Vol. 13. Núm. 55.
Páginas 3203-3214 (Mayo 2022)

Neumonías bacterianas no neumocócicas (I). Infecciones por Legionella, fiebre Q y otras

Non-pneumococcal bacterial pneumonias (I). Legionella, Q fever, and other infections

C. Hernández GutiérrezM. Novella MenaM. García SánchezJ. Sanz Moreno
Doi : https://10.1016/j.med.2022.05.001
Opciones
Resumen

La neumonía adquirida en la comunidad es una patología muy frecuente. En esta unidad temática, dedicaremos 2 actualizaciones a revisar aquellas producidas por bacterias menos frecuentes en nuestro medio, pero con rasgos distintivos, como son las causantes de las neumonías denominadas «atípicas». Estas están producidas por microorganismos que ocasionan unas alteraciones clínicas, analíticas y radiológicas muy inespecíficas, por lo que el diagnóstico se apoya en los antecedentes epidemiológicos y en la sospecha del clínico, para así poder llevar a cabo un tratamiento, seguimiento y prevención adecuados. Los microorganismos causantes de neumonía atípica más relevantes son Legionella spp. y Coxiella burnetii. Es necesaria su documentación microbiológica, puesto que tiene repercusiones en el ámbito de salud pública, así como en el seguimiento por el riesgo de cronicidad, respectivamente. Otras bacterias menos frecuentes, en las que la neumonía no es la presentación clínica más habitual, son las desarrolladas en el contexto del tifus murino, tularemia, peste neumónica y leptospirosis.

Palabras clave
Neumonía atípica
Legionella spp.
Fiebre Q
Tularemia
Tifus murino
Leptospirosis
Peste neumónica
Abstract

Community-acquired pneumonia is a very common disease. In this thematic unit, we will dedicate 2 updates to reviewing pneumonias caused by bacteria that are less common in our setting, but which have distinctive characteristics, such as those which cause so-called «atypical» pneumonias. These are produced by microorganisms which cause very nonspecific clinical, analytical, and radiological changes. Therefore, the diagnosis is based on the epidemiological history and clinical suspicion in order to provide appropriate treatment, follow-up, and prevention. The most important microorganisms that cause atypical pneumonia are Legionella spp. and Coxiella burnetii. Their microbiological documentation is necessary, given that it has repercussions on public health and follow-up due to risk of chronicity. Other less common bacteria in which pneumonia is not the most habitual clinical presentation are those related to murine typhus, tularemia, pneumonic plague, and leptospirosis.

Keywords
Atypical pneumonia
Legionella spp.
Q fever
Tularemia
Murine typhus
Leptospirosis
Pneumonic plague

