Legionella infection in transplant patients

Neil M. Ampel, Edward J. Wing

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Since the discovery of Legionalla pneumophila in the late 1970s, this organism and other Legionella sp have been an important cause of pneumonia in solid organ transplant recipients. Legionella sp are obligate aerobes that require a source of amino acids, iron, and L-cystine. Growth is enhanced in a 5% CO2 atmosphere at 37°C in the presence of charcoal. Legionelle sp reside in water supplies and hospital outbreaks associated with contaminated water have been described. Transplant recipients are particularly susceptible to Legionella infection. Legionella pneumonia tends to occur within several weeks after transplantation and frequently coincides with episodes of rejection. A prodrome of influenza-like symptoms is followed by a sometimes "explosive" pneumonia with patchy lobular or interstitial infiltrates on chest radiograph. High fever, abdominal pain, and mental status changes are sometimes seen. Diagnosis is made by examination of respiratory secretions by the direct fluorescent antibody technique or culture of the organism. Intravenous erythromycin is the treatment of choice. Rifampin is added if there is a lack of response. Both erythromycin and rifampin have important and opposite effects on cyclosporine metabolism, which may result, respectively, in increased cyclosporine toxicity or graft loss. Patients who must continue cyclosporine will, therefore, require frequent monitoring of cyclosporine levels.

Original languageEnglish (US)
Pages (from-to)30-37
Number of pages8
JournalSeminars in Respiratory Infections
Issue number1
StatePublished - Mar 1990
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Microbiology (medical)


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