scholarly journals A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality

2007 ◽  
Vol 136 (6) ◽  
pp. 823-832 ◽  
Author(s):  
J. CASTILLA ◽  
A. BARRICARTE ◽  
J. ALDAZ ◽  
M. GARCÍA CENOZ ◽  
T. FERRER ◽  
...  
Keyword(s):  
Early Detection ◽  
Legionella Pneumophila ◽  
Case Fatality ◽  
Disease Outbreak ◽  
Cooling Towers ◽  
Resident Population ◽  
Null Case ◽  
Environmental Actions ◽  
Rapid Control ◽  
Legionnaires Disease

SUMMARYAn outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detectLegionella pneumophilaantigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed.L. pneumophilaantigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

scholarly journals Epidemiological investigation and case–control study: a Legionnaires’ disease outbreak associated with cooling towers in Warstein, Germany, August–September 2013

2015 ◽  
Vol 20 (46) ◽  
Author(s):  
Anna Maisa ◽  
Ansgar Brockmann ◽  
Frank Renken ◽  
Christian Lück ◽  
Stefan Pleischl ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Case Control Study ◽  
Case Fatality ◽  
Case Control ◽  
Cooling Towers ◽  
Multiple Sources ◽  
Source Tracing ◽  
Infection Source ◽  
Legionnaires Disease ◽  
Control Study

Between 1 August and 6 September 2013, an outbreak of Legionnaires’ disease (LD) with 159 suspected cases occurred in Warstein, North Rhine-Westphalia, Germany. The outbreak consisted of 78 laboratory-confirmed cases of LD, including one fatality, with a case fatality rate of 1%. Legionella pneumophila, serogroup 1, subtype Knoxville, sequence type 345, was identified as the epidemic strain. A case–control study was conducted to identify possible sources of infection. In univariable analysis, cases were almost five times more likely to smoke than controls (odds ratio (OR): 4.81; 95% confidence interval (CI): 2.33–9.93; p < 0.0001). Furthermore, cases were twice as likely to live within a 3 km distance from one identified infection source as controls (OR: 2.14; 95% CI: 1.09–4.20; p < 0.027). This is the largest outbreak of LD in Germany to date. Due to a series of uncommon events, this outbreak was most likely caused by multiple sources involving industrial cooling towers. Quick epidemiological assessment, source tracing and shutting down of potential sources as well as rapid laboratory testing and early treatment are necessary to reduce morbidity and mortality. Maintenance of cooling towers must be carried out according to specification to prevent similar LD outbreaks in the future.

scholarly journals Complete Genome Sequences of the HistoricalLegionella pneumophilaStrains OLDA and Pontiac

2016 ◽  
Vol 4 (4) ◽  
Author(s):  
Jeffrey W. Mercante ◽  
Shatavia S. Morrison ◽  
Brian H. Raphael ◽  
Jonas M. Winchell
Keyword(s):  
Legionella Pneumophila ◽  
Complete Genome ◽  
Health Department ◽  
Sporadic Case ◽  
Disease Outbreak ◽  
Genome Sequences ◽  
Outbreak Strain ◽  
Legionnaires Disease

Here, we report the complete genome sequences ofLegionella pneumophilaserogroup 1 strains OLDA and Pontiac, which predate the 1976 Philadelphia Legionnaires’ disease outbreak. Strain OLDA was isolated in 1947 from an apparent sporadic case, and strain Pontiac caused an explosive outbreak at a Michigan health department in 1968.

scholarly journals Complete Genome Sequences of Three Outbreak-Associated Legionella pneumophila Isolates

2016 ◽  
Vol 4 (4) ◽  
Author(s):  
Shatavia S. Morrison ◽  
Heta P. Desai ◽  
Jeffrey W. Mercante ◽  
Pascal Lapierre ◽  
Brian H. Raphael ◽  
...  
Keyword(s):  
New York ◽  
Legionella Pneumophila ◽  
Complete Genome ◽  
Large Study ◽  
Virulence Gene ◽  
Disease Outbreak ◽  
Environmental Isolate ◽  
Genome Sequences ◽  
Legionnaires Disease ◽  
Specific Virulence

We report here the complete genome sequences of three Legionella pneumophila isolates that are associated with a Legionnaires’ disease outbreak in New York in 2012. Two clinical isolates (D7630 and D7632) and one environmental isolate (D7631) were recovered from this outbreak. A single isolate-specific virulence gene was found in D7632. These isolates were included in a large study evaluating the genomic resolution of various bioinformatics approaches for L. pneumophila serogroup 1 isolates.

Legionellosis and legionnaires’ disease

2020 ◽  
pp. 1226-1229
Author(s):  
Diego Viasus ◽  
Jordi Carratalà
Keyword(s):  
Legionella Pneumophila ◽  
Case Fatality ◽  
Water Systems ◽  
Natural Habitats ◽  
Cooling Systems ◽  
Freshwater Streams ◽  
First Choice ◽  
Legionnaires Disease ◽  
Failure Prognosis ◽  
Human Infections

