LEGIONELLA - World Health Organization

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Muder RR (2005). Other Legionella species. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 6th ed., Philadelphia, Churchill Livingston, 2725–2730. Muder RR et al. (1983). Nosocomial Legionnaires’ disease uncovered in a prospective pneumonia study. Journal of the American Medical Association, 249(23):3184–3188. Muhlenberg W (1993). Fatal travel-associated legionella infection caused by shower aerosols in a German hotel. Gensundheitswessen, 55(12):653–656. Mülazimoglu L, Yu VL (2001). Can Legionnaires’ disease be diagnosed by clinical criteria? A critical review. Chest, 120(4):1049–1053. Mundy LM et al. (1995). Community-acquired pneumonia: impact of immune status. American Journal of Respiratory and Critical Care Medicine, 152:1309–1315. Murga R et al. (2001). Role of biofilms in the survival of Legionella pneumophila in a model potable-water system. Microbiology, 147:3121–3126. Murray RGE et al (1990). Report of the ad hoc committee on approaches to taxonomy within the Proteobacteria. International Journal of Systematic Bacteriology, 40:213–215. Nagai T et al. (2003). Neonatal sudden death due to Legionella pneumonia associated with water birth in a domestic spa bath. Journal of Clinical Microbiology, 41:2227–2229. Nagington J, Smith DJ (1980). Pontiac fever and amoebae. Lancet, 2:1241. New South Wales Health (1996). Public swimming pool and spa pool guidelines. Department of Health, New South Wales, Australia. Nguyen TM et al. (2006). A community-wide outbreak of legionnaires disease linked to industrial cooling towers — how far can contaminated aerosols spread? Journal of Infectious Diseases, 193(1):102–11. NHMRC (National Health and Medical Research Council) (1988). Australian guideline for the control of Legionella and Legionnaires’ disease. Australian Government Publishing Service, Canberra. Niederman MS et al. (1993). Guidelines for the initial management of adults with communityacquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association. American Review of Respiratory Disease, 148:1418–1426. Niedeveld CJ, Pet FM, Meenhorst PL (1986). Effect of rubbers and their constituents on proliferation of Legionella pneumophila in naturally contaminated hot water. Lancet, 2(8500):180–184. O’Brien SJ, Bhopal RS (1993). Legionnaires’ disease: the infective dose paradox. Lancet, 342:5. Ogawa M et al. (2001). Morphological variety of intracellular microcolonies of Legionella species in Vero cells. Microbiology and Immunology, 45:557–562. 0 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
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11.2.2 Detecting Legionella antigen
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DFA has been used successfully with
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• Serologic testing can be used f
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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 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: McEvoy M et al. (2000). A cluster o
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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