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Clinical Infectious Diseases : An... Jan 2007During March 2004, a large outbreak of legionnaires disease and Pontiac fever occurred among hotel guests in Oklahoma. An investigation was conducted to identify the...
BACKGROUND
During March 2004, a large outbreak of legionnaires disease and Pontiac fever occurred among hotel guests in Oklahoma. An investigation was conducted to identify the source and evaluate the utility of the Legionella urine antigen assay and serologic testing for the identification of Pontiac fever.
METHODS
A retrospective cohort investigation of hotel guests and employees and an environmental evaluation were performed. Participants were interviewed, and clinical specimens were collected from consenting individuals.
RESULTS
Six cases of legionnaires disease and 101 cases of Pontiac fever were identified. Exposure to the indoor pool and hot tub area was associated with legionellosis (relative risk, 4.4; 95% confidence interval, 2.8-6.9). Specimens from the pool and hot tub tested positive for Legionella pneumophila serogroup 1 by polymerase chain reaction. For Pontiac fever, the sensitivity and positive predictive value were 35.7% and 100%, respectively, for the urine antigen assay, and 46.4% and 90%, respectively, for serologic testing. The specificity and negative predictive value were 100% and 47.8%, respectively, for the urine antigen assay, and 89.3% and 45.5%, respectively, for serologic testing.
CONCLUSIONS
Urine antigen testing, with or without serologic testing, can be used to confirm outbreak-associated cases of Pontiac fever caused by L. pneumophila serogroup 1.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Bacterial; Antigens, Bacterial; Child; Child, Preschool; Cohort Studies; Disease Outbreaks; Female; Humans; Infant; Legionnaires' Disease; Male; Middle Aged; Oklahoma; Retrospective Studies; Surveys and Questionnaires; Travel
PubMed: 17173221
DOI: 10.1086/510387 -
Ryoikibetsu Shokogun Shirizu 1999
Review
Topics: 4-Quinolones; Anti-Bacterial Agents; Anti-Infective Agents; Diagnosis, Differential; Humans; Legionellosis; Legionnaires' Disease; Macrolides; Prognosis
PubMed: 10088325
DOI: No ID Found -
Infectious Disease Clinics of North... Sep 1987Legionnaires' disease is a distinct clinical entity caused by Legionella pneumophila. Following an epidemic of pneumonia in Philadelphia in 1976, it was found that the... (Review)
Review
Legionnaires' disease is a distinct clinical entity caused by Legionella pneumophila. Following an epidemic of pneumonia in Philadelphia in 1976, it was found that the bacterium had in fact been first isolated in 1947. Other species of Legionella have been identified, many of which are indistinguishable from L. pneumophila infection. Legionella species also cause extrapulmonary infections and a mild nonpneumonic form of disease known in its epidemic form as Pontiac Fever.
Topics: Diagnosis, Differential; Humans; Legionella; Legionnaires' Disease; Water Microbiology
PubMed: 3332887
DOI: No ID Found -
Przeglad Epidemiologiczny 2016The aim of the study was to assess the epidemiological situation of legionellosis in Poland in 2014.
OBJECTIVE
The aim of the study was to assess the epidemiological situation of legionellosis in Poland in 2014.
MATERIAL AND METHODS
We reviewed data published in the annual bulletin: “Infectious diseases and poisonings in Poland in 2014” and its prior versions along with the legionellosis case reports sent to the Department of Epidemiology of NIPH - NIH.
RESULTS
In Poland, both two forms of legionellosis - Legionnaires’ disease (a severe form of disease accompanied by pneumonia) and Pontiac fever (mild, influenza-like form of infection) - are routinely reported to the surveillance. In 2014, a total of 14 cases were reported (12 cases of Legionnaires’ disease and 2 cases of Pontiac fever); the incidence (0.036 per 100,000 population) was comparable to previous year as well as the median (incidence) for 2008-2012. The infections were reported in eight provinces, including five, which in previous years usually did not register any cases. The incidence in males (0.04 per 100,000) was slightly higher compared to females (0.03). Death rate of females was unusually high = 75%. No outbreaks or clusters were reported - only sporadic cases. All patients required hospitalization, including cases of Pontiac fever. The Sanitary Inspection reported three fatal cases – all women 49- 60 years/old. Twelve cases were likely acquired in the country, including two probably in hospital and three linked with inhalation of aerosols during professional activity. Two cases were associated with travels abroad (one to Italy and one to Germany).
