key: cord-0882208-795qib7m
authors: Argemí, Gemma; Somoza, María; Andrés, Marta; Llunell, Antonia
title: SARS-CoV-2 and Legionella pneumophila coinfection
date: 2021-09-23
journal: Enferm Infecc Microbiol Clin
DOI: 10.1016/j.eimc.2021.08.008
sha: 76c36efb613b0041e9d3e38d039bb71052e86d40
doc_id: 882208
cord_uid: 795qib7m

nan

Factors associated with a poorer prognosis of COVID-19 are advanced age, male sex, comorbidities, and laboratory parameters such as lymphopenia and elevated inflammatory markers. Bacterial coinfections have also been associated with a worse prognosis 1 .

Coinfection with Legionella pneumophila has been scarcely reported [2] [3] [4] [5] , and to the best of our knowledge no cases have been described in Spain. We present a case of community-acquired coinfection by L. pneumophila and SARS-CoV-2 admitted to our hospital. This is a 35-year-old male patient, non-smoker and with no medical history of interest, who works as a butane cylinder deliverer. He arrived to the emergency room on November 15, 2020 with a 10-day history of fever, myalgia, nausea, diarrhea, anosmia and dysgeusia. A dry cough without dyspnea appeared later. A PCR for SARS-CoV-2 performed in his primary care center two days before admission was positive. Vital signs on admission were as follows: blood pressure 130/93 mmHg, heart rate116 bpm, axillary temperature 39ºC, respiratory rate 26 breaths per minute. Respiratory and cardiac auscultations were normal. The chest x-ray showed a condensation in the right upper lobe (RUL) with air bronchogram ( Figure 1A ). Blood tests showed the following The diagnosis of coinfection in these patients is hampered by the lack of specific symptoms. Consequently, coinfection might be underdiagnosed, and broad-spectrum antibiotics overprescribed 10 .

In Catalonia the reported incidence of Legionnaires' disease is higher than in other Spanish autonomous communities. Specifically, in our Vallès Occidental area, the incidence rate in 2019 was 9.94 cases/100,000 persons (95%CI 8. 11-12.19 ). In addition, in the two weeks prior to the patient's admission, two other cases of legionellosis were diagnosed in the city where the patient resided, although no common source was identified for the three cases (data obtained from the Health Department, Government of Catalonia). On the other hand, it must be taken into account that, due to his work, the patient entered many homes and commercial premises. These data, together with the season of the year and the clinical picture of a male with a lobar condensation, hyponatremia, diarrhea, and a negative determination of pneumococcal antigen in urine, made it necessary to consider the diagnosis of Legionnaires' disease. Once the diagnosis was established, treatment with azithromycin was continued, since there is no difference in the observed outcomes for patients with Legionella spp. pneumonia treated with azithromycin vs. levofloxacin 12 .

In conclusion, this case demonstrates the importance of making an etiological diagnosis of bacterial coinfection in patients with COVID-19 when there are suggestive clinical and/or radiological findings. We consider that in areas with a relatively high incidence of legionellosis, the urinary antigen test for Legionella should be performed in cases of community-acquired pneumonia with epidemiological suspicion, or with criteria for hospital admission and a negative pneumococcal urinary antigen test. With a specific diagnosis the antibiotic treatment can be targeted, thus reducing the threat of bacterial resistance.

Funding information: This research did not receive funding from the public, commercial, or not-for-profit sectors.

The authors declare no conflict of interests.

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