The incidence rate of legionellosis for patients receiving TNF-α antagonists is high, and the risk is higher for patients receiving anti-TNF-α monoclonal antibodies than soluble TNF-receptor therapy. In case of pneumonia occurring during TNF-α antagonist therapy, specific urine antigen detection should be performed and antibiotic therapy should cover legionellosis.
The CAP guidelines recommend legionella coverage for all patients. Urinary antigen testing, however, is only recommended for select groups (e.g. ICU admissions, outpatient treatment failure) with no mention made of anti-TNF treatment status.