LEGIONELLA - World Health Organization

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Hofflin JM et al. (1987). Infectious complications in heart transplant recipients receiving cyclosporins and corticosteroids. Annals of Internal Medicine, 106:209–216. Hookey JV et al. (1996). Phylogeny of Legionellaceae on small-subunit ribosomal DNA sequences and proposal of Legionella lytica comb. nov. for Legionella-like amoebal pathogens. International Journal of Systematic Bacteriology, 46:526–531. Horwitz MA (1983). Formation of a novel phagosome by the Legionnaires’ disease bacterium (Legionella pneumophila) in human monocytes. Journal of Experimental Medicine, 158:2108–2126. Horwitz MA (1984). Phagocytosis of the Legionnaires’ disease bacterium (Legionella pneumophila) occurs by a novel mechanism: engulfment within a pseudopod coil. Cell, 36:27–33. Horwitz MA (1993). Toward an understanding of host and bacterial molecules mediating pathogenesis. In: Barbaree JM, Breiman RF and Doufur AF, eds. Legionella: current status and emerging perspectives, Washington, DC, American Society for Microbiology, 55–62. Hospedales, CJ et al. (1996). Final report of an investigation into an outbreak of Legionnaires’ disease associated with the St James’s Club, Antigua, 1996. CAREC (PAHO/WHO), Port of Spain, Trinidad and Public Health Laboratory Service, London, 1–19. Howden BP et al. (2003). Treatment and outcome of 104 hospitalized patients with Legionnaires’ disease. Internal Medicine Journal, 33(11):484–488. HPA (2006). Management of Spa Pools: Controlling the Risk of Infection, Health Protection Agency, London. ISBN 0 901144 80 0. HSC (Health and Safety Commission, United Kingdom) (2000). Legionnaires’ disease. The control of legionella bacteria in water systems. Approved code of practice and guidance, Norwich, Her Majesty’s Stationery Office. HSE (Health and Safety Executive of the United Kingdom) (1992). Statutory Instruments 1992 No. 2225, The notification of cooling towers and evaporative condensers regulations, London, HSE Books. HSE (2004). Legionnaires’ Disease — A Guide for Employers. HSE, London. http://www.hse.gov.uk/pubns/iac127.pdf Hsu SC, Martin R, Wentworth BB (1984). Isolation of Legionella species from drinking water. Applied and Environmental Microbiology, 48:830–832. Hu J et al. (2002). Direct detection of legionellae in respiratory tract specimens by using fluorescence in situ hybridization. In: Marre R et al., eds. Legionella, Washington DC, ASM Press, 221–224. Hume RD, Hann WD (1984). Growth relationships of Legionella pneumophila with green algae (Chlorophyta). In: Thornsberry C et al., eds., Legionella: proceedings of the 2nd international symposium, American Society for Microbiology, Washington DC, ASM Press, 323–324. IEE (Institute of Environmental Epidemiology) (2001). Code of practice for the control of Legionella bacteria in cooling towers. Ministry of the Environment, Singapore. LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS
Ingram JG, Plouffe JF (1994). Danger of sputum purulence screens in culture of Legionella species. Journal of Clinical Microbiology, 32:209–10. International Health Regulations (2005). World Health Assembly, May 2005. World Health Assembly adopts new International Health Regulations. 23 May 2005, WHO news release. Ishikawa A et al. (2004). Legionella pneumonia which occurred in a private whirlpool bath user. Kansenshogaku Zasshi, 78:898–904. ISO 11731:1998. ISO Standard: Water quality — detection and enumeration of Legionella. Geneva, International Organization for Standardization. ISO 5667: 2001. ISO Standard: Water quality sampling. Geneva, International Organization for Standardization. ISO 11731–2:2004. ISO Standard: Water quality — detection and enumeration of Legionella — Part 2: Direct membrane filtration method for waters with low bacterial counts. Geneva, International Organization for Standardization. Jeppesen C, Bagge L, Jeppesen VF (2000). Legionella pneumophila in pool water. Ugeskr. Laeger, 162:3592–3594. Jernigan DB et al. (1994). Pulmonary infection due to Legionella cincinnatiensis in renal transplant recipients: two cases and implications for laboratory diagnosis. Clinical Infectious Diseases, 18(3):385–389. Jernigan D et al. (1996). Outbreak of Legionnaires’ disease among cruise ship passengers exposed to a contaminated whirlpool spa. The Lancet, 347:494–499. Johnson JT et al. (1985). Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet, 2(8450):298–300. Joly JR, Alary M (1994). Occurrence of nosocomial Legionnaires’ disease in hospitals with contaminated potable water supply. In: Barbaree JM, Breiman RF, Dufour AP, eds. Legionella: current status and emerging perspectives, Washington DC, ASM Press. Joly JR et al. (1986). Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. Journal of Clinical Microbiology, 23(4):768–71. Jones TF et al. (2003). Epidemiologic investigation of a restaurant-associated outbreak of Pontiac fever. Clinical Infectious Diseases, 37(10):1292–1297. Joseph CA (1997). Outbreak of Legionnaires’ disease among British tourists associated with Rhine cruise. Eurosurveillance Weekly, 1:971030. (http://www.eurosurv.org) Joseph C (2002a). Surveillance of Legionnaires disease in Europe. In: Marre R et al., eds. Legionella, Washington DC, ASM Press, 311–320. Joseph C (2002b). The risk of suffering from Legionnaires’ disease whilst abroad. Journal of the Royal Society of Health, 122:6–7. 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
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Country General prevent on DW Wp SB
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Chapter 11 Laboratory aspects of Le
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• detection of the bacterium in t
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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 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: Hayden RT et al. (2001). Direct det
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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