Legionella and Mycoplasma Pneumonia

Information for general practitioners - please distribute to medical and nursing staff
Among the many causes of pneumonia, bacterial pathogens (such as Mycoplasma pneumoniae and Legionella
species) are important to consider.
Legionella pneumophila
 Seven recent cases of Legionella pneumophila who travelled to Sydney CBD have been notified recently.
 Legionella pneumophila can cause serious illness, particularly when it occurs with other co-morbidities or
in the context of immune suppression.
 The bacteria can contaminate air conditioning cooling towers, whirlpool spas, shower heads and other
bodies of water. People outside may be exposed if they inhale aerosolized contaminated water.
 The typical incubation period is 2 to 10 days, but more commonly 5 to 6 days.
 Symptoms usually include fever, chills, a cough, and shortness of breath. Cases may also have muscle
aches, headache, tiredness, loss of appetite and diarrhoea.
 It is difficult to distinguish Legionella from other types of pneumonia by symptoms alone.
Mycoplasma pneumoniae
 Mycoplasma infections, particularly in children aged 5 to 16 years have increased in NSW recently.
 Globally, there has been an increase in cases of Mycoplasma pneumoniae in children in China, Taiwan,
Philippines, South Korea, North America, and Europe.
 Increase in Mycoplasma pneumoniae circulation usually occurs every 3-7 years as population immunity
wanes.
 Mycoplasma pneumoniae commonly causes mild respiratory infections and generally resolves without serious
complications. Cough and weakness may persist for more than 1 month.
 Infection is most common in age groups 5 and 20 years but can occur at any ag
Symptoms may develop over 1 to 3 weeks and include fever, dry cough, headache, sore throat and malaise.
 People with Mycoplasma pneumonia may appear well, often referred to as “walking pneumonia”.
Testing for pneumonia
 Diagnosis can be supported by investigations including:
o respiratory nose and throat swab PCR including atypical bacteria such as Mycoplasma (especially for
children aged 5 to 16 years) and Legionella, o Legionella urinary antigen testing (especially in adults), sputum culture and/or PCR, blood culture,
acute and convalescent sera, and/or chest x-ray.
Management
 Manage as per treatment guidelines (penicillins e.g., amoxicillin) for typical pneumonia.
 For patients with clinically consistent disease and/or epidemiological suspicion of pneumonia caused by an
atypical pathogen, consider including treatment with appropriate antimicrobial cover e.g., doxycycline
(children 8 years and over), azithromycin or clarithromycin.
 Refer to clinical guidelines or discuss with an infectious disease specialist for further management advice.
Further information
 NSW Legionnaires’ disease website https://www.health.nsw.gov.au/Infectious/legionnaires/Pages/default.aspx
 Pneumonia NSW Emergency Care Institute

https://aci.health.nsw.gov.au/networks/enical/clinical-tools/respiratory/pneumonia