The unusual case of a man contracting Legionnaire's disease through a cut on his hand while handling compost is detailed in a Case Report in this week's edition of The Lancet. Despite the rare incidence of such cases, The UK Royal Horticultural Society has issued warnings about the risk of contracting Legionnaire's disease from handling compost, and has announced that bags of potting compost will carry cautionary statements. The Case Report is by Dr Simon M Patten, Royal Alexandra Hospital, Paisley, UK, and colleagues.
In March 2010, a previously fit and health 67-year-old man presented to hospital with an 8-day history of fever with trembling, confusion, lethargy, and shortness of breath. He had a high temperature and signs of left-sided pneumonia, and in a chest radiograph the left lung showed as completely opaque. An unusual or viral pneumonia was suspected but a range of tests, including for urinary legionella bacteria, proved negative. Despite antibiotic and other treatment, the man's condition deteriorated and he was sent to intensive care.
A more invasive lavage was done on the man's lung to provide a sputum sample, which later tested positive for Legionella longbeachae, a rare form of legionella which cannot be detected through urine samples. The patient revealed he was a keen gardener, and he had cut his left index finger 2 weeks before the onset of his symptoms, while planting with compost. This was assumed to be the site of entry of the organism. Treatment with levofloxacin improved his condition and he was discharged to a regular respiratory ward 7 days later, before being discharged. He was well at follow-up in May 2010.
Legionnaire's disease is a common pneumonia that is usually caused by Legionella pneumophila (90% of cases). Legionnaires' disease caused by L longbeachae is much less common, and outbreaks in the UK and the USA are sporadic. In the UK, nine cases have been reported since 1984. L longbeachae does, however, have a much higher incidence in Australia, New Zealand, and Japan, where it accounts for about 30% of all cases of Legionnaires' disease.
Antibiotic treatment for Legionnaire's disease is the same whatever the organism causing it. The authors say that in cases of community-acquired pneumonia such as this, continued treatment with such antibiotics may be prudent until all possible types of legionella have been excluded from the diagnosis—particularly in those associated with exposure to gardening compost.
For Dr Simon M Patten, Royal Alexandra Hospital, Paisley, UK, please contact press office T) +44 (0) 141 201 4429 E) press.office@ggc.scot.nhs.uk / simonpatten@doctors.net.uk
For full Case Report see: http://press.thelancet.com/cr0409.pdf
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Journal
The Lancet