever	100 (1,451/1,451) to strain Lens, CR628337; 1	TZB, AZM, LVX; recovered
19, 69/M; BAL fluid	AML; 51.4-leukemic, 0	Pneumonia	100 (1,443/1,443) to strain Lens, CR628337; 1	FEP, TGC, MXF; recovered
30, 68/M; BAL fluid	AML; 0, 0	Pneumonia, resp. failure, neutropenic fever	99.9 (1,458/1,459) to strain Lens, CR628337; 1	FEP, LZD, IPM, CIP; death @ 30 days
10, 55/F; BAL fluid	AML, allo-HSCT; 0.4, 0.28	Pneumonia, neutropenic fever	99.6 (1,403/1,408) to strain Alcoy, CP001828; 1	FEP, LZD; recovered
3 cases with L. pneumophila subsp. fraseri or subsp. pascullei
18, 56/M; bronchial washings	Esophageal; 3.6, 2.63	No symptoms	99.9 (1,443/1,445) to HQ287902; 6	LVX after culture; no infection
5, 74/M; blood	Renal cell; 8.3, 4.92	Pneumonia-bacteremia, resp. failure, coagulopathy	100 (1,441/1,441) to HQ287902; not serogrouped	FEP, CIP, VAN; recovered
7, 54/F; BAL fluid	AML; 1.8, 1.10	Pneumonia, neutropenic fever	99.9 (1,436/1,438) to HQ287902; not serogrouped	LVX; recovered
4 cases with L. donaldsonii
1, 35/M; BAL fluid	CML, allo-HSCT; 2.5, 1.13	Pneumonia, neutropenic fever	99.6 (1,403/1,409) to Z49724	FEP, AZM, MEM; recovered
12, 43/F; BAL fluid	ALL; 0, 0	Pneumonia, neutropenic fever	99.6 (1,403/1,409) to Z49724	CIP, AZM, SXT; recovered
33, 72/F; BAL fluid	CLL; 21.6-leukemic, 0.65	Pneumonia, neutropenic fever	99.6 (1,403/1,409) to Z49724	MEM, LZD, CIP; recovered
26, 66/M; BAL fluid	CLL; 15.8-leukemic, 0.4	Pneumonia, neutropenic fever	98.6 (1,389/1,409) to Z49724	FEP, CIP, LZD; recovered
3 cases with L. micdadei
9, 54/M; BAL fluid	ALL, allo-HSCT; 8.8, 6.59	Pneumonia	100 (1,405/1,405) to AF227162	CIP, LZD; recovered
23, 57/M; BAL fluid	Large-cell lymphoma; 2.9, 0.7	Pneumonia, neutropenic fever	100 (1,443/1,443) to AF227162	FEP, MEM, VAN; recovered
25, 71/F; BAL fluid	CLL; 11.8-leukemic, 0.8	Pneumonia-severe, neutropenic fever, coagulopathy	100 (1,442/1,442) to AF227162	FEP, MEM, VAN; recovered
8 cases with other Legionella species
3, 65/F; BAL fluid	Myeloma, auto-HSCT; 2.2, 1.15	Pneumonia, resp. failure, neutropenic fever	99.4 (1,387/1,396) to L. bozemanae, Z49718	SXT, DOX; death @ 23 days
11, 59/M; BAL fluid	Lung; 10.5, 8.67	Pneumonia (postobstructive, severe)	99.7 (1,404/1,408) to L. feeleii, X73406	LVX; hospice, death
8, 65/M; BAL fluid	ALL; 0.4, 0.22	Pneumonia (severe), neutropenic fever	99.4 (1,415/1,424) to L. gormanii, Z32639	AMK, MEM, VAN, AZM; death @ 14 days
31, 59/M; BAL fluid	AML; leukemic, 3.0	Pneumonia	100 (1,455/1,455) to L. longbeachae, FN650140	FEP, TGC, CIP; hospice, death
27, 81/F; BAL fluid	Myelodysplastic syndrome; 2.0, 0.6	Pneumonia (low grade)	99.9 (1,442/1,443) to L. maceachernii, NR_041790	FEP, LZD; death @ 4 days, unrelated
20, 50/M; BAL fluid	CML, allo-HSCT, GVHD; 4.9, 4.12	Pneumonia	99.5 (1,396/1,403) to L. parisiensis, Z49731	LVX, DOX; recovered
2, 28/M; BAL fluid	Acute leukemia, allo-HSCT, GVHD; 5.5, 4.4	Pneumonia	99.5 (1,445/1,452) to L. sainthelensi, X73399	CRO, AZM, GAT; recovered
13, 38/F; BAL fluid	CLL; 3.1, 0.42	Pneumonia, neutropenic fever	99.9 (1,360/1,361) to Legionella sp. strain D5382, JN380990	LVX, DOX; recovered

^aF, female; BAL, bronchoalveolar lavage; M, male.

^bHSCT, hematopoietic stem cell transplant; WBC, white blood cell count; ANC, absolute neutrophil count; AML, acute myelogenous leukemia; allo-HSCT, allogeneic HSCT; auto-HSCT, autologous HSCT; CML, chronic myelogenous leukemia; ALL, acute lymphoblastic leukemia; CLL, chronic lymphocytic leukemia; GVHD, graft-versus-host disease.

^cFEP, cefepime; AZM, azithromycin; VAN, vancomycin; LVX, levofloxacin; MXF, moxifloxacin; MEM, meropenem; (+), positive; CIP, ciprofloxacin; CRO, ceftriaxone; (−), negative; TZP, piperacillin-tazobactam; LZD, linezolid; SXT, trimethoprim-sulfamethoxazole; DFA, direct fluorescent assay; TGC, tigecycline; DOX, doxycycline; GAT, gatifloxacin.

^dresp., respiratory.

^ePhily-1, strain Philadelphia-1.