-
Epidemiology and Infection Jul 2023Over the past two decades, the incidence of legionellosis has been steadily increasing in the United States though there is noclear explanation for the main factors... (Review)
Review
Over the past two decades, the incidence of legionellosis has been steadily increasing in the United States though there is noclear explanation for the main factors driving the increase. While legionellosis is the leading cause of waterborne outbreaks in the US, most cases are sporadic and acquired in community settings where the environmental source is never identified. This scoping review aimed to summarise the drivers of infections in the USA and determine the magnitude of impact each potential driver may have. A total of 1,738 titles were screened, and 18 articles were identified that met the inclusion criteria. Strong evidence was found for precipitation as a major driver, and both temperature and relative humidity were found to be moderate drivers of incidence. Increased testing and improved diagnostic methods were classified as moderate drivers, and the ageing U.S. population was a minor driver of increasing incidence. Racial and socioeconomic inequities and water and housing infrastructure were found to be potential factors explaining the increasing incidence though they were largely understudied in the context of non-outbreak cases. Understanding the complex relationships between environmental, infrastructure, and population factors driving legionellosis incidence is important to optimise mitigation strategies and public policy.
Topics: United States; Humans; Incidence; Legionellosis; Disease Outbreaks; Temperature; Legionnaires' Disease
PubMed: 37503568
DOI: 10.1017/S0950268823001206 -
Therapeutische Umschau. Revue... Oct 2001Legionnaire's disease is a life-threatening disease, observed in up to 15% of patients with pneumonia. Legionella pneumophila serogroup 1 is the most frequently...
Legionnaire's disease is a life-threatening disease, observed in up to 15% of patients with pneumonia. Legionella pneumophila serogroup 1 is the most frequently implicated species among the genus Legionella. Legionella can cause two clinical pictures: Legionnaire's disease, a severe pneumonia, or Pontiac fever, a self-limiting disease. The attributable mortality of Legionnaire's disease is between 5-30%. Patients with typical Legionnaire's disease present with fever > 39 degrees C, cough and flu-like symptoms that do not respond to betalactam antibiotics. Neurological disorders may accompany severe cases. Laboratory findings include non-purulent sputum, increased liver enzymes and hyponatriemia. However, most patients do not fulfill all of these signs, symptoms and laboratory finding. Patients present with Legionella are frequently missed in the microbiology laboratory because clinicians do not ask for the specimen to be tested for Legionella. Established risk factors for Legionnaire's disease are chronic obstructive pulmonary disease (COPD), smoking and immunosuppressive therapy. New diagnostics tools such as the Legionella antigen in the urine, as well as PCR of a sputum sample allow rapid and accurate diagnosis. Such investigations are recommended for patients with severe pneumonia and those requiring hospitalization. State-of-the-art treatment includes a second generation macrolide, or alternatively, newer quinolones which are recommended as first-line drug for transplant patients. Prevention of Legionella requires a multi-faceted approach: The warm water should be kept at 60 degrees C in the boiler; the warm water should reach 50 degrees C at the faucet two minutes of opening the handle and the shower heads should be preferably made of stainless steel. In the hospital, the warm water supply should be free of Legionella at least for severely immunocompromised patients.
Topics: Anti-Bacterial Agents; Diagnosis, Differential; Humans; Legionnaires' Disease; Microbial Sensitivity Tests; Risk Factors; Water Microbiology
PubMed: 11695089
DOI: 10.1024/0040-5930.58.10.592 -
Przeglad Epidemiologiczny 2023The aim of this study is to compare the epidemiological situation of legionellosis in Poland in 2018-2021 to prior years, taking into account the impact of the COVID-19...
OBJECTIVES
The aim of this study is to compare the epidemiological situation of legionellosis in Poland in 2018-2021 to prior years, taking into account the impact of the COVID-19 pandemic in 2020-2021.
MATERIAL AND METHODS
The assessment is based on national surveillance data published in the annual bulletin "Infectious Diseases and Poisons in Poland" from 2013 to 2021, as well as data from Legionnaires' disease case reports collected and sent to the Department of Epidemiology of Infectious Diseases and Surveillance NIPH NIH - NRI by sanitary and epidemiological stations or submitted to EpiBase.
RESULTS
In Poland, both Legionnaires' disease (an acute infection that progresses to pneumonia) and Pontiac fever (a mild, flu-like sickness) are reported. In 2018-2021, a total of 255 cases of legionellosis were registered, including 236 cases of Legionnaires' disease and 19 cases of Pontiac fever. Each year, there was an increase in the number of notifications compared to the annual median number of cases from 2013-2017. The annual incidence rate in 2019 (0.23 per 100,000 population) was the highest since the start of legionellosis case registration in Poland. It declined again during the years of the COVID-19 pandemic. The notifications occurred throughout the country, but the highest notification rate was observed in the western belt of voivodeships. Pomorskie reported the highest incidence, accounting for more than 20% of all registered cases. The median incidence of Legionnaires' disease in men (0.23 per 100,000) was more than twice that of women (0.10), with the highest incidence (0.58) recorded in men 65 years of age or older. All indigenous cases of Legionnaires' disease were sporadic; all but three patients were hospitalized. State Sanitary Inspection reported 26 fatal cases of Legionnaires' disease (mortality = 11%). Twenty-four cases were linked to contaminated water systems in health-care settings, and 21 cases were likely associated with travel abroad.
SUMMARY AND CONCLUSIONS
Although the number of notifications has increased in recent years, Legionnaires' disease is still an infrequently diagnosed respiratory infection in Poland, and the reported incidence remains one of the lowest in the entire EU. The most affected demographic group is men aged 65 and older. Improving the early diagnosis of Legionnaires' disease in healthcare settings remains a priority.
