LEGIONELLA - World Health Organization

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De Schrijver K et al. (2000). An outbreak of legionnaires’ disease among visitors to a fair in Belgium, 1999. Eurosurveillance, 5:115–119. Dieterle RR (1927). Methods for the demonstration of Spirochaeta pallida in single microscopic sections. Archives of Neurology and Psychiatry, 18:73–80. Domingo C et al. (1991). Radiographic appearance of nosocomial Legionnaires’ disease after erythromycin treatment. Thorax, 46:663–666. Dondero TJ Jr et al. (1980). An outbreak of Legionnaires’ disease associated with a contaminated air-conditioning cooling tower. New England Journal of Medicine, 302:365–370. Donlan RM (2002). Biofilms: microbial life on surfaces. Emerging Infectious Diseases, 8(9):881–890. Dournon E (1988). Isolation of legionellae from clinical specimens. In: Harrison TG, Taylor AG, eds. A laboratory manual for Legionella. London, United Kingdom, John Wiley & Sons Ltd, 13–30. Dournon E et al. (1988). Monoclonal antibody reactivity as a virulence marker for Legionella pneumophila serogroup 1 strains. Journal of Infectious Diseases, 157(3):496–501. Dournon E et al. (1990). Comparison of the activity of three antibiotic regimens in severe Legionnaires’ disease. Journal of Antimicrobial Chemotherapy, 26(Suppl. B):129–139. Drenning SD et al. (2001). Unexpected similarity of pulsed-field gel electrophoresis patterns of unrelated clinical isolates of Legionella pneumophila, serogroup 1. Journal of Infectious Diseases, 183(4):628–632. Dresden Panel (2002). Pan-European study on culture-proven Legionnaires’s disease: distribution of Legionella pneumophila serogroups and monoclonal antibodies. European Journal of Microbiology and Infectious Diseases, 21(10):710–716. Drozanski W (1963). Studies of intracellular parasites of free-living amoebae. Acta Microbiologica Polonica, 12:3–8. Drozanski W (1991). Sarcobium lyticum gen. nov., sp. nov., an obligate intracellular parasite of small free-living amoebae. International Journal of Systematic Bacteriology, 41:82–87. DVGW (Deutscher Verein des Gas- und Wasserfaches) (2004). DVGW Arbeitsblatt W 551: Trinkwassererwärmungs- und Leitungsanlagen; Technische Maßnahmen zur Verminderung des Legionellenwachstums; Planung, Errichtung, Betrieb und Sanierung von Trinkwasser- Installationen. DVGW e.V., Germany, 15. Edelstein PH (1981). Improved semiselective medium for isolation of Legionella pneumophila from contaminated clinical and environmental specimens. Journal of Clinical Microbiology, 14:298–303. Edelstein PH (1982a). Legionella wadsworthii species nova: a cause of human pneumonia. Annals of Internal Medicine, 97:809–813. 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
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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 and 246: Byrne B, Swanson MS (1998). Express
Page 247: Crespi S (1993). Legionella y legio
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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