Case report: Severe neonatal Legionella pneumophila pneumonia: Insights from clinical management and epidemiological investigation

Abstract

Background: Legionella pneumophila is a rare but potentially fatal pathogen in neonates.

Case presentation: We report a critically ill 3-week-old full-term male infant admitted to a Saudi tertiary hospital on March 9, 2024, with severe pneumonia and sepsis. The diagnosis was confirmed using the QIAstat-Dx Respiratory SARS-CoV-2 Panel (QIAGEN, Germany), which detected L. pneumophila via multiplex PCR. The specimen tested was an endotracheal aspirate collected through closed suction.

Management and outcome: The patient required high-frequency oscillatory ventilation (HFOV), intensive supportive therapy, and a 21-day course of targeted intravenous moxifloxacin, rifampin, and cefotaxime. Despite liver enzyme elevation likely secondary to sepsis and cardiovascular anomalies, the infant made a full recovery. This case underscores the significance of utilizing the PCR technique to diagnose rare and severe respiratory infections in neonates.

Epidemiological investigation: An extensive investigation, including water system sampling, revealed no additional cases, classifying the incident as isolated. Environmental assessments underscored the importance of robust water safety management, surveillance, and prevention strategies to mitigate neonatal Legionella risk.

Conclusion: This case underscores the value of syndromic PCR diagnostics, rapid intervention, and vigilant environmental surveillance in neonatal infection control. National and international water safety plans must maintain surveillance and infection prevention measures to prevent severe neonatal Legionella pneumonia.

Keywords: Infection; Legionella pneumophila; Neonate; PCR; Pneumonia; Public health.