LEGIONELLA - World Health Organization

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Anon. (1992). The United Kingdom Management of Health and Safety at Work (MHSW) Regulations 1992. Anon. (1996a). Legionella and the European Council for Package Travel. Communicable Diseases Reports CDR, 6(25):213. Anon. (1996b). An outbreak of Legionnaires’ disease in Spain. Communicable Diseases Report CDR Weekly, 6(45):391. Anon. (1998a). Legionnaires’ disease on board a cruise ship. CDR Weekly, 8(27):237 (http:// www.hpa.org.uk/cdr/archives/CDR98/cdr2798.pdf, accessed 18 July 2005). Anon. (1998b). Inventory of the means of controlling communicable diseases in the European Union, Norway and Switzerland. European Commission — Directorate General V, Luxembourg. Anon. (1999). A code of practice for prevention of Legionnaires’ disease in hotels and other establishments. Malta, Department of Health. Anon. (2001). Legionnaires’ Disease: managing the health risk associated with cooling tower and warm water systems. Regulatory Impact Statement Health (Legionella) Regulations 2001, Victoria, Australia, Department of Human Services. Anon. (2003). Legionnaires’ disease in Hereford. Communicable Diseases Report, 13(51):5. Arata S et al. (1992). Enhanced growth of Legionella pneumophila in tetrahydrocannabinol-treated macrophages. Proceedings of the Society of Experimental Biology and Medicine, 199:65–67. Arnow PM et al. (1982). Nosocomial Legionnaires’ disease caused by aerosolized tap water from respiratory devices. Journal of Infectious Diseases, 146(4):460–467. Arthur J (1998). EHOs Steer cruise ship from unsafe waters. Environmental Health, 106(10):285–288. ASHRAE (American Society of Heating, Refrigerating and Air-Conditioning Engineers) (2000). Guideline 12–2000 — Minimizing the risk of legionellosis associated with building water systems. Atlanta, Georgia, ASHRAE Inc. Atlas RM (1999). Legionella: from environmental habitats to disease pathology, detection and control. Environmental Microbiology, 1(4):283–293. ATS (American Thoracic Society) (2001). Guidelines for the management of adults with communityacquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. American Journal of Respiratory and Critical Care Medicine, 163:1730–1754. Baker J, Farrell ID, Hutchinson JG (1981). Factors affecting growth of Legionella pneumophila in liquid media. Journal of Neurology Neurosurgery and Psychiatry, 44:1054–1056. Ballard AL et al. (2000). Detection of Legionella pneumophila using a real-time PCR hybridization assay. Journal of Clinical Microbiology, 38:4215–4218. Barbaree JM et al. (1986). Isolation of protozoa from water associated with a legionellosis outbreak and demonstration of intracellular multiplication of Legionella pneumophila. Applied and Environmental Microbiology, 51:422–424. LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS
Barbaree JM et al. (1987). Protocol for sampling environmental sites for legionellae. Applied and Environmental Microbiology, 53(7):1454–1458. Barker J, Farrell ID, Hutchison JG (1986). Factors affecting growth of Legionella pneumophila in liquid media. Journal of Medical Microbiology, 22:97–100. Barker J et al. (1992). Relationship between Legionella pneumophila and Acanthamoeba polyphaga: physiological status and susceptibility to chemical inactivation. Applied and Environmental Microbiology, 58:2420–2425. Bartlett CL et al. (1983). Legionella in hospital and hotel water supplies. Lancet, 2(8362):1315. Bartlett C et al. (1984). Recurrent Legionnaires’ disease from a hotel water system. In: Thornsberry C et al., eds. Legionella: proceedings of the 2nd international symposium, Washington DC, ASM Press. Bartlett C et al. (1985). Final Report on a Public Health Laboratory Service Collaborative Study of Legionella Species in Water Systems 1981–1985. Final report to the Department of Health, unpublished. Bartlett JG et al. (1998). Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America. Clinical Infectious Diseases, 26:811–838. Baskerville A et al. (1986). Pulmonary damage caused by a protease from Legionella pneumophila. British Journal of Experimental Pathology, 67(4):527–536. Bazovska S, Spalekova M (1994). Legionellosis [in Slovakian]. Bratislavske Lekarske Listy, 95(11):515–517. Bell JC et al. (1996). Legionellosis linked with a hotel car park — how many were infected? Epidemiology and Infection, 116(2):185–192. Benin AL et al. (2002). An outbreak of travel-associated Legionnaires’ disease and Pontiac fever: the need for enhanced surveillance of travel-associated legionellosis in the United States. Journal of Infectious Diseases, 185(2):237–243. Benson RF, Fields BS (1998). Classification of the genus Legionella. Seminars in Respiratory Infections, 13:90–99. Benson RF, Ward KW (1992). Direct immunofluorescent antibody examination for Legionella species. In: Isenberg HD, ed. Clinical microbiology procedures handbook,Vol. 2, Washington DC, American Society for Microbiology. Benson RF et al. (1989). Legionella quinlivanii sp. nov. isolated from water. Current Microbiology, 18:195–197. Benson RF et al. (1990). Legionella sainthelensi serogroup 2 isolated from patients with pneumonia. Respiratory Microbiology, 141(4):453–463. Benson RF et al. (1996a). Legionella adelaidensis, a new species isolated from cooling tower water. Journal of Clinical Microbiology, 29:1004–1006. LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS
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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
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9.4 Case studies This section descr
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9.4.4 Concrete batcher process on a
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Chapter 10 Regulatory aspects David
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• 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 and 232: Strictly Confidential 2 Hospital Ac
Page 233 and 234: Glossary aerobic bacteria Bacteria
Page 235 and 236: health-care acquired Legionellosis
Page 237 and 238: surveillance The process of systema
Page 239: References Abu KY, Eisenstein BI, E
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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