{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T02:40:31Z","timestamp":1794278431104,"version":"4.9.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006190","name":"Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006190","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:italic>Legionella<\/jats:italic> is an aerobic, gram-negative, intracellular pathogen and is an important cause of community-acquired pneumonia. <jats:italic>Legionella pneumophila<\/jats:italic> is the most common causative agent of <jats:italic>Legionella<\/jats:italic> pneumonia. Clinical diagnosis of <jats:italic>Legionella<\/jats:italic> pneumonia is challenging due to the lack of specific clinical manifestations and the low positive rates of conventional pathogen detection methods. In this study, we report a case of a patient with chronic myeloid leukemia who developed rigors and high fever after chemotherapy and immunotherapy. Chest computed tomography revealed consolidation in the left lower lobe of the lung and ground-glass opacities in both lower lobes. Multiple blood cultures showed <jats:italic>Escherichia coli<\/jats:italic>, <jats:italic>Staphylococcus aureus<\/jats:italic>, <jats:italic>Bacillus licheniformis<\/jats:italic>, and positive results in the \u03b2-D-glucan test (G test). The patient was treated with various sensitive antimicrobial agents, including meropenem plus fluconazole, meropenem plus carpofungin, and vancomycin. Unfortunately, the patient\u2019s condition gradually worsened and eventually resulted in death. On the following day of death, metagenomic next-generation sequencing (mNGS) of 1whole blood revealed <jats:italic>L. pneumophila<\/jats:italic> pneumonia with concurrent bloodstream infection (blood mNGS reads 114,302). These findings suggest that when conventional empirical antimicrobial therapy proves ineffective for critically ill patients with pneumonia, the possibility of combined <jats:italic>Legionella<\/jats:italic> infection must be considered, and mNGS can provide a diagnostic tool in such cases.<\/jats:p>","DOI":"10.3389\/fmed.2023.1266895","type":"journal-article","created":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T15:09:08Z","timestamp":1700752148000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia"],"prefix":"10.3389","volume":"10","author":[{"given":"Chunhong","family":"Bu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linguang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqiu","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoli","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwei","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1056\/NEJM199709043371006","article-title":"Legionellosis","volume":"337","author":"Stout","year":"1997","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2200114","DOI":"10.2807\/1560-7917.ES.2023.28.11.2200114","article-title":"Legionnaires' disease in the EU\/EEA*: increasing trend from 2017 to 2019","volume":"28","author":"Samuelsson","year":"2023","journal-title":"Euro Surveill"},{"key":"ref3","first-page":"128","article-title":"Legionella and immunosuppression","volume":"13","author":"Schlossberg","year":"1998","journal-title":"Semin Respir Infect"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"924597","DOI":"10.3389\/fcimb.2022.924597","article-title":"Metagenomic next-generation sequencing clinches the diagnosis of Legionella pneumonia in a patient with acute myeloid leukemia: a case report and literature review","volume":"12","author":"Niu","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"30566","DOI":"10.2807\/1560-7917.es.2017.22.27.30566","article-title":"Legionnaires' disease in Europe, 2011 to 2015","volume":"22","author":"Beaut\u00e9","year":"2017","journal-title":"Euro Surveill"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"189","DOI":"10.3109\/10428199509051722","article-title":"Legionnaires' disease during induction of remission chemotherapy for acute nonlymphocytic leukemia","volume":"17","author":"Landau","year":"1995","journal-title":"Leuk Lymphoma"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"498","DOI":"10.3390\/microorganisms11020498","article-title":"Legionella pneumophila infections during a 7-year retrospective analysis (2016\u20132022): epidemiological, clinical features and outcomes in patients with Legionnaires' disease","volume":"11","author":"Lupia","year":"2023","journal-title":"Microorganisms"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1007\/s40121-022-00635-7","article-title":"Legionnaires' disease: update on diagnosis and treatment","volume":"11","author":"Viasus","year":"2022","journal-title":"Infect Dis Ther"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1111\/resp.12808","article-title":"Legionnaires' disease caused by Legionella longbeachae: clinical features and outcomes of 107 cases from an endemic area","volume":"21","author":"Isenman","year":"2016","journal-title":"Respirology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"543","DOI":"10.4266\/acc.2022.00521","article-title":"Incidence and risk factors associated with progression to severe pneumonia among adults with non-severe Legionella pneumonia","volume":"37","author":"Huh","year":"2022","journal-title":"Acute Crit Care"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"6126","DOI":"10.3390\/jcm11206126","article-title":"Legionella pneumophila: the journey from the environment to the blood","volume":"11","author":"Iliadi","year":"2022","journal-title":"J Clin Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/S0140-6736(15)60078-2","article-title":"Legionnaires' disease","volume":"387","author":"Cunha","year":"2016","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s12941-017-0229-6","article-title":"Diagnostic testing for Legionnaires' disease","volume":"16","author":"Pierre","year":"2017","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"81","DOI":"10.21775\/cimb.042.081","article-title":"European surveillance of Legionnaires' disease","volume":"42","author":"Jong","year":"2021","journal-title":"Curr Issues Mol Biol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1099\/jmm.0.035014-0","article-title":"Immunochromatic kits Xpect Legionella and BinaxNOW Legionella for detection of Legionella pneumophila urinary antigen have low sensitivities for the diagnosis of Legionnaires' disease","volume":"61","author":"Svarrer","year":"2012","journal-title":"J Med Microbiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"661589","DOI":"10.3389\/fcimb.2021.661589","article-title":"Metagenomic next-generation sequencing for pathogenic diagnosis and antibiotic management of severe community-acquired pneumonia in immunocompromised adults","volume":"11","author":"Sun","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1007\/s40121-021-00476-w","article-title":"Exploring the clinical utility of metagenomic next-generation sequencing in the diagnosis of pulmonary infection","volume":"10","author":"Xie","year":"2021","journal-title":"Infect Dis Ther"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"323","DOI":"10.3390\/diagnostics13020323","article-title":"The clinical impact of metagenomic next-generation sequencing (mNGS) test in hospitalized patients with suspected Sepsis: a multicenter prospective study","volume":"13","author":"Zuo","year":"2023","journal-title":"Diagnostics"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"643473","DOI":"10.3389\/fmed.2021.643473","article-title":"Case report: metagenomic next-generation sequencing in diagnosis of Legionella pneumophila pneumonia in a patient after umbilical cord blood stem cell transplantation","volume":"8","author":"Wang","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"iii1","DOI":"10.1136\/thx.2009.121434","article-title":"BTS guidelines for the management of community acquired pneumonia in adults: update 2009","volume":"64","author":"Lim","year":"2009","journal-title":"Thorax"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1016\/S1473-3099(14)70713-3","article-title":"Epidemiology and clinical management of Legionnaires' disease","volume":"14","author":"Phin","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.idc.2016.10.013","article-title":"Antimicrobial therapy for Legionnaire's disease: antibiotic stewardship implications","volume":"31","author":"Cunha","year":"2017","journal-title":"Infect Dis Clin N Am"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1266895\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T15:09:13Z","timestamp":1700752153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1266895\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,22]]},"references-count":22,"alternative-id":["10.3389\/fmed.2023.1266895"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1266895","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,22]]},"article-number":"1266895"}}