| Abstract | Retrospektivno su analizirane kliničke i epidemiološke značajke legionarske bolesti u 60 bolesnika, dobi od 27 do 79 godina (50 muškaraca i 10 žena), koji su hospitalizirani u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu od 01. siječnja 2018. do 31. prosinca 2019. godine. Dijagnoza legionarske bolesti utvrđena je određivanjem specifičnih protutijela Legionella pneumophila serotip 1-7 (11/60) i/ili određivanjem antigena L. pneumophila serotip 1 u urinu (58/60). Bolest je registrirana tokom cijele godine, a više oboljelih je bilo tijekom rujna (23,3%). Većina bolesnika su se pojavljivali kao sporadičan slučaj bolesti. Više od polovice bolesnika (58,4%) imalo je blaži oblik bolesti. Vodeći simptomi bolesti bili su vrućica (100,0%), kašalj (83,3%) i zimice (81,7%), a najvažniji laboratorijski pokazatelji povišena vrijednost C-reaktivnog proteina (100,0%), ubrzana sedimentacija eritrocita (98,1%) i leukocitoza (79,7%). Rendgenske slike pluća bile su nekarakteristične, a u više od dvije trećine bolesnika opisuje se bronhopneumonički infiltrat na plućima (68,3%). Pleuralni izljev je registriran u 41,7% bolesnika. Većina bolesnika prije dolaska u bolnicu nije uzimala adekvatnu antimikrobnu terapiju (96,7%). Najčešća inicijalna antimikrobna terapija u bolnici bila je kombinacija beta laktamskog antibiotika i azitromicina (53,3%), potom monoterapija azitromicinom (15,0%), levofloksacinom (11,7%) te moksifloksacinom (8,3%). U otprilike polovice bolesnika (48.3%) nakon prispijeća mikrobioloških testova inicijalna antimikrobna terapija je korigirana, najčešće u monoterapiju azitromicinom (35,4%), potom levofloksacin (6,7%) te moksifloksacin (5,0%). Nije zabilježena razlika u liječenju pacijenata između azitromicina, levofloksacina i moksifloksacina, Mehanička ventilacija provedena je u pet (8,3%), a tri bolesnika su razvila ARDS. Tri (5,0 %) bolesnika su umrla. |
| Abstract (english) | A retrospectively analysis was performed of the clinical and epidemiological characteristics of legionnaries' disease in 60 patients, aged 27 to 79 years (50 males, and 10 females), hospitalized at the University Hospital for Infectious Diseases “Dr. Fran Mihaljević” in Zagreb from January 1, 2018 to December 31, 2019. The diagnosis of legionnaries' disease was confirmed by determining the specific antibodies to Legionella pneumophila serotype 1-7 (11/60) and/or by determining the antigen of L. pneumophila serotype 1 in urine (58/60). The disease occurred throughout the year, with more patients recorded during September (23,3%). Most patients appeared as sporadic cases. More than half of the patients (58,4%) had mild form of disease. The leading symptoms of disease were fever (100,0%), cough (83,3%) and chills (81,7%), and the most significant laboratory findings were increased C- reactive protein (100,0%), accelerated erythrocyte sedimentation rate (98,1%) and leukocytosis (79,7%). Chest X-rays were non-characteristic, and in more than two-third of the patients showing bronchopneumonic lung infiltrate (68,3%). Pleural effusion was recorded in 41,7% of patients. Most patients did not receive adequate antimicrobial therapy prior to hospitalization (96,7%). The most common initial antimicrobial therapy in the hospital was a combination of beta-lactam antibiotic and azithromycin (53,3%), followed by monotherapy with azithromycin (15,0%), levofloxacin (11,7%) and moxifloxacin (8,3%). In approximately half of the patients (48,3%) after obtaing microbiology test results, the initial antimicrobial therapy was corrected, most often to azithromycin monotherapy (35,4%), followed by levofloxacin (6,7%) and moxifloxacin (5,0%). There was no difference in the treatment of patients between azithromycin, levofloxacin and moxifloxacin. Mechanical ventilation was performed in five (8,3%) patients, and three patients developed ARDS. Three (5,0%) patients died. |
