LEGIONELLA - World Health Organization

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Strictly Confidential 3 Legionella Microbiology Results PLEASE ENSURE ALL POSITIVE SAMPLES ARE SENT TO RSIL A: Culture: Done Not done Date Specimen Species Serogroup Result * Positive Negative 1 2 * If positive, was the isolate referred to RSIL? Yes No B: Urine Antigen detection: Done Not done Date Manufacturer & Kit used Result * Positive Negative * If positive, was the urine referred to RSIL? Yes No C: Serology: Done Not done Date Titre Assay used (Manufacturer & Kit used) Result * Positive Negative * If positive, was the sera referred to RSIL Yes No Has this result been confirmed in the presence of campylobacter blocking fluid? Yes No Not Sure D: Other Method: (Specify) Date Specimen Result Positive Negative Equivocal Laboratory Details Laboratory where microbiology carried out: Laboratory confirmation at HPA, CFI, RSIL, Colindale? Yes No Confirmation at another laboratory? Yes No If Yes, please specify: Environmental Investigations Has sampling of water systems been requested (see: www.hpa.org.uk/infections/topics_az/legionella/advice) If Yes, please specify i.e. patients home, hospital, industrial/commercial, other: Name and address of laboratory carrying out sampling: Yes No Please give details: Results of sampling (if known): Pos Neg Not Known Reporter’s Details Name of person reporting case to CDSC: Date of report: ___/___/___ Telephone contact number: Email address: Name of CCDC relevant to case: Name of HPU responsible for reporting case: Signature: ………………………………………………………….. Date: ………………………………………….. 0 <strong>LEGIONELLA</strong> AND THE PREVENTION OF LEGIONELLOSIS
Glossary aerobic bacteria Bacteria that require the presence of free or dissolved oxygen in their environment for survival and reproduction. aerosol A suspension of fine solid or liquid particles in a gas, such as air. anaerobic bacteria Bacteria that live and reproduce in an environment that contains no free or dissolved oxygen. antibody A protein produced by the body’s immune system that recognizes and helps fight infections and other foreign substances in the body. antigen A foreign substance that stimulates the production of antibodies by the immune system. ascertainment The determination through diagnostic methods of whether or not a person is infected with the disease. aspiration The inhalation of foreign material, such as food or airborne particles, into the lung. biofilm A slimy matrix produced and inhabited by bacteria, which enables the bacteria to adhere to a surface and carry out certain essential biochemical processes. blow-down (or bleed-off) Removing some of the water of a system periodically or continuously, and replacing it with fresh water, to control the continuous accumulation of dissolved solids in the water. bronchoalveolar lavage Washing the bronchial tubes and alveoli with repeated injections of water. community acquired Cases of legionellosis that are not acquired in a health-care, travel or domestic (i.e. the patient’s home) setting. comorbidity A disease or disorder that is not directly caused by another disorder but occurs at the same time. control measure Any action and activity that can be used to prevent or eliminate a water safety hazard or reduce it to an acceptable level. control point A step at which control can be applied to prevent or eliminate a water safety hazard or reduce it to an acceptable level. Some plans contain key control points; that is, points at which control might be essential to prevent or eliminate a water safety hazard. corrective action Any action to be taken when the results of monitoring at the control point indicate a loss of control. deadleg A length of water-filled pipe where there is little or no flow. decimal reduction time A unit of microbial heat resistance, defined as the time required to kill 90% of a population of microorganisms at a constant temperature, under specified conditions. <strong>LEGIONELLA</strong> AND THE PREVENTION OF LEGIONELLOSIS 0
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LEGIONELLA AND THE PREVENTION OF LE
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LEGIONELLA AND THE PREVENTION OF LE
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Foreword Legionellosis is a collect
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Contents Foreword . . . . . . . . .
