Clinical cases of legionelliosis in the Krasnodar region during the new coronavirus infection COVID-19 pandemic: difficulties in diagnosis

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Abstract

The high incidence of community-acquired pneumonia during the COVID-19 pandemic requires early differential diagnosis because of the differences in patient management techniques. Among community-acquired pneumonias, legionelliosis deserves special attention. The difficulty of clinical diagnosis of legionellosis during the COVID-19 pandemic leads to untimely prescription of specific antibacterial therapy, which worsens the prognosis. This study presents clinical examples that draw the attention of specialists to the clinical, laboratory, and radiological features of legionellosis and to the important role of epidemiological data in the differential diagnosis of legionellosis with COVID-19.

A feature of the described clinical cases was as follows: late diagnosis with hospitalization on days 7–10 of illness in patients with increased body mass index, severe bilateral polysegmental pneumonia with the formation of a cavity and multirow bullae in the lungs, presence of proteinuria, increased levels of urea and/or creatinine, and lymphopenia. In all cases, the patients had history of staying in air-conditioned rooms and traveling by train. Compute tomography diagnostics described a localization that is not typical for COVID-19, manifestation from areas of consolidation with a symptom of air bronchography, presence of pleural effusion, discrepancy between the intensity of changes from the disease onset, and severity of the patient’s condition.

For the specific diagnosis of legionellosis, testing for Legionella spp. To determine the legionella antigen in the urine is recommended upon hospital admission for all patients with severe community-acquired pneumonia.

About the authors

Marina G. Avdeeva

Kuban State Medical University

Author for correspondence.
Email: avdeevam@mail.ru
ORCID iD: 0000-0002-4979-8768
SPIN-code: 2066-2690

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Krasnodar

Lyudmila P. Blazhnyaya

Kuban State Medical University

Email: p-blazhnyaya@mail.ru
ORCID iD: 0000-0002-0055-1764
SPIN-code: 1164-7038

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Krasnodar

Darya Yu. Moshkova

Kuban State Medical University

Email: Mrs_darya@mail.ru
ORCID iD: 0000-0003-1401-6970
SPIN-code: 9489-0057

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Krasnodar

Makka I. Kulbuzheva

Kuban State Medical University; Specialized Clinical Infectious Diseases Hospital

Email: kulbuzhevamakka@yandex.ru
ORCID iD: 0000-0003-1817-6664
SPIN-code: 8090-3715

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Krasnodar; Krasnodar

Ilina M. Savitskaya

Specialized Clinical Infectious Diseases Hospital

Email: avdeevam@mail.ru
ORCID iD: 0009-0004-5818-5287
Russian Federation, Krasnodar

Angelina A. Podsadnyaya

Kuban State Medical University; Specialized Clinical Infectious Diseases Hospital

Email: avdeevam@mail.ru
ORCID iD: 0009-0009-5225-9296
SPIN-code: 8490-1523
Russian Federation, Krasnodar; Krasnodar

Natalya A. Kirilenko

Kuban State Medical University; Specialized Clinical Infectious Diseases Hospital

Email: nafany-78@mail.ru
ORCID iD: 0000-0003-2302-6214
Russian Federation, Krasnodar; Krasnodar

Elena E. Yakovchuk

Specialized Clinical Infectious Diseases Hospital

Email: elena-yakovchuk@yandex.ru
ORCID iD: 0009-0001-9690-7285
Russian Federation, Krasnodar

Oksana V. Chernyavskaya

Specialized Clinical Infectious Diseases Hospital

Email: kdlskib@mail.ru
ORCID iD: 0009-0007-8032-3537
Russian Federation, Krasnodar

Polina O. Mamonova

Specialized Clinical Infectious Diseases Hospital

Email: polinadoncova@yandex.ru
ORCID iD: 0009-0002-6945-7263
Russian Federation, Krasnodar

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2. Fig. 1. Axial sections at the level of the aortic arch, pulmonary window. Dynamics of areas of heterogeneous infiltration: a — CT scan of the chest dated July 15, 2022, 11th day of illness, 1st day of hospitalization; b — CT scan of the chest dated July 22, 2022, 18th day of illness, 7th day of hospitalization; c — CT scan of the chest dated August 3, 2022, 30th day of illness, 19th day of hospitalization; d — CT scan of the chest dated August 9, 2022, 36th day of illness, 25th day of hospitalization.

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3. Fig. 2. Axial sections at the level of the main bronchi, pulmonary window. Dynamics of areas of heterogeneous infiltration: a — CT scan of the chest dated July 15, 2022, 11th day of illness, 1st day of hospitalization; b — CT scan of the chest dated July 22, 2022, 18th day of illness, 7th day of hospitalization; c — CT scan of the chest dated August 3, 2022, 30th day of illness, 19th day of hospitalization; d — CT scan of the chest dated August 9, 2022, 36th day of illness, 25th day of hospitalization.

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4. Fig. 3. Axial sections at the level of the basal parts of the lungs, pulmonary window. Dynamics of areas of heterogeneous infiltration. a — CT scan of the chest dated July 15, 2022, 11th day of illness, 1st day of hospitalization; b — CT scan of the chest dated July 22, 2022, 18th day of illness, 7th day of hospitalization; c — CT scan of the chest dated August 3, 2022, 30th day of illness, 19th day of hospitalization; d — CT scan of the chest dated August 9, 2022, 36th day of illness, 25th day of hospitalization.

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5. Fig. 4. Axial section, pulmonary window. Small bullae against a background of ground glass areas. 16th day of illness, 9th day of hospitalization.

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6. Fig. 5. Axial section, pulmonary window. Bilateral areas of low-intensity ground glass. 16th day of illness, 9th day of hospitalization.

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7. Fig. 6. Axial section, pulmonary window. Area of compaction in S8 of the right lung. 16th day of illness, 9th day of hospitalization.

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8. Fig. 7. Axial sections in dynamics at the level of the upper parts of the lungs, pulmonary window: a — CT scan of the chest dated May 18, 2022, 8th day of illness, 3rd day of hospitalization; b — CT scan of the chest dated June 2, 2022, 23rd day of illness, 17th day of hospitalization.

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9. Fig. 8. Axial sections in dynamics at the level of the lower parts of the lungs, pulmonary window: a — CT scan of the OGK dated May 18, 2022, 8th day of illness, 3rd day of hospitalization; b — CT scan of the chest dated June 2, 2022, 23rd day of illness, 17th day of hospitalization.

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