新生儿嗜肺军团菌肺炎1例并文献复习

Neonatal Legionella pneumophila pneumonia:a case report and literature review

目的探讨新生儿嗜肺军团菌肺炎的临床特点。方法对郑州大学第三附属医院新生儿科收治的1例嗜肺军团菌肺炎新生儿临床资料进行回顾性分析,以“嗜肺军团菌”、“新生儿”、“早产儿”、“Legionella pneumophila”、“Legionnaires'disease”、“neonate”、“infant”、“newborn”为关键词,对中国知网、万方、维普、中华医学期刊全文数据库、PubMed、Web of science、Embase数据库自建库至2023年6月收录的文献进行检索,总结新生儿嗜肺军团菌肺炎的临床特点。结果本例患儿为足月男婴,表现为呛咳、发热、呼吸窘迫、感染性休克,CT示肺实变、空洞,常规抗感染治疗无效,经纤维支气管镜诊断先天性食管闭锁(Ⅴ型),送检肺泡灌洗液宏基因二代测序确诊嗜肺军团菌肺炎,予阿奇霉素联合左氧氟沙星抗感染、手术修补气管食管瘘等治疗后好转出院,随访至10月龄,未遗留后遗症。经文献检索共纳入19篇新生儿嗜肺军团菌肺炎文献,加上本例共31例,起病时表现为发热24例,呼吸窘迫22例,纳差、嗜睡11例,咳嗽5例;主要并发症为呼吸衰竭20例,脓毒症19例,感染性休克16例,多脏器功能衰竭13例,持续性低钠血症6例,抽搐2例,颅内出血、深静脉血栓各1例。30例描述了肺部影像学检查结果,24例肺炎伴实变,6例囊性变、空洞形成,3例坏死性肺炎,2例合并先天性食管闭锁Ⅴ型,1例肺纤维化。经呼吸道分泌物聚合酶链反应确诊24例、培养阳性5例;血清嗜肺军团菌抗体、尿嗜肺军团菌抗原阳性各12例,宏基因二代测序检出嗜肺军团菌3例;尸检发现肺组织嗜肺军团菌阳性3例。死亡7例,24例好转出院,预后良好。结论新生儿嗜肺军团菌肺炎临床表现无特异性,病情常进展迅速,救治不及时病死率高,新生儿肺炎常规抗生素治疗无效时需考虑嗜肺军团菌感染可能。

Objective To study the clinical characteristics of Legionella pneumophila pneumonia in neonates.Methods The clinical data of a neonate diagnosed with Legionnaires'disease admitted to the Department of Neonatology at the Third Affiliated Hospital of Zhengzhou University were retrospectively reviewed.Relevent literature published up to June 2023 were retrieved from CNKI,Wanfang Database,CQVIP database,Chinese Medical Journal Full-Text Database,PubMed and Web of Science and Embase with the terms of"Legionella pneumophila","newborn","premature","Legionnaires'disease","neonate"and"infant".The clinical characteristics of Legionnaires'disease in neonates were analyzed.Results Our patient was a full-term male neonate,14 days old,presented with symptoms of coughing,fever,respiratory distress,and septic shock.The CT scan suggested consolidation and cavitation of the lung.Conventional antibiotic therapy was ineffective.Legionnaires'disease and congenital esophageal atresia(type V)were diagnosed by fiberoptic bronchoscopy and metagenomics next-generation sequencing(mNGS).By emloying a combination therapy of azithromycin and levofloxacin,along with surgical repair for congenital esophageal atresia and symptomatic treatment,the patient achieved full recovery and was discharged.In the literature review,19 articles involving 30 cases of neonates with Legionnaires'disease were found(a total of 31 cases including our case).At the onset of the disease,the main clinical manifestations were fever in 24 cases,respiratory distress and dyspnea in 22 cases,anorexia and drowsiness in 11 cases and cough in 5 cases.The main complications were respiratory failure in 20 cases,sepsis in 19 cases,septic shock in 16 cases,multiple organ failure in 13 cases,persistent hyponatremia in 6 cases,convulsion in 2 cases,intracranial hemorrhage and deep vein thrombosis in 1 case.Pulmonary imaging examinations were described in 30 cases,24 cases with diffused infiltration with consolidation,6 with cystic changes or cavity formation,3 with necrotizing pneumonia,2 with congenital esophageal atresia type V,and 1 with pulmonary fibrosis.24 cases were confirmed by polymerase chain reaction testing of respiratory secretions,12 cases were positive for serum Legionella pneumophila antibody,12 cases were positive for urine Legionella pneumophila antigen,5 cases were positive in airway secretion culture,3 cases were detected through mNGS and 3 were positive in lung tissue by autopsy.There were 7 cases of death and 24 cases of hospital discharge with good prognosis.Conclusions The clinical manifestations of Legionnaires'disease in neonates are nonspecific.Rapid deterioration and high mortality rate can occur in cases without prompt treatment.The possibility of Legionella pneumophila infection should be considered in neonates with poor response to conventional antibiotics.