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Archivum Immunologiae Et Therapiae... 2009The Legionellae are Gram-negative bacteria able to survive and replicate in a wide range of protozoan hosts in natural environments, but they also occur in man-made... (Review)
Review
The Legionellae are Gram-negative bacteria able to survive and replicate in a wide range of protozoan hosts in natural environments, but they also occur in man-made aquatic systems, which are the major source of infection. After transmission to humans via aerosols, Legionella spp. can cause pneumonia (Legionnaires' disease) or influenza-like respiratory infections (Pontiac fever). In children, Legionnaires' disease is uncommon and is mainly diagnosed in children with immunosuppression. The clinical picture of Legionella pneumonia does not allow differentiation from pneumonia caused by others pathogens. The key to diagnosis is performing appropriate microbiological testing. The clinical presentation and the natural course of Legionnaires' disease in children are not clear due to an insufficient number of samples, but morbidity and mortality caused by this infection are extremely high. The mortality rate for legionellosis depends on the promptness of an appropriate antibiotic therapy. Fluoroquinolones are the most efficacious drugs against Legionella. A combination of these drugs with macrolides seems to be promising in the treatment of immunosuppressed patients and individuals with severe legionellosis. Although all Legionella species are considered potentially pathogenic for humans, Legionella pneumophila is the etiological agent responsible for most reported cases of community-acquired and nosocomial legionellosis.
Topics: Aerosols; Animals; Diagnosis, Differential; Disease Transmission, Infectious; Drug Therapy, Combination; Fever; Fluoroquinolones; Humans; Legionellaceae; Legionnaires' Disease; Macrolides; Pneumonia; Virulence
PubMed: 19578813
DOI: 10.1007/s00005-009-0035-8 -
The Journal of the Kentucky Medical... Sep 1996Legionella pneumophila is the cause of Legionnaires' disease, and Pontiac fever, an influenza-like condition without pneumonia. We present a case of Pontiac fever after...
Legionella pneumophila is the cause of Legionnaires' disease, and Pontiac fever, an influenza-like condition without pneumonia. We present a case of Pontiac fever after exposure to a hot tub contaminated with L pneumophila. A 37 y/o wf presented to the office with acute onset of sore throat, fever, headache, and myalgia. Patient was hospitalized 3 days later because of worsening shortness of air. Chest x-ray was normal. Patient was treated with 2 days of IV erythromycin and was discharged home on oral erythromycin. Her Legionella IFA was 1:16,384. Two days later, she developed chest tightness, pleuritic chest pain, and increasing shortness of air but did not have any cough or sputum production. She was re-hospitalized with a diagnosis of Pontiac fever and treated with IV erythromycin plus oral rifampin. A repeat chest x-ray remained normal. After a detailed epidemiologic history was obtained, it was noted that she became ill after using a hot tub, which her two children also used and they themselves developed a self limited illness. Water from the hot tub was positive for L pneumophila by DFA, culture, and PCR. Patient improved gradually with therapy and was discharged home. This report emphasizes the importance of a complete epidemiologic history in the diagnosis of respiratory infections. It also demonstrates that aquatic environment can be contaminated with Legionella and serve as a source of infection.
Topics: Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Hydrotherapy; Legionella pneumophila; Legionnaires' Disease; Risk Factors; Water Microbiology
PubMed: 8855593
DOI: No ID Found -
Epidemiology and Infection Apr 2001In April 1999, an outbreak of Pontiac fever occurred at a hotel in Northern Sweden. A retrospective cohort study to find the source and define the extent of the outbreak...
