LEGIONELLA - World Health Organization

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Chereshsky AY, Bettelheim KA (1986). Serological studies of legionellosis in New Zealand. Israel Journal of Medical Science, 22(10):737–739. Cherry WB et al. (1982). Legionella jordanis: a new species of Legionella isolated from water and sewage. Journal of Clinical Microbiology, 15:290–297. Chien M et al. (2004). The genomic sequence of the accidental pathogen Legionella pneumophila. Science, 305:1966–1968. Chow JW, Yu VL (1998). Legionella: a major opportunistic pathogen in transplant recipients. Seminars in Respiratory Infections, 13(2):132–139. Christenson B et al. (1986). Outbreak of respiratory illness on board a ship cruising to ports in Southern Europe and Northern Africa. Journal of Infection, 14:247–254. Cianciotto NP (2001). Pathogenicity of Legionella pneumophila. International Journal of Medical Microbiology, 5:331–343. Ciancotto NP, Fields BS (1992). Legionella pneumophila mip gene potentiates intracellular infection of protozoa and human macrophages. Proceedings of the National Academy of Sciences, 89:5188–5191. Cianciotto NP et al. (1989). A Legionella pneumophila gene encoding a species-specific surface protein potentiates initiation of intracellular infection. Infection and Immunity, 57(4):1255–1262. Cianciotto NP et al. (1990). A mutation in the mip gene results in an attenuation of Legionella pneumophila virulence. Journal of Infectious Diseases, 162(1):121–126. Cloete TE et al. (1989). The use of planktonic bacterial populations in open and closed recirculating water cooling systems for the evaluation of biocides. International Biodeterioration, 25:115–122. Colbourne JS, Ashworth J (1986). Rubbers, water, and legionella. Lancet, 2(8506):583. Colbourne JS, Dennis PJ (1985). Distribution and persistence of Legionella in water systems. Microbiological Sciences, 2:40–43. Colbourne JS, Trew RM (1986). Presence of Legionella in London’s water supplies. Israel Journal of Medical Science, 22(9):633–639. Colbourne JS et al. (1984). Water fittings as sources of Legionella pneumophila in a hospital plumbing system. Lancet, 1:210–213. Colbourne JS et al. (1988). Legionella and public water supplies. Water Science and Technology, 20(11– 12):5–10. Cooper AW, Barnes HR, Myers ER (2004). Assessing risk of Legionella. ASHRAE Journal, 46(4):22–26. Cosentini R et al. (2001). Community-acquired pneumonia: role of atypical organisms. Monaldi Archives for Chest Disease, 56(6):527–534. Coward S et al. (1999). The risks of Legionella in water systems in homes, Part 1. Building research establishment client report number CR361/98R. Final report prepared for the Building Regulations Division, London, Department of Environment, Transport and the Regions. LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS
Crespi S (1993). Legionella y legionelosis: normas básicas de prevención y control de instalciones hoteleras. Fundación Barceló. Palma de Mallorca. Crespi S, Ferra J (1997). Outbreak of legionellosis in a tourist complex in Lanzarote concomitant with a treatment of the water systems with megadoses of polyphosphates. Water Science and Technology, 35(11–12):307–309. Crespi S, Ferra J (1998). Chlorination and thermal treatment in the control of Legionella in hotels: 5 years follow-up. 13th Meeting of the European Working Group on Legionella Infections, Abstract 3. Crespi S, Ferra J (2002). Educational program for prevention of legionellosis in the tourism sector. In: Marre R et al., eds. Legionella, Washington DC, ASM Press, 425–427. Crespi S et al. (1999). Legionella and legionellosis in Mallorca: distribution in hotels, tourist epidemiology and field applications of hot water UV-disinfection. In: Lobel H, Steffen R, Kozarsky, eds. Travel Medicine 2. Atlanta, Georgia, International Society of Travel Medicine, 1991:269–270. Cunha BA (1998). Clinical features of Legionnaires’ disease. Seminars in Respiratory Infection, 13(2):116–127. Davison A et al. (2005). Water safety plans: managing drinking-water quality from catchment to consumer. Geneva, World Health Organization (WHO/SDE/WSH/05.06). de Jong JM (1997). History of healing; bath treatment as psychiatric therapy (1900–1950). Ned. Tijdschr. Geneeskd, 141:1487–1491. Den Boer JW et al. (2002). A large outbreak of Legionnaires’ disease at a Dutch flower show. Emerging Infectious Diseases, 8:1. Deng C (1993). A report on investigation of an outbreak of Legionnaires’ disease in a hotel in Beijing. Zhonghua Liu Xing Bing Xue Za Zhi, 14(2):78–80. Dennis PJ (1988a). Isolation of legionellae from environmental specimens. In: Harrison TG, Taylor AG, eds. A laboratory manual for Legionella. London, United Kingdom, John Wiley & Sons Ltd, 31–44. Dennis R (1988b). Legionnaires’ disease — preventative maintenance. Journal of the Institute of Hospital Engineering, 42:14–15. Dennis PJ, Lee JV (1988). Differences in aerosol survival between pathogenic and non-pathogenic strains of Legionella pneumophila serogroup 1. Journal of Applied Bacteriology, 65(2):135–141. Dennis PJ, Green D, Jones BP (1984). A note on the temperature tolerance of Legionella. Journal of Applied Bacteriology, 56:349–350. Dennis PJ et al. (1993). Five new Legionella species isolated from water. International Journal of Systematic Bacteriology, 43:329–337. Department of Transport (1986). Recommendations to prevent contamination of a ship’s fresh water storage and distribution systems. London, Her Majesty’s Stationery Office (Merchant Shipping Notice 1214). 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
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• operating conditions, such as t
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10.4.6 Outbreak investigation and n
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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 and 242: Barbaree JM et al. (1987). Protocol
Page 243 and 244: Blatt SP et al. (1994). Legionnaire
Page 245: Byrne B, Swanson MS (1998). Express
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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