LEGIONELLA - World Health Organization

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Rowbotham TJ (1984). Legionellae and Amoebae. In: Thornsberry C, Balows A, Feeley JC, Jakubowski W, eds. Legionella: proceedings of the 2nd international symposium, American Society for Microbiology, Washington DC, ASM Press, 325–327. Rowbotham TJ (1986). Current views on the relationships between amoebae, legionellae and man. Israel Journal of Medical Science, 22:678–689. Rowbotham TJ (1998). Legionellosis associated with ships: 1977 to 1997. Communicable Disease and Public Health, 1(3):146–151. Ruf B et al. (1990). Prevalence and diagnosis of Legionella pneumonia: a 3-year prospective study with emphasis on application of urinary antigen detection. Journal of Infectious Diseases, 162(6):1341–1348. Ruiz M et al. (1999). Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. American Journal of Respiratory Critical Care Medicine, 160(2):397–405. Russell AD (2000). Do biocides select for antibiotic resistance? Journal of Pharmacy and Pharmacology, 52(2):227–233. Russell AD (2002). Antibiotic and biocide resistance in bacteria: introduction. Journal of Applied Microbiology, 92(1):1 s–3 s. Sabrià M, Yu VL (2002). Hospital-acquired legionellosis solutions for a preventable infection. Lancet Infectious Disease, 2:368–373. Sabrià M et al. (2001). Presence and chromosomal subtyping of Legionella species in potable water systems in 20 hospitals of Catalonia, Spain. Infection Control and Hospital Epidemiology, 22:676–676. Sabrià M et al. (2004). Environmental cultures and hospital-acquired Legionnaires’ disease: a 5-year prospective study in 20 hospitals in Catalonia, Spain. Infection Control and Hospital Epidemiology, 25:1072–1076. Sadosky AB, Wiater LA, Shuman HA (1993). Identification of Legionella pneumophila genes required for growth within and killing of human macrophages. Infection and Immunity, 61(12):5361–5373. Santegoeds CM, Schramm A, de Beer D (1998). Microsensors as a tool to determine chemical microgradients and bacterial activity in wastewater biofilms and flocs. Biodegradation, 9:159–167. Saunders NA, Doshi N, Harrison TG (1992). A second serogroup of Legionella erythra serologically indistinguishable from Legionella rubrilucens. Journal of Applied Bacteriology, 72:262–265. Schlech AF III et al. (1985). Legionnaires’ disease in the Caribbean. An outbreak associated with a resort hotel. Archives of Internal Medicine, 145(11):2076–2079. Schoonmaker D, Heimberger T, Birkhead G (1992). Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishing Legionella pneumophila isolates obtained during a nosocomial outbreak. Journal of Clinical Microbiology, 30(6):1491–1498. 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
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Generally, any water source that ma
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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 and 264: McEvoy M et al. (2000). A cluster o
Page 265 and 266: Olaechea PM et al. (1996). A predic
Page 267: Regan CM et al. (2003). Outbreak of
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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