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Bibliografía
[1]
J.
202205130558457228
Almirall, I. Bolíbar, J. Vidal, G. Sauca, P. Coll, B. Niklasson, et al.
Epidemiology of community-acquired pneumonia in adults: a population-based study.
Eur Respir J., (2000), 15 pp. 757-763
[2]
R.S.
202205130558457229
2022051305584572210
Holzman, M.S. Simberkoff.
Neumonía aguda.
Mandell, Douglas y Bennett. Enfermedades infecciosas. Principios y práctica, 9a ed., Elsevier España, pp. 889-913
[3]
C.
2022051305584572211
Cillóniz, A. Torres, M. Niederman, M. van der Eerden, J. Chalmers, T. Welte, et al.
Community-acquired pneumonia related to intracellular pathogens.
Intensive Care Med., (2016), 42 pp. 1374-1386
[4]
B.A.
2022051305584572212
2022051305584572213
Cunha, A. Burillo, E. Bouza.
Legionnaireśdisease.
Lancet., (2016), 387 pp. 376-385
[5]
A.
2022051305584572214
Burillo, M.L. Pedro-Botet, E. Bouza.
Microbiology and epidemiology of legionnaire's disease.
Infect Dis Clin North Am., (2017), 31 pp. 7-27
[6]
D.N.
2022051305584572215
Fisman, S. Lim, G.A. Wellenius, C. Johnson, P. Britz, M. Gaskins, et al.
It's not the heat, it's the humidity: wet weather increases legionellosis risk in the greater Philadelphia metropolitan area.
J Infect Dis., (2005), 192 pp. 2066-2073
[7]
H.J.
2022051305584572216
Newton, D.K.Y. Ang, I.R. van Driel, E.L. Hartland.
Molecular pathogenesis of infections caused by Legionella pneumophila.
Clin Microbiol Rev., (2010), 23 pp. 274-298
[8]
B.S.
2022051305584572217
Fields, R.F. Benson, R.E. Besser.
Legionella and Legionnaires’ disease: 25 years of investigation.
Clin Microbiol Rev., (2002), 15 pp. 506-526
[9]
J.E. Stout, V.L. Yu.
Legionellosis.
N Engl J Med., (1997), 337 pp. 682-687
[10]
B.A.
2022051305584572218
2022051305584572219
Cunha, C.B. Cunha.
Legionnaire's disease: A clinical diagnostic approach.
Infect Dis Clin North Am., (2017), 31 pp. 81-93
[11]
S.
2022051305584572220
Mittal, A.P. Singh, M. Gold, A.N. Leung, L.B. Haramati, D.S. Katz.
Thoracic imaging features of legionnaire's disease.
Infect Dis Clin North Am., (2017), 31 pp. 43-54
[12]
Z.
2022051305584572221
Zhang, X. Liu, L. Chen, J. Qiu.
Chest radiographic characteristics of community-acquired Legionella pneumonia in the elderly.
Chin Med J (Engl)., (2014), 127 pp. 2270-2274
[13]
J.P.
2022051305584572222
2022051305584572223
Metlay, G.W. Waterer, A.C. Long, A. Anzueto, J. Brozek, K. Crothers, et al.
Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and infectious diseases society of America.
Am J Respir Crit Care Med., (2019), 200 pp. e45-e67
[14]
J.W.
2022051305584572224
2022051305584572225
Mercante, J.M. Winchell.
Current and emerging Legionella diagnostics for laboratory and outbreak investigations.
Clin Microbiol Rev., (2015), 28 pp. 95-133
[15]
E.
2022051305584572226
2022051305584572227
Cristovam, D. Almeida, D. Caldeira, J.J. Ferreira, T. Marques.
Accuracy of diagnostic tests for Legionnaires’ disease: a systematic review.
J Med Microbiol., (2017), 66 pp. 485-489
[16]
A.S.
2022051305584572228
Jasper, J.S. Musuuza, J.S. Tischendorf, V.W. Stevens, S.D. Gamage, F. Osman, et al.
Are fluoroquinolones or macrolides better for treating Legionella pneumonia?. A systematic review and meta-analysis.
Clin Infect Dis., (2021), 72 pp. 1979-1989
[17]
H.
2022051305584572229
Kato, M. Hagihara, N. Asai, Y. Shibata, Y. Koizumi, Y. Yamagishi, et al.
Meta-analysis of fluoroquinolones versus macrolides for treatment of legionella pneumonia.
J Infect Chemother., (2021), 27 pp. 424-433
[18]
L.
2022051305584572230
Sharma, A. Losier, T. Tolbert, C.S. Dela Cruz, C.R. Marion.
Atypical pneumonia: Updates on Legionella.
Chlamydophila, and Mycoplasma Pneumonia. Clin Chest Med., (2017), 38 pp. 45-58
[19]
J.D.
2022051305584572231
2022051305584572232
Hartzell, T.J. Marrie, D. Raoult.
Coxiella burnetii (fiebre Q).
Mandell, Douglas y Bennett. Enfermedades infecciosas. Principios y práctica, 8a ed., Elsevier España, pp. 2208-2216
[20]
M.T.
2022051305584572233
Fraile, C. Muñoz.
Infección por Coxiella burnetii (fiebre Q).
Enferm Infecc Microbiol Clin., (2010), 28 pp. 29-32
[21]
M.
2022051305584572234
Maurin, D. Raoult.
Q fever.
Clin Microbiol Rev., (1999), 12 pp. 518-553
[22]
2022051305584572235
2022051305584572236
Raoult D. Microbiology and epidemiology of Q fever. UpToDate 2021. Disponible en: https://www-uptodate-com., m-hupa., a17., csinet., s/contents/microbiology-and-epidemiology-of-q-fever?search=coxiella%20burnetii, source=search_result, selectedTitle=3∼71, usage_type=default, display_rank=3.