In April 1999, an outbreak of Pontiac fever occurred at a hotel in Northern Sweden. A retrospective cohort study to find the source and define the extent of the outbreak was carried out among 530 Swedish and Norwegian guests. Twenty-nine epidemiological cases (8% of 378 responders) aged 21-57 years were identified. Antibodies against Legionella micdadei were detected in 17 of 27 tested cases and 3 other symptomatic persons. Visiting the whirlpool area was identified as the sole risk factor (RR 86; 95% CI 21-352) and infected cases were confined to visitors to this area over three successive days. The attack rate was 71% (27/38) and 24 cases (83%) used the whirlpool. Environmental sampling was negative for Legionella sp. But epidemiological investigation strongly suggests that the whirlpool was the source of the outbreak. The possibility of serious legionella infections underlines the importance of strict maintenance practices to maintain hygiene of whirlpools.
Topics: Adult; Antibodies, Bacterial; Disease Outbreaks; Female; Housing; Humans; Hydrotherapy; Legionella; Legionnaires' Disease; Male; Middle Aged; Retrospective Studies; Surveys and Questionnaires; Sweden; Water Microbiology
PubMed: 11349975
DOI: 10.1017/s0950268801005313 -
JAMA Mar 1978
Topics: Humans; Legionnaires' Disease; Respiratory Tract Infections; United States
PubMed: 628057
DOI: No ID Found -
British Medical Journal Jul 1979
Topics: Humans; Legionnaires' Disease
PubMed: 466325
DOI: No ID Found -
JAAPA : Official Journal of the... Oct 2022Legionnaires disease is an important, relatively uncommon, yet well known form of atypical community-acquired pneumonia (CAP). If not appropriately treated in the early... (Review)
Review
Legionnaires disease is an important, relatively uncommon, yet well known form of atypical community-acquired pneumonia (CAP). If not appropriately treated in the early stage of infection, it can be fatal. Several factors increase the risk of contracting Legionnaires disease, including age over 50 years, chronic cardiovascular disease, underlying respiratory disease, chronic renal disease, diabetes, smoking, any immunosuppressing condition, travel history, and certain types of employment. Legionnaires disease can present without the usual symptoms associated with pneumonia. The incidence of Legionnaires disease is increasing, and because of its morbidity and mortality, clinicians should consider it in the differential when treating patients with CAP. This article reviews the pathophysiology and treatment of Legionnaires disease and when to refer patients to tertiary centers for higher levels of care, including extracorporeal membrane oxygenation.
Topics: Community-Acquired Infections; Extracorporeal Membrane Oxygenation; Humans; Legionella; Legionnaires' Disease; Middle Aged; Pneumonia
PubMed: 36165547
DOI: 10.1097/01.JAA.0000873792.00538.78 -
Clinics in Chest Medicine Jun 1991As specialized laboratory tests became more widely available, Legionella species were found to be common causes of nosocomial and community-acquired pneumonia. Patients... (Review)
Review
As specialized laboratory tests became more widely available, Legionella species were found to be common causes of nosocomial and community-acquired pneumonia. Patients with chronic lung disease and organ transplants are at greatest risk. Clinical manifestations are non-specific, although fever greater than 39 degrees C and diarrhea are common. Erythromycin remains the antibiotic of choice, although many alternative agents are available. Once cases are discovered, a search for the organism in water distribution systems and respiratory equipment can be fruitful. Disinfection of water distribution systems by superheating and flushing or by hyperchlorination is feasible.
Topics: Erythromycin; Humans; Legionella; Legionnaires' Disease
PubMed: 1855370
DOI: No ID Found -
Infectious Disease Clinics of North... Mar 2017Legionnaire's disease (LD) is the pneumonic form of legionellosis caused by aerobic gram-negative bacilli of the genus Legionella. Individuals become infected when they... (Review)
Review
Legionnaire's disease (LD) is the pneumonic form of legionellosis caused by aerobic gram-negative bacilli of the genus Legionella. Individuals become infected when they inhale aerosolized water droplets contaminated with Legionella species. Forty years after the identification of Legionella pneumophila as the cause of the 1976 pneumonia outbreak in a hotel in Philadelphia, we have non-culture-based diagnostic tests, effective antibiotics, and preventive measures to handle LD. With a mortality rate still around 10%, underreporting, and sporadic outbreaks, there is still much work to be done. In this article, the authors review the microbiology, laboratory diagnosis, and epidemiology of LD.
