Clinical Scorecard: Legionnaires’ Disease in Children: A Case Study and Literature Review
At a Glance
Category
Detail
Condition
Legionnaires’ disease
Key Mechanisms
Infection with Legionella species, most commonly Legionella pneumophila, through inhalation of aerosolized particles.
Target Population
Children aged 0–17 years, particularly very young children and those with underlying conditions, immunosuppression, or healthcare exposure.
Care Setting
Community and healthcare settings; 55% of cases with available acquisition data were healthcare-associated.
Key Highlights
Pediatric Legionnaires’ disease is rare, accounting for less than 1% of notified cases in Europe.
The European Legionnaires’ disease notification rate reached 2.6 cases per 100,000 people in 2022.
The review identified 44 pediatric cases, including a severe case in a previously healthy 15-month-old girl.
Clinical Considerations
Diagnosis
Consider Legionella testing in children with severe pneumonia, particularly newborns, immunocompromised patients, healthcare-associated cases, and those who do not respond to beta-lactam antibiotics after 48 hours.
Complementary diagnostic approaches may be needed because reliance on a single diagnostic method may underestimate the role of non–serogroup 1 infections.
Management
Early recognition and timely targeted antimicrobial treatment may improve outcomes.
In the reported case, clarithromycin was started after Legionella pneumophila serogroup 1 was detected, followed by rapid clinical improvement.
Monitoring & Follow-up
Pediatric Legionnaires’ disease can be severe; 73% of reviewed cases required intensive care and 66% required invasive respiratory support.
Risks
Very young age, underlying conditions, immunosuppression, and healthcare exposure were common among reported pediatric cases.
Patient & Treatment Data
The review included children aged 0–17 years with microbiological evidence of Legionella infection. Targeted antimicrobial therapy was reported in 91% of cases and was associated with lower odds of death in exploratory univariate analysis.
Clinical Best Practices
Consider Legionella testing in children with severe pneumonia.
Maintain a low threshold for Legionella testing in pediatric patients in high-risk healthcare settings, even when standard water safety measures are in place.
Early recognition and timely targeted treatment may improve outcomes.
The high proportion of healthcare-associated cases supports strengthened prevention and infection-control strategies.
Related Resources & Content
Greenberg D, Chiou CC, Famigilleti R, Lee TC, Yu VL. “Problem pathogens: paediatric legionellosis—Implications for improved diagnosis.” The Lancet Infectious Diseases. 2006;6:529–535. Earlier pediatric Legionnaires’ disease review updated by the current study.
Rello J, Allam C, Ruiz-Spinelli A, Jarraud S. “Severe legionnaires’ disease.” Annals of Intensive Care. 2024;14:51. Reviews severe Legionnaires’ disease and related diagnostic considerations.
Ha R, Heilmann A, Lother SA, Turenne C, Alexander D, Keynan Y, et al. “The adequacy of current Legionnaires’ disease diagnostic practices in capturing the epidemiology of clinically relevant Legionella: a scoping review.” Pathogens. 2024;13:857. Reviews diagnostic practices for Legionnaires’ disease.
Kanarek P, Bogiel T, Breza-Boruta B. “Legionellosis risk—An overview of Legionella spp. habitats in Europe.” Environmental Science and Pollution Research. 2022;29:76532–76542. Reviews environmental sources and risk considerations for Legionella.
European Centre for Disease Prevention and Control. “Legionnaires’ disease.” In ECDC Annual Epidemiological Report for 2022. Stockholm: ECDC; 2026. Provides European surveillance and notification data cited in the review.
Centers for Disease Control and Prevention. “Legionellosis surveillance and trends.” Legionella (Legionnaires’ Disease and Pontiac Fever). 2026. Provides surveillance information cited by the authors; the source notes access on March 11, 2026.
