LEGIONELLA - World Health Organization

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Tesh MJ, Miller RD (1981). Amino acid requirements for Legionella pneumophila growth. Journal of Clinical Microbiology, 13:865–869. Thacker WL et al. (1988a). Legionella cincinnatiensis sp. nov. isolated from a patient with pneumonia. Journal of Clinical Microbiology, 26(3):418–420. Thacker WL et al. (1988b). Legionella jordanis isolated from a patient with fatal pneumonia. Journal of Clinical Microbiology, 26(7):1400–1401. Thacker WL et al. (1989). Legionella tucsonensis sp. nov. isolated from a renal transplant recipient. Journal of Clinical Microbiology, 27(8):1831–1834. Thacker WL et al. (1990). Characterization of a Legionella anisa strain isolated from a patient with pneumonia. Journal of Clinical Microbiology, 28(1):122–123. Thacker WL et al. (1991). Legionella fairfieldensis sp. nov. isolated from cooling tower waters in Australia. Journal of Clinical Microbiology, 29:475–478. Thacker WL et al. (1992). Legionella lansingensis sp. nov. isolated from a patient with pneumonia and underlying chronic lymphocytic leukemia. Journal of Clinical Microbiology, 30(9):2398–2401. Thomason BM et al. (1979). Effect of various histological fixatives on fluorescent antibody detection of Legionnaires’ disease bacteria. Journal of Clinical Microbiology, 10:106–108. Thornsberry C, Baker CN, Kirven LA (1978). In vitro activity of antimicrobial agents on Legionnaires’ disease bacterium. Antimicrobial Agents Chemotherapy, 13:78–80. Thorpe TC, Miller RD (1981). Extracellular enzymes of Legionella pneumophila. Infection and Immunity, 33:632–635. Tison DL, Seidler RJ (1983). Legionella incidence and density in potable drinking water supplies. Applied and Environmental Microbiology, 45:337–339. Tison DL et al. (1980). Growth of Legionella pneumophila in association with blue-green algae (cyanobacteria). Applied and Environmental Microbiology, 39:456–459. Tkatch LS et al. (1998). Epidemiology of Legionella pneumonia and factors associated with legionellarelated mortality at a tertiary care center. Clinical Infectious Diseases, 27(6):1479–1486. Tobin JO et al. (1980). Legionnaires’ disease in a transplant unit: isolation of the causative agent from shower baths. Lancet, 2:118–121. Tompkins LS et al. (1988). Legionella prosthetic-valve endocarditis. New England Journal of Medicine, 318(9):530–535. Tran Minh et al. (2004). A prolonged outbreak of legionnaires’ disease associated with an industrial cooling tower — how far can airborne transmission go?, European Programme for Intervention Epidemiology Training (http://www.epiet.org). Trulear MG, Characklis WG (1982). Dynamics of biofilm processes. Journal of Water Pollution Control Federation, 54:1288–1301. Tully M (1991). A plasmid from a virulent strain of Legionella pneumophila is conjugative and confers resistance to ultraviolet light. FEMS Microbiology Letters, 69:43–48. <strong>LEGIONELLA</strong> 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
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• other Legionella species that d
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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 and 268: Regan CM et al. (2003). Outbreak of
Page 269 and 270: Schulze-Robbecke R, Rodder M, Exner
Page 271: Surman SB, Morton LHG, Keevil CW (1
Page 275 and 276: Welti M et al. (2003). Development
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