TABLE 1.
Characteristics of Legionnaires’ Disease Case Patients (n = 10) With Exposure to a Hospital Hematology-Oncology Unit — Alabama, 2014.
| Case Characteristics | No. (%)a | Median (range) |
|---|---|---|
| Demographics | ||
| Age, y | 58.5 (43–85) | |
| Male | 5 (50) | |
| White race | 7 (70) | |
| Hispanic ethnicityb | 0 (0) | |
| Signs and symptoms of Legionnaires’ disease | ||
| Fever (temperature ≥100.4°F) | 10 (100) | |
| Shortness of breath | 9 (90) | |
| Cough | 8 (80) | |
| Diarrhea | 5 (50) | |
| Nausea | 3 (30) | |
| Confusion/altered mental status | 2 (20) | |
| Hypoxia (oxygen saturation <90%) | 8 (80) | |
| Chest imaging suggestive of pneumoniac | 10 (100) | |
| Positive Legionella urinary antigen test | 10 (100) | |
| Positive Legionella respiratory cultured | 3 (43) | |
| Medical history and risk factors | ||
| Any known medical risk factore | 10 (100) | |
| Current or former smoker | 5 (50) | |
| Alcohol abusef | 2 (20) | |
| Active leukemia diagnosis | 8 (80) | |
| Acute myeloid leukemia | 7 (88) | |
| Chronic lymphocytic leukemia | 1 (13) | |
| Received chemotherapyg | 8 (100) | |
| Received radiationg | 0 (0) | |
| Leukopeniag,h | 9 (100) | |
| Antibiotic exposure prior to symptom onseti,j | 1 (10) | |
| Systemic steroid exposure prior to symptom onseti,k | 7 (70) | |
| Exposure history | ||
| Days of exposure to hematology-oncology unitl | 9 (2–9) | |
| Any invasive medical procedurem | 3 (30) | |
| Outcome and complications | ||
| Survived to hospital discharge | 8 (80) | |
| Required ICU admission | 7 (70) | |
| Required mechanical ventilation | 6 (60) | |
NOTE. ICU, intensive care unit.
Data were available for all 10 case patients except where indicated.
Ethnicity data were available for 3 case patients.
Defined as a chest x-ray or computed tomography scan with evidence of a new consolidation or infiltrate.
Respiratory cultures were obtained for 7 case patients.
Clinical risk factors include chronic lung disease, immune suppression from a medical condition (eg, diabetes, cancer, kidney failure), and immune suppression from medications.
Alcohol abuse was considered to be present if it was documented in the chart under “past medical history” or if social history indicated >14 alcoholic drinks/week (women) or >21 alcoholic drinks per week (men).
At any point during the admission where exposure to Legionella likely occurred.
Defined as white blood cell count (WBC) < 4,000 cells/μL; data were available for the 9 inpatients only, and of these, 8 patients had a white cell differential available and all were neutropenic, with median absolute neutrophil count of 22 cells/μL (range, 0–43).
During the 10 days prior to symptom onset.
Excludes antibiotics with no known in vivo activity against Legionella species (eg, β-lactams, aminoglycosides, vancomycin); 1 case patient was prescribed an antibiotic with potential activity against Legionella (trimethoprim [160 mg]-sulfa-methoxazole [800 mg], 1 tablet 3 days a week), and she received 2 doses over 3 days in the 10 days prior to her symptom onset.
Systemic steroids included prednisone, methylprednisolone, hydrocortisone, and dexamethasone.
During the 2–10 days prior to symptom onset.
Procedures included bone marrow biopsy (n = 2), Hickmann catheter placement (n = 1), and lumbar puncture (n = 1).