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Legionellosis and biologic therapies.
[legionellosis]
Biologic
therapies
are
widely
used
in
inflammatory
diseases
,
and
they
are
associated
to
an
increased
infection
risk
,
especially
to
granulomatous
and
intracellular
infections
such
as
Legionella
.
A
review
of
the
literature
revealed
105
cases
of
Legionella
pneumonia
in
patients
taking
biologic
therapies
.
Sixty
-
four
patients
(
65
.
3
%
)
were
treated
with
infliximab
,
23
(
23
.
5
%
)
with
adalimumab
,
5
(
5
%
)
with
etanercept
and
3
(
3
%
)
with
rituximab
.
Seventy
-
one
per
cent
of
the
patients
were
treated
for
rheumatologic
diseases
and
16
%
for
inflammatory
bowel
diseases
.
The
majority
of
the
patients
received
one
or
more
concomitant
immunosuppressive
drugs
,
especially
steroids
(
43
%
)
.
Overall
mortality
was
19
%
.
Legionella
pneumonia
might
complicate
therapy
with
biologic
therapies
,
especially
in
patients
being
treated
with
infliximab
or
adalimumab
given
concomitantly
with
other
immunosuppressive
medications
during
their
first
6
months
of
treatment
.
Physicians
should
be
aware
of
this
potentially
severe
association
.
Early
recognition
and
treatment
would
likely
result
in
reduced
morbidity
and
mortality
.
