Case of the Month – September 2017

A neonate was discharged from hospital three days following delivery by Caesarean section. Although well on discharge, the mother returned to the hospital with the 2-week old neonate, who now presented with fever and poor feeding with no clear source. The neonate was admitted with a temperature of 38.5°C, pulse rate of 189 bpm and an oxygen saturation while crying, of 100%. Blood tests showed levels of C-reactive protein (CRP) of 127 mg/L (normal range: <5.0 mg/L) and procalcitonin of 10.35 ng/mL (normal range: 0.0 - 0.5 ng/mL). Cerebrospinal fluid (CSF) analysis was acellular. The chest X-ray was normal. There was no growth of any common bacterial meningeal pathogens. The neonate did not respond to meropenem and vancomycin.

A laparotomy was performed after 5 days of hospitalisation. The liver showed multiple micro abscesses from which tissue biopsies and a pus swab were collected. The Gram stain of the pus swab demonstrated scanty Gram-negative bacilli. No growth was obtained from these specimens after 5 days of culture for common bacterial pathogens. Metronidazole, azithromycin, TB treatment and fluconazole were added to treatment. The clinical microbiologist recommended that 16S rRNA PCR be performed on the specimens collected intra-operatively. The liver tissue sample was found to be positive for Legionella pneumophila. Thereafter, urine was collected which was positive for L. pneumophila serogroup 1. The baby was already on azithromycin by that stage and showed a clinical response.

Question 1 - What are the clinical features of Legionnaires’ disease?

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