SARS-CoV-2 and Legionella Co-Infection.

The COVID-19 pandemic has caused a historic public health emergency, with an estimated 458 million confirmed cases and 6 million deaths.[1] The highly transmissible SARS-CoV-2 virus can cause severe pneumonia as well as extrapulmonary sequelae, making accurate diagnosis and management crucial.[2] Legionnaire’s disease is a severe atypical bacterial pneumonia that can be associated with SARS-CoV-2 infection.[3] Like SARS-CoV-2 infection, legionella may be associated with extrapulmonary symptoms, including diarrhea, hyponatremia, and neurological manifestations such as encephalopathy, among others.[4] Importantly, the mortality rate of legionella infection is high, with one study reporting over 6% mortality despite appropriate antibiotic therapy with either azithromycin or a fluoroquinolone.[5]