Topics: Male; Humans; Female; Aged; Legionnaires' Disease; Poland; Pandemics; Disease Outbreaks; Registries; COVID-19; Legionellosis; Incidence; Communicable Diseases
PubMed: 37861069
DOI: 10.32394/pe.77.23 -
Lancet (London, England) Dec 1977
Topics: Baths; Fever; Humans; Legionnaires' Disease; Michigan; Syndrome
PubMed: 73920
DOI: 10.1016/s0140-6736(77)90460-3 -
Current Issues in Molecular Biology 2021Legionnaires' disease and Pontiac fever are both diseases with important public health implications and require prompt and thorough responses to outbreaks for future...
Legionnaires' disease and Pontiac fever are both diseases with important public health implications and require prompt and thorough responses to outbreaks for future prevention. Effective methods for defining, diagnosing, reporting and responding to legionellosis outbreaks ideally should be standardized across countries. Therefore, the European Union surveillance methods for countering Legionnaires' disease is a useful model especially for travel-associated Legionnaires' disease (TALD) cases which are on the rise. Multi-country surveillance in the EU and European Economic Area (EEA) has evolved since the first organizational efforts in the 1980's to the currently responsible, European Legionnaires' Disease Surveillance Network (ELDSNet). This chapter outlines the practices of the EU surveillance of Legionnaires' disease including their schemata, definitions, responsibilities of participating members, methods and the results of the data collected since the program's inception. Lastly, improvements must still be made as the incidence of Legionnaires' disease in the EU is likely underestimated due to underreporting and/or underdiagnosis. Nearly 70% of cases are reported from only four countries, France, Germany, Italy and Spain, which represent 50% of the EU population.
Topics: Disease Outbreaks; Europe; Humans; Legionella; Legionnaires' Disease; Public Health Surveillance
PubMed: 33284133
DOI: 10.21775/cimb.042.081 -
The New England Journal of Medicine Sep 1997
Review
Topics: Adult; Child; Humans; Legionella pneumophila; Legionnaires' Disease; Risk Factors
PubMed: 9278466
DOI: 10.1056/NEJM199709043371006 -
The American Journal of Pathology Jun 1981
Review
Topics: Agglutination Tests; Antibody Specificity; Culture Media; Enzyme-Linked Immunosorbent Assay; Fluorescent Antibody Technique; Humans; Legionella; Legionnaires' Disease; Risk; Serologic Tests; Tissue Preservation; United States
PubMed: 7015873
DOI: No ID Found -
Epidemiology and Infection Jan 2010Previous outbreaks of Pontiac fever have invariably been associated with water droplet spread of Legionella spp. In January 2007 three workers from a horticultural...
Previous outbreaks of Pontiac fever have invariably been associated with water droplet spread of Legionella spp. In January 2007 three workers from a horticultural nursery were admitted to hospital with non-pneumonic legionellosis. Investigations showed that a working party of ten people had been exposed to aerosolized potting mix; nine of these workers met the case definition for Pontiac fever. The presence of genetically indistinguishable Legionella longbeachae serogroup 2 was demonstrated in clinical specimens from two hospitalized workers and in the potting mix to which they had been exposed. A further seven cases were diagnosed by serological tests. This is the first documented outbreak of Pontiac fever from L. longbeachae serogroup 2 confirmed from inhalation of potting mix. Pontiac fever is likely to be under-diagnosed. We advocate the introduction of an industry standard that ensures the use of face masks when handling potting mix and attaching masks and warning labels to potting mix bags sold to the public.
Topics: Adult; Agricultural Workers' Diseases; Bacterial Typing Techniques; Disease Outbreaks; Female; Humans; Legionella longbeachae; Legionnaires' Disease; Male; Middle Aged; New Zealand; Soil Microbiology; Young Adult
PubMed: 19781115
DOI: 10.1017/S0950268809990835 -
Science (New York, N.Y.) Aug 1979Pontiac fever affected ten men who had cleaned a steam turbine condenser with compressed air. Previous epidemics of Pontiac fever and Legionnaires' disease--both caused...
Pontiac fever affected ten men who had cleaned a steam turbine condenser with compressed air. Previous epidemics of Pontiac fever and Legionnaires' disease--both caused by Legionella Pneumophila (proposed sp. nov.)--involved "airborne spread" from air-conditioning cooling towers or evaporative condensers. Aerosols of contaminated water in heat-rejection systems appear to be important sources of epidemic legionellosis.
Topics: Adolescent; Air Microbiology; Humans; Legionnaires' Disease; Male; Occupational Medicine; Time Factors
PubMed: 462175
DOI: 10.1126/science.462175 -
Rinsho Biseibutsu Jinsoku Shindan... Mar 2018, the causative agent of Legionnaires' disease, was first recognized in 1977 following an epidemic of acute pneumonia in Philadelphia, USA. Since then, a total of 59...
, the causative agent of Legionnaires' disease, was first recognized in 1977 following an epidemic of acute pneumonia in Philadelphia, USA. Since then, a total of 59 species containing 80 serogroups have been characterized. Twenty-six of the species have been reported as pathogenic in humans. This review describes the microbiological characteristics of species, their habits in the environment, the source and route of infection, symptoms and diagnosis of Legionnaires' disease, and disease outbreaks in Japan.
Topics: Humans; Japan; Legionella pneumophila; Legionnaires' Disease; Philadelphia
PubMed: 29562743
DOI: No ID Found