SUMMARY AND CONCLUSIONS
In 2014 diagnosis of legionellosis cases was confirmed by rapid chromatographic test detecting legionella antigen in urine. The examinations were performed even in small town hospitals, so infections were detected and reported in provinces which usually did not register any cases. This study suggests, that legionellosis is likely under recognized and under diagnosed in all provinces of the country. Presumably physicians often do not suspect or not confirm the clinical diagnosis of Legionnaires’ disease in cases with atypical pneumonia.
Topics: Adolescent; Adult; Age Distribution; Aged; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Immunoglobulin M; Incidence; Infant; Infant, Newborn; Infection Control; Legionnaires' Disease; Male; Middle Aged; Poland; Registries; Rural Population; Sex Distribution; Urban Population; Young Adult
PubMed: 27779835
DOI: No ID Found -
Clinical Infectious Diseases : An... Nov 2003This case-control study investigated a cluster of respiratory illness among patrons of a restaurant. Of 173 patrons interviewed, 117 (68%) were ill. Symptoms included...
This case-control study investigated a cluster of respiratory illness among patrons of a restaurant. Of 173 patrons interviewed, 117 (68%) were ill. Symptoms included myalgias (93%), headache (87%), and fatigue (79%). The mean incubation period was 49 h and the mean duration of illness was 71 h. Patrons aged >15 years were more likely to have been ill than younger patrons (odds ratio [OR], 2.96; P=.002); 58% of persons who were ill sat near a large fountain, compared with 18% of respondents who were not ill (OR, 7.5; P=.005). Legionella anisa was cultured from water samples obtained from the fountain pool. Of 22 individuals who were ill, 11 (50%) had a > or =4-fold increase in the titer of antibody to that strain of L. anisa from acute-phase to convalescent-phase serum samples; 3 others (14%) had persistently elevated titers of > or =512; of a group of 20 individuals who had not been exposed to the restaurant, none had titers of >128. Pontiac fever should be considered as a diagnosis during acute outbreaks of influenza-like illness with a high attack rate and no other identified etiology.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Disease Outbreaks; Humans; Legionella; Legionnaires' Disease; Middle Aged; Restaurants; Surveys and Questionnaires; United States; Water Microbiology
PubMed: 14583861
DOI: 10.1086/379017 -
Health Estate Oct 2012Steve Mount, an independent Legionella management consultant and trainer with over 25 years' previous experience in microbiology and UKAS-accredited Legionella analysis,...
Steve Mount, an independent Legionella management consultant and trainer with over 25 years' previous experience in microbiology and UKAS-accredited Legionella analysis, underlines the rising number of nosocomial cases of Legionnaires' disease in recent years, and explains the key risk assessment, management, and monitoring steps that must be taken by those responsible for hospital water systems to comply with legislation governing the 'control and management' of Legionella risk.