[23]
2022051305584572237
Espejo E, Gil-Díaz A, Oteo JA, Castillo-Rueda R, García-Álvarez L, Santana-Báez S, et al., Clinical presentation of acute Q fever in Spain: Seasonal and geographical differences. Clin J Infect Dis. 2014; 26:162-4.
[24]
2022051305584572238
2022051305584572239
Centers for Disease Control and Prevention. Diagnosis and Management of Q Fever, United States, 2013. MMWR. 2013; 62 (3):1-29.
[25]
T.J.
2022051305584572240
Marrie.
Q fever pneumonia.
Infect Dis Clin N Am., (2010), 24 pp. 27-41
[26]
2022051305584572241
2022051305584572242
Raoult D. Clinical manifestations and diagnosis of Q fever. UpToDate 2021. Disponible en: https://www-uptodate-com.m-hupa.a17.csinet.es/contents/clinical-manifestations-and-diagnosis-of-q-fever?search=coxiella%20burnetii&source=search_result&selectedTitle=1∼71&usage_type=default&display_rank=1.
[27]
2022051305584572243
NSW Control Guidelines for Public Health Units. Q fever. Revisado en Junio 2019. Disponible en: https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx.
[28]
M.C.
2022051305584572244
Wegdam-Blans, L.M. Kampschreur, C.E. Delsing, C.P. Bleeker-Rovers, T. Sprong, M.E. van Kasteren, et al.
Chronic Q fever: review of the literature and a proposal of new diagnostic criteria.
J Infect., (2012), 64 pp. 247-259
[29]
J.M.
2022051305584572245
Munster, A.C.A.P. Leenders, W. van der Hoek, P.M. Schneeberger, A. Rietveld, J. Riphagen-Dalhuisen, et al.
Cost-effectiveness of a screening strategy for Q fever among pregnant women in risk areas: a clustered randomized controlled trial.
BMC Womens Health., (2010), 10 pp. 32
[30]
2022051305584572246
2022051305584572247
Raoult D. Treatment and prevention of Q fever. UpToDate 2021. Disponible en: https://www-uptodate-com.m-hupa.a17.csinet.es/contents/treatment-and-prevention-of-q-fever?search=coxiella%20burnetii&source=search_result&selectedTitle=2∼71&usage_type=default&display_rank=2.
[31]
S.P.
2022051305584572248
Keijmel, C.E. Delsing, G. Bleijenberg, J.W.M. van der Meer, R.T. Donders, M. Leclercq, et al.
Effectiveness of long-term doxycycline treatment and cognitive-behavioral therapy on fatigue severity in patients with Q fever fatigue syndrome (Qure Study): A randomized controlled trial.
Clin Infect Dis., (2017), 64 pp. 998
[32]
M.L.
2022051305584572249
Guerrero.
Fiebre Q en España: «una historia inconclusa».
Enferm Infecc Microbiol Clin., (2014), 32 pp. 211-212
[33]
L.D.
2022051305584572250
Thomas, W. Schaffner.
Tularemia pneumonia.
Infect Dis Clin N Am., (2010), 24 pp. 43-45
[34]
M.
2022051305584572251
Gyuranecz, M. Maurin.
Tularemia: clinical aspects in Europe.
Lancet Infect Dis., (2016), 16 pp. 113-124
[35]
T.W.
2022051305584572252
Van der Vaart, P. van Thiel, N.P. Juffermans, M. van Vugt, S.E. Geerlings, M.P. Grobusch, et al.
Severe murine typhus with pulmonary system involvement.
Emerg Infec Dis., (2014), 20 pp. 1375-1377
[36]
C.
2022051305584572253
Tsioutis, M. Zafeiri, A. Avramopoulos, E. Prousali, M. Miligkos, S.A. Karageorgos.
Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review.
Acta Tropica., (2017), 166 pp. 16-24
[37]
L.S.
2022051305584572254
2022051305584572255
Blanton, J.S. Dumler, D.H. Walker.
Rickettsia typhi (Murine Typhus).
Mandell, Douglas y Bennett. Enfermedades infecciosas. Principios y práctica, 8a ed., Elsevier España, pp. 2221-2224
[38]
Z.M.P.
2022051305584572256
Soo, N.A. Khan, R. Siddiqui.
Leptospirosis: Increasing importance in developing countries.
[39]
K.B.
2022051305584572257
Karpagam, B. Ganesh.
Leptospirosis: a neglected tropical zoonotic infection of public health importance-an updated review.
Eur J Clin Microbiol Infect Dis., (2020), 39 pp. 835-846
[40]
D.
2022051305584572258
Raoult, N. Mouffok, I. Bitam, R. Piarroux, M. Drancourt.
Plague: history and contemporary analysis.
J Infect., (2013), 66 pp. 18-26
[41]
M. Daya, Y. Nakamura.
Pulmonary disease from biological agents: anthrax, plague, Q fever, and tularemia.
Crit Care Clin., (2005), 21 pp. 747-763
[42]
C.A.
2022051305584572259
2022051305584572260
Nelson, D. Meaney-Delman, S. Fleck-Derderian, K.M. Cooley, P.A. Yu, P.S. Mead, et al.
Antimicrobial treatment and prophylaxis of plague: Recommendations for naturally acquired infections and bioterrorism response.
MMWR Recomm Rep., (2021), 70 pp. 1-27