LEGIONELLA - World Health Organization

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Benson RF et al. (1996b). Legionella waltersii sp. nov. and an unnamed Legionella genomospecies isolated from water in Australia. International Journal of Systematic Bacteriology, 46:631–634. Bentham RH (1993). Environmental factors affecting the colonisation of cooling towers by Legionella spp. in South Australia. Internat. biodet. Biodegrad, 31:55–63. Bentham RH (2000). Routine sampling and the control of Legionella spp. in cooling tower water systems. Current Microbiology, 41(4):271–275. Bentham RH (2002). Routine sampling and the temporal variation of Legionella spp. concentrations in cooling tower water systems. In: Marre R et al., eds. Legionella: proceedings of the 5th conference on legionella. Washington DC, American Society for Microbiology, 321–324. Bentham RH, Broadbent CR (1993). A model for autumn outbreaks of Legionnaires’ disease associated with cooling towers, linked to system operation and size. Epidemiology and Infection, 111:287–295. Beovic B et al. (2003). Aetiology and clinical presentation of mild community-acquired bacterial pneumonia. European Journal of Clinical Microbiology and Infectious Diseases, 22:584–591. Bercovier H et al. (1986). Isolation of legionellae from oxidation ponds and fishponds in Israel and description of Legionella israelensis sp. nov. International Journal of Systematic Bacteriology, 36:368–371. Berendt RF (1980). Survival of Legionella pneumophila in aerosols: effect of relative humidity. Journal of Infectious Diseases, 141:689. Bhopal R (1995). Source of infection of sporadic Legionnaires’ disease: a review. Journal of Infection, 30:9–12. Bhopal RS et al. (1991). Proximity of the home to a cooling tower and risk of non-outbreak Legionnaires’ disease. British Medical Journal, 302(6773):378–383. Birtles RJ (1990). Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection. Journal of Clinical Pathology, 43:685–690. Birtles RJ et al. (1991). Second serogroup of Legionella quinlivanii isolated from two unrelated sources in the United Kingdom. Journal of Applied Bacteriology, 71:402–406. Birtles RJ et al. (1996). Phylogenetic diversity of intra-amoebal legionellae as revealed by 16S rRNA gene sequence comparison. Microbiology, 142(12):3525–3530. Blander SJ, Horwitz MA (1991). Vaccination with the major secretory protein of Legionella induces humoral and cell-mediated immune responses and protective immunity across different serogroups of Legionella pneumophila and different species of Legionella. Journal of Immunology, 147(1):285–291. Blanquer J et al. (1991). Aetiology of community acquired pneumonia in Valencia, Spain: a multicentre prospective study. Thorax, 46(7):508–511. Blatt SP, Parkinson MD, Pace E (1993). Nosocomial Legionnaires’ disease: aspiration as a primary mode of disease acquisition. American Journal of Medicine, 95:16–22. <strong>LEGIONELLA</strong> AND THE PREVENTION OF LEGIONELLOSIS
Blatt SP et al. (1994). Legionnaires’ disease in human immunodeficiency virus-infected patients: eight cases and review. Clinical Infectious Diseases, 18:227–232. Bohach GA, Snyder IS (1983). Characterization of surfaces involved in adherence of Legionella pneumophila to Fischerella species. Infection and Immunity, 42:318–325. Boldur I et al. (1985). Legionnaires’ disease: new etiologic agents. Israel Journal of Medical Sciences, 21(7):617–620. Boldur I et al. (1987). Isolation of Legionella pneumophila from calves and the prevalence of antibodies in cattle, sheep, horses, antelopes, buffaloes and rabbits. Veterinary Microbiology, 13:313–320. Boldur I et al. (1999). Legionellosis in Israel — a view of the situation. Harefuah, 136(4):257–261. Bollin GE et al. (1985a). Difference in virulence of environmental isolates of Legionella pneumophila. Journal of Clinical Microbiology, 21:674–677. Bollin GE et al. (1985b). Aerosols containing Legionella pneumophila generated by shower heads and hot-water faucets. Applied and Environmental Microbiology, 50(5):1128–1131. Bopp CA et al. (1981). Isolation of Legionella spp. from environmental water samples by lowpH treatment and use of a selective medium. Journal of Clinical Microbiology, 13:714–719. Bornstein N et al. (1987). Bacteriological and serological diagnosis of community-acquired acute pneumonia, specially Legionnaires’ disease. Multicentric prospective study of 274 hospitalized patients. Zentralblatt für Bakteriologie Mikrobiologie und Hygiene A, 264(1–2):93–101. Bornstein N et al. (1989a). Pleural infection caused by Legionella anisa. Journal of Clinical Microbiology, 27(9):2100–2101. Bornstein N et al. (1989b). Legionella gratiana sp. nov. isolated from French spa water. Research in Microbiology, 140:541–552. Bosshardt SC, Benson RF, Fields BS (1997). Flagella are a positive predictor for virulence in Legionella. Microbial Pathogenesis, 23(2):107–112. Boswell TC, Marshall LE, Kudesia G (1996). False-positive legionella titres in routine clinical serology testing detected by absorption with campylobacter: implications for the serological diagnosis of legionnaires’ disease. Journal of Infection, 32:23–26. Boulanger CA, Edelstein PH (1995). Precision and accuracy of recovery of Legionella pneumophila from seeded tap water by filtration and centrifugation. Applied and Environmental Microbiology, 61:1805–1809. Bozue JA, Johnson W (1996). Interaction of Legionella pneumophila with Acanthamoeba castellanii: uptake by coiling phagocytosis and inhibition of phagosome–lysosome fusion. Infection and Immunity, 64:668–673. Brabender W et al. (1983). Legionella pneumophila wound infection. Journal of the American Medical Association, 250:3091–3092. Brady MT (1989). Nosocomial legionnaires’ disease in a children’s hospital. Journal of Pediatrics, 115:46–50. <strong>LEGIONELLA</strong> 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
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• 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 and 240: References Abu KY, Eisenstein BI, E
Page 241: Barbaree JM et al. (1987). Protocol
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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