Legionnaires' disease is an established and frequent cause of
pneumonia in adults but is thought to be a rare cause in children. We reviewed the medical literature for cases of
Legionnaires' disease in children and analysed the epidemiology, clinical characteristics, and treatment. 76 cases of legionella
infection in children were identified. In 56%, diagnosis was made with culture methodology. 46% were
community-acquired infections. 51.5% were under 2 years of age. 78% of the patients had an underlying condition such as
malignancy.
Fever,
cough, and tachypnoea were the most common symptoms. The overall mortality rate was 33% and was higher in immunosuppressed children and in children younger than the age of 1 year. Patients who were treated empirically with anti-legionella
therapy had a notably lower mortality rate compared with patients on inappropriate
therapy (23%vs 70%). In 88% of hospital-acquired cases, an environmental link to
potable water colonised with legionella was identified. We found no clinical features unique to
Legionnaires' disease in children that would allow differentiation from
pneumonia due to other respiratory pathogens. Awareness of legionella as a potential cause of paediatric
pneumonia is particularly important because
infection can be severe and life threatening and antimicrobial
therapy often used for empirical
therapy in children is not effective against legionella. In any case of
pneumonia unresponsive to
antibiotics,
Legionnaires' disease should be considered and specific diagnostic tests to verify this diagnosis should be done. As legionella diagnostic tests become more widely applied, we predict that
legionellosis may appear as an
emerging infectious disease in children.