Legionellaceae are Gram-negative bacilli, of which Legionella pneumophila is the principal cause of human infections. Their natural habitats are freshwater streams, lakes, thermal springs, moist soil, and mud, but the principal source for large outbreaks of legionellosis is cooling systems used for air conditioning and other cooling equipment. Legionella spp. are principally transmitted to humans through contaminated water aerosols. Middle-aged men, smokers, regular alcohol drinkers, and those with comorbidity are most at risk. Aside from supportive care, the first-choice antibiotics are macrolides (mainly azithromycin) and/or fluoroquinolones (especially levofloxacin). Case fatality is 5–15% in previously well adults, but much higher in those who are immunocompromised or develop respiratory failure. Prognosis is improved by early administration of effective anti-legionella antibiotic therapy. Prevention is by the correct design, maintenance, and monitoring of water systems.

scholarly journals A Legionnaires’ disease outbreak associated with cooling towers in Warstein, Germany, August 2013

2015 ◽  
Vol 4 (S1) ◽  
Author(s):  
A Jurke ◽  
A Maisa ◽  
F Renken ◽  
A Brockmann ◽  
C Lück ◽  
...  
Keyword(s):  
Disease Outbreak ◽  
Cooling Towers ◽  
Legionnaires Disease

Water Cultures Are More Sensitive Than Swab Cultures for the Detection of EnvironmentalLegionella

2017 ◽  
Vol 39 (1) ◽  
pp. 108-110 ◽  
Author(s):  
Brooke K. Decker ◽  
Patricia L. Harris ◽  
Diana L. Toy ◽  
Robert R. Muder ◽  
Ali F. Sonel ◽  
...  
Keyword(s):  
Healthcare System ◽  
Legionella Pneumophila ◽  
Disease Outbreak ◽  
Veterans Affairs ◽  
Infect Control Hosp ◽  
System Sensitivity ◽  
Legionnaires Disease

Water cultures were significantly more sensitive than concurrently collected swab cultures (n=2,147 each) in detectingLegionella pneumophilawithin a Veterans Affairs healthcare system. Sensitivity for water versus swab cultures was 90% versus 30% overall, 83% versus 48% during a nosocomial Legionnaires’ disease outbreak, and 93% versus 22% post outbreak.Infect Control Hosp Epidemiol2018;39:108–110

Investigation of Pontiac-like illness in office workers during an outbreak of Legionnaires' disease, 2008

2010 ◽  
Vol 138 (11) ◽  
pp. 1667-1673 ◽  
Author(s):  
N. NICOLAY ◽  
M. BOLAND ◽  
M. WARD ◽  
L. HICKEY ◽  
C. COLLINS ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Retrospective Cohort ◽  
Case Definition ◽  
Office Workers ◽  
Severe Illness ◽  
Cooling Towers ◽  
Increased Risk ◽  
Pontiac Fever ◽  
Legionnaires Disease ◽  
Clinical Case Definition

SUMMARYIn July 2008, office workers in Dublin complained of influenza-like illness preceding and interspersing two cases of notified Legionnaires' disease. Legionella pneumophila serogroup 1 was identified in both cooling towers supplying the office. A retrospective cohort study was undertaken to investigate possible Pontiac fever (PF). Forty-seven employees (23%) met the clinical case definition for PF but confirmatory testing was negative. Exposure to the smoking area situated beside the cooling towers was associated with an increased risk of PF (RR 2·4, 95% CI 1·5–3·8). The diagnosis of PF should be considered when many persons exposed to a possible reservoir of Legionella spp. present with flu-like symptoms. More sensitive microbiological tests would allow better confirmation and more comprehensive reporting of PF. Early detection is vital to prevent potentially severe illness and outbreaks of PF or Legionnaires' disease.

scholarly journals Community outbreak of Legionnaires’ disease in Vic-Gurb, Spain in October and November 2005

2007 ◽  
Vol 12 (3) ◽  
pp. 5-6 ◽  
Author(s):  
M R Sala ◽  
C Arias ◽  
J M Oliva ◽  
A Pedrol ◽  
P Roura ◽  
...  
Keyword(s):  
Central Region ◽  
Legionella Pneumophila ◽  
Cooling Tower ◽  
Weather Conditions ◽  
High Humidity ◽  
Cooling Towers ◽  
Large Area ◽  
Environmental Investigation ◽  
Flat Terrain ◽  
Legionnaires Disease

This paper reports the investigation of a community-acquired outbreak of Legionnaires'; disease in the municipalities of Vic and Gurb (Central Region of Catalonia, Spain). There were 55 cases reported in October and November 2005. An epidemiological and environmental investigation was undertaken. Thirty-five case patients (64%) lived in Vic or Gurb, while 36% had visited or worked in Vic or Gurb during the 10 days before onset of symptoms, but no commonly frequented building could be identified. Water probes for culture were obtained from 30 cooling towers. In five cooling towers of two industrial settings in Gurb (plants A and B), Legionella pneumophila (Lp) serogroup 1 was present. Two Lp-1 strains were recovered from cooling towers in plants A and B. The Lp-1 strain from plant A showed a PGFE profile identical with those obtained from three patients. The exposure to Legionella pneumophila apparently occurred in a large area, since 43 of the 55 cases lived, visited or worked within a distance of 1,800 m from plant A, and six cases in a distance between 2,500 and 3,400 m. The inspections of cooling towers in plant A revealed inadequate disinfectant doses of biocide, non-existent maintenance records on weekends and wrong sample points for routine microbial check-ups. Weather conditions in October 2005 template temperature and high humidity (wind conditions are unappreciable) could have been favourable factors in this outbreak together with the flat terrain of Gurb and Vic area, explaining the extensive horizontal airborne dissemination of contaminated aerosols. The outbreak could have been prevented by proper and correct maintenance of the cooