Pediatric Legionnaires' disease: a case report and a review of the literature.
OBJECTIVES Following the first pediatric review on Legionnaires' Disease (LD) in 2006, we provide an updated literature review on LD in a pediatric population. METHODS We reviewed PubMed and Scopus for case reports and case series of LD in children, extracted clinical-epidemiological data and used the CARE checklist to assess completeness of reporting. RESULTS We report a severe case of LD in a previously healthy 15-month-old girl who developed the infection following short-term steroid therapy. The disease was likely acquired in a healthcare setting, despite the implementation of standard water-safety prevention strategies. To contextualize this finding, we systematically reviewed the available literature, identifying a total of 44 pediatric LD cases, predominantly from Europe, Asia, and North America. Sixty-four percent (n=28/44) were up to one year of age, with neonates accounting for one-third of cases (34%, n=15/44). Comorbidities and immune deficiencies were present in 61% (n=27/44) and 41% (n=18/44) of cases, respectively. Hospital-acquired cases were common (55%, n=18/33). Diagnosis relied on PCR (93% positivity, n=26/28) and culture (57%, n=25/44) performed mainly on respiratory samples. Targeted antibiotic therapy was strongly associated with reduced mortality (p=0.031). The overall mortality rate was 23% (n=10/44). CONCLUSION Our findings appear consistent with previous observations suggesting a potential benefit of early identification of LD and timely targeted treatment. The high proportion of healthcare-associated LD cases stresses the need for strengthened prevention and infection-control strategies.