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Chapter 5 Cooling towers and evapor
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Chapter 9 Disease surveillance and
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Tables Table 1.1 Main characteristi
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Figure 8.1 Visible biofilm on inter
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Acknowledgements The World Health O
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• John Newbold, Health and Safety
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Executive summary Legionellosis is
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• Health-care facilities — Chap
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Chapter 1 Legionellosis Britt Horne
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Legionnaires’ disease is often in
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1.1.2 Pontiac fever Symptoms Pontia
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Table . Extrapulmonary nfect ons ca
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Proteins produced by the body’s i
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Aspiration may occur in patients wi
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Table . R sk factors for Legionella
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In the outbreak of Legionnaires’
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Table . Potent al treatments for d
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1.4.2 Species and serogroups associ
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Other causes of infection In Europe
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The interaction of virulent legione
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1.5.2 Surface structures involved i
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1.5.4 Host defence The host defence
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Chapter 2 Ecology and environmental
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L. pneumophila is thermotolerant an
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2.2.3 Environmental factors and vir
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Figure 2.1 Biofilm formation Biofil
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2.4 Sources of Legionella infection
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Chapter 3 Approaches to risk manage
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Table . Cool ng tower outbreaks Fac
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Even when a source reaches a state
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The WSP should be prepared in conju
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Identify control measures Control m
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F gure . Dec mal reduct on t mes fo
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Method Advantages D sadvantages Dos
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Validate effectiveness of water saf
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• clear statements of responsibil
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Chapter 4 Potable water and in-buil
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The remainder of this chapter provi
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4.3.1 Document and describe the sys
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Construction materials — risk fac
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Where temperature controls (discuss
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4.4.2 Monitor control measures This
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Chapter 5 Cooling towers and evapor
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5.1.1 Cross-flow cooling towers As
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water treatments (including chemica
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5.3 System assessment This section
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Spray drift — risk factors Even w
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The section on control measures for
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• periodic or continuous bleed-of
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Box . Po nts to be noted when clean
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In certain circumstances, samples m
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Table . Example documentat on for m
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Chapter 6 Health-care facilities Ma
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For 1999 and 2000, a total of 384 c
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6.3 System assessment This section
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Table . Type of colon zat on of wat
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6.4.1 Identify control measures Thi
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6.5.1 Prepare management procedures
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Until the situation is under contro
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Chapter 7 Hotels and ships Roisin R
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F gure . Detected and reported case
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Table . Rev ew of outbreaks (more t
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7.2 Water safety plan overview WSPs
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The risk of legionellosis is increa
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Kingdom to 66% in Spain (Starlinger
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Agency, Legionella Section, United
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Given the complexity of distributio
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Chapter 8 Natural spas, hot tubs an
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Spas “Natural spa”, denotes fac
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Rare cases of Legionnaires’ disea
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Process step P pework Water n hot t
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Hosepipes may sometimes be used to
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Hot tubs that are not effectively d
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Nutrients — control measures Bath
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Various additives may also be used
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• descriptions of any significant
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Table . Examples of m crob olog cal
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Chapter 9 Disease surveillance and
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Exposure histories allow cases to b
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F gure . Invest gat ng a s ngle cas
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Box . (cont nued) Since the incepti
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Country United Kingdom All reported
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F gure . Annual reported cases, - 0
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Training opportunities Trainees in
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Box . Example of terms of reference
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ecause doing anything more could un
Page 181 and 182: 9.4 Case studies This section descr
Page 183 and 184: 9.4.4 Concrete batcher process on a
Page 185 and 186: Chapter 10 Regulatory aspects David
Page 187 and 188: • validation of the effectiveness
Page 189 and 190: • operating conditions, such as t
Page 191 and 192: 10.4.6 Outbreak investigation and n
Page 193 and 194: hot water (e.g. health-care facilit
Page 195 and 196: General prevent on Country DW Wp SB
Page 197 and 198: Country General prevent on DW Wp SB
Page 199 and 200: Chapter 11 Laboratory aspects of Le
Page 201 and 202: • detection of the bacterium in t
Page 203 and 204: Method Sens t v ty (%) PCR • Rapi
Page 205 and 206: 11.2.2 Detecting Legionella antigen
Page 207 and 208: DFA has been used successfully with
Page 209 and 210: • Serologic testing can be used f
Page 211 and 212: Although not all strains can be rel
Page 213 and 214: Generally, any water source that ma
Page 215 and 216: During outbreak investigations, swa
Page 217 and 218: • other Legionella species that d
Page 219 and 220: Appendix 1 Example of a water syste
Page 221 and 222: Weekly water system check list Week
Page 223 and 224: Appendix 2 Example of a 2-week foll
Page 225 and 226: Travel Work/travel in the UK: ❑ Y
Page 227 and 228: Checklist of local places Health/sp
Page 229 and 230: Appendix 3 Example of a national su
Page 231: Strictly Confidential 2 Hospital Ac
Page 235 and 236: health-care acquired Legionellosis
Page 237 and 238: surveillance The process of systema
Page 239 and 240: References Abu KY, Eisenstein BI, E
Page 241 and 242: Barbaree JM et al. (1987). Protocol
Page 243 and 244: Blatt SP et al. (1994). Legionnaire
Page 245 and 246: Byrne B, Swanson MS (1998). Express
Page 247 and 248: Crespi S (1993). Legionella y legio
Page 249 and 250: Edelstein PH (1982b). Comparative s
Page 251 and 252: Falguera M et al. (2001). Nonsevere
Page 253 and 254: Gaia V et al. (2003). Sequence-base
Page 255 and 256: Hayden RT et al. (2001). Direct det
Page 257 and 258: Ingram JG, Plouffe JF (1994). Dange
Page 259 and 260: Ko KS et al. (2003). Molecular evol
Page 261 and 262: Loret JF et al. (2003). Comparison
Page 263 and 264: McEvoy M et al. (2000). A cluster o
Page 265 and 266: Olaechea PM et al. (1996). A predic
Page 267 and 268: Regan CM et al. (2003). Outbreak of
Page 269 and 270: Schulze-Robbecke R, Rodder M, Exner
Page 271 and 272: Surman SB, Morton LHG, Keevil CW (1
Page 273 and 274: Tully M, Williams A, Fitzgeorge RB
Page 275 and 276: Welti M et al. (2003). Development
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