Pandemic Influenza and Pneumonia Due to Legionella pneumophila:A Frequently Underestimated Coinfection
Abstract
To the Editor—Secondary bacterial pneumonia is recognized as one of the most common causes of death in influenza cases. Coinfection has been found in ∼30% of all influenza cases in persons with seasonal influenza, and the pathogens most often involved are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenza [1, 2]. However, the role of bacterial coinfection in complicating pandemic flu is not well described, because of the scarcity of data. From July 2009 through February 2010 in Italy, 2500 confirmed cases of pandemic influenza and 4.5 million cases of influenza-like illnesses were reported to the sentinel surveillance system. Of the confirmed cases of pandemic influenza, 1278 (∼50%) were hospitalized. Of the patients hospitalized, 271 (21%) presented with pneumonia, which was attributed to bacterial coinfection in 33 cases. Of the 33 cases with pneumonia due to bacterial coinfection, 6 (18%) were caused by Legionella pneumophila serogroup 1, and both the national legionellosis and the Italian mandatory 2009 A(H1N1) virus surveillance systems [3] were notified. The 2009 A(H1N1) virus reporting system is Web-based and was established in July 2009, whereas the national legionellosis surveillance system was established in 1983. Both systems include information about symptoms and risk factors, such as chronic illness, previous hospitalization, and travel.
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Conditional pathogenic bacteria, such as Legionella pneumophila, Neisseria meningitidis, Moraxella catarrhalis, from the upper respiratory tract are also associated with influenza co-infection.
“Conditional pathogenic bacteria, such as Legionella pneumophila (Rizzo et al., 2010), Neisseria meningitidis, Moraxella catarrhalis (Dela Cruz and Wunderink, 2017), from the upper respiratory tract are also associated with influenza co-infection.”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Rizzo et al., 2010
Legionella pneumophila was found to be associated with influenza infection in the 2009 H1N1 pandemic.
“Legionella pneumophila a less common bacterium was also found to be associated with influenza infection in the 2009 H1N1 pandemic.65”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [65]
Six cases of bacterial co-infection due to Legionella pneumophila were reported from Italy.
“Six cases of bacterial co‐infection due to Legionella pneumophila were reported from Italy”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [65]
Bacterial co-infections associated with the influenza A H1N1 pandemic have not been well described yet because of lack of data.
“bacterial co‐infections associated with the influenza A H1N1 pandemic have not been well described yet because of lack of data.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [65]
A range of bacteria including Legionella pneumophila, Streptococcus pyogenes, Neisseria meningitidis, Moraxella catarrhalis, S. pneumoniae, H. influenzae, S. aureus, Pseudomonas aeruginosa, and other Streptococcus and Staphylococcus spp. have been associated with co-infection of influenza.
“Legionella pneumophila (Rizzo et al., 2010), Streptococcus pyogenes (Chertow and Memoli, 2013), Neisseria meningitidis, Moraxella catarrhalis, S. pneumoniae, H. influenzae, S. aureus (Dela Cruz and Wunderink, 2017), Pseudomonas aeruginosa as well as a number of other Streptococcus and Staphylococcus spp. (Yang et al., 2016a) have all been associated with co-infection of influenza.”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Rizzo et al., 2010
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- Authors
- Rizzo, C., Caporali, M. G., & Rota, M. C.
- Affiliations
- Istituto Superiore di Sanità (IT)
- Corresponding author
- Rizzo, Caterina
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-07
- Volume
- 51
- Issue
- 1
- Pages
- 115-115
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2018214923
- Cited by
- 29
- References
- 2
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 1 · 2017: 5 · 2016: 4 · 2015: 1 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 1.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Legionella and Acanthamoeba research
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Keywords
- Legionella pneumophila, pandemic influenza, 2009 H1N1 influenza, bacterial co-infection, secondary bacterial pneumonia, Legionnaires' disease, hospitalized influenza patients, sentinel surveillance, Italy
- MeSH terms
- Adult, Aged, Disease Outbreaks, Female, Humans, Influenza, Human, Italy, Legionnaires' Disease, Male, Middle Aged, Population Surveillance, Legionella pneumophila, Influenza A Virus, H1N1 Subtype
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