Topics: Humans; Legionnaires' Disease; Risk Management; United Kingdom; Water Microbiology; Water Supply
PubMed: 23140001
DOI: No ID Found -
Seminars in Respiratory Infections Dec 1987The study of outbreaks of Legionella pneumophila has been essential in understanding the organism, the disease, and its pathogenesis. Early epidemics defined the... (Review)
Review
The study of outbreaks of Legionella pneumophila has been essential in understanding the organism, the disease, and its pathogenesis. Early epidemics defined the clinical spectrum: Pontiac fever is an acute, self-limited, febrile illness with an attack rate of 95% to 100% and an incubation period of 36 hours. In contrast, legionnaires' disease is a life-threatening bronchopneumonia with an attack rate of 2% to 7% and an incubation period of two to ten days. Three times as many males as females are affected with legionnaires' disease, and age, cigarette smoking, and chronic medical disease (particularly immunosuppression) appear to be separate risk factors. Furthermore, L pneumophila is responsible for approximately 1% to 3% of community-acquired pneumonias, 13% of those acquired in the hospital and as many as 26% of atypical pneumonias. Diverse environmental reservoirs have been identified, including cooling systems, potable or domestic water systems, respiratory therapy devices, industrial coolants, and whirlpool spas. Hot water temperature, stagnant water, sediment, and the presence of other microorganisms are important factors in the amplification of the Legionellaceae. Although airborne transmission has been widely suggested, aspiration may be an important mode in certain patients. Regional and national surveillance may identify common sources and allow the introduction of early control measures. The latter have included primarily pulse and continuous hyperchlorination and super-heating hot water systems to 50 to 60 degrees C. Experimental data suggest that ozone and UV light may be useful in the future. Additionally, cooling towers and evaporative condensers have been decontaminated and maintained with a variety of biocides. The prevention of outbreaks requires thoughtful planning, redesign, and good engineering practices.
Topics: Disease Outbreaks; Humans; Legionnaires' Disease; Population Surveillance; Risk Factors; Spain; United States
PubMed: 3328890
DOI: No ID Found -
Journal of Occupational and... Feb 2017Legionellae are waterborne bacteria which are capable of causing potentially fatal Legionnaires' disease (LD), as well as Pontiac Fever. Public concern about Legionella... (Review)
Review
Legionellae are waterborne bacteria which are capable of causing potentially fatal Legionnaires' disease (LD), as well as Pontiac Fever. Public concern about Legionella exploded following the 1976 outbreak at the American Legion conference in Philadelphia, where 221 attendees contracted pneumonia and 34 died. Since that time, a variety of different control methods and strategies have been developed and implemented in an effort to eradicate Legionella from building water systems. Despite these efforts, the incidence of LD has been steadily increasing in the U.S. for more than a decade. Public health and occupational hygiene professionals have maintained an active debate regarding best practices for management and control of Legionella. Professional opinion remains divided with respect to the relative merits of performing routine sampling for Legionella, vs. the passive, reactive approach that has been largely embraced by public health officials and facility owners. Given the potential risks and ramifications associated with waiting to assess systems for Legionella until after disease has been identified and confirmed, a proactive approach of periodic testing for Legionella, along with proper water treatment, is the best approach to avoiding large-scale disease outbreaks.
Topics: Air Conditioning; Disease Outbreaks; Drinking Water; Legionella; Legionnaires' Disease; United States; Water Microbiology; Water Purification
PubMed: 27624495
DOI: 10.1080/15459624.2016.1229481 -
Paediatric Respiratory Reviews 2004
Review
Topics: Child; Humans; Immunocompetence; Legionnaires' Disease; Q Fever
PubMed: 14980266
DOI: 10.1016/s1526-0542(04)90033-4 -
Infectious Disease Clinics of North... Mar 2017Whenever the cardinal manifestations of a disorder occur in similar disorders, there is potential for a disease mimic. Legionnaire's disease has protean manifestations... (Review)
Review
Whenever the cardinal manifestations of a disorder occur in similar disorders, there is potential for a disease mimic. Legionnaire's disease has protean manifestations and has the potential to mimic or be mimicked by other community acquired pneumonias (CAPs). In CAPs caused by other than Legionella species, the more characteristic features in common with legionnaire's disease the more difficult the diagnostic conundrum. In hospitalized adults with CAP, legionnaire's disease may mimic influenza or other viral pneumonias. Of the bacterial causes of CAP, psittacosis and Q fever, but not tularemia, are frequent mimics of legionnaire's disease.
Topics: Community-Acquired Infections; Diagnosis, Differential; Humans; Influenza, Human; Legionnaires' Disease; Pneumonia; Psittacosis; Q Fever; Radiography, Thoracic
PubMed: 28159179
DOI: 10.1016/j.idc.2016.10.008