Topics: Adult; Anti-Bacterial Agents; Disease Outbreaks; Female; Humans; Legionella pneumophila; Legionnaires' Disease; Male; Middle Aged; Risk Factors; Water Microbiology
PubMed: 28159177
DOI: 10.1016/j.idc.2016.10.002 -
Przeglad Epidemiologiczny 2019The aim of this study is to assess the epidemiological situation of legionellosis in Poland in 2017 in comparison with previous years.
OBJECTIVE
The aim of this study is to assess the epidemiological situation of legionellosis in Poland in 2017 in comparison with previous years.
MATERIAL AND METHODS
The analysis is based on national surveillance data published in the annual bulletin: “Infectious diseases and poisonings in Poland in 2017” and bulletins from previous years along with data from legionellosis case reports collected and sent to the Department of Epidemiology of Infectious Diseases and Surveillance NIPH – NIH by Sanitary and Epidemiological Stations.
RESULTS
In Poland, both cases of Legionnaires’ disease (an acute form of infection with pneumonia) and Pontiac fever (a mild, influenza-like form of infection) are routinely reported to the surveillance system. In 2017, a total of 39 cases of legionellosis were registered, including 38 cases of Legionnaires’ disease and 1 case of Pontiac fever; the annual incidence rate 0.102 (per 100,000 population) has increased by almost 50 percent since previous year (0.070) and is almost three times higher than the median incidence (0.036) for 2011-2015. The infections were reported in fourteen voivodeships; only one voivodeship (Świętokrzyskie) did not register any case in last years. The incidence in men (0.129 per 100,000) was higher compared to women (0.076); the highest incidence (0.323) was noted in men aged 50-59. All reported cases were sporadic and were hospitalised. The Sanitary Inspection reported nine fatal cases – 6 women and 3 men. Thirty three cases were autochthonous including four cases linked with contaminated water systems in health-care settings. Six cases were associated with travels abroad (to Egypt, Albania, Italy and Crete).
SUMMARY AND CONCLUSIONS
Although in recent years number of reported cases continues to rise, the incidence of legionellosis in Poland remains one of the lowest in the entire EU. Also draws attention variation of incidence between provinces and a high mortality among reported cases. Our data suggest significant under-diagnosis of legionellosis. A priority remains to improve early diagnosis of Legionnaires’ disease in health care settings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Incidence; Legionellosis; Legionnaires' Disease; Male; Middle Aged; Poland; Registries; Young Adult
PubMed: 31385671
DOI: 10.32394/pe.73.26 -
Journal of Environmental and Public... 2010In June and July 2008, two office workers were admitted to a Dublin hospital with Legionnaires' disease. Investigations showed that cooling towers in the basement car...
In June and July 2008, two office workers were admitted to a Dublin hospital with Legionnaires' disease. Investigations showed that cooling towers in the basement car park were the most likely source of infection. However, positive results from cooling tower samples by polymerase chain reaction (PCR) did not correlate with subsequent culture results. Also, many employees reported Pontiac fever-like morbidity following notification of the second case of Legionnaires' disease. In total, 54 employees attended their general practitioner or emergency department with symptoms of Legionnaires' disease or Pontiac fever. However, all laboratory tests for Legionnaires' disease or Pontiac fever were negative. In this investigation, email was used extensively for active case finding and provision of time information to employees and medical colleagues. We recommend clarification of the role of PCR in the diagnosis of legionellosis and also advocate for a specific laboratory test for the diagnosis of the milder form of legionellosis as in Pontiac fever.
Topics: Air Conditioning; Disease Outbreaks; Humans; Ireland; Legionella pneumophila; Legionnaires' Disease; Male; Middle Aged; Occupational Diseases; Polymerase Chain Reaction; Water Microbiology
PubMed: 20414339
DOI: 10.1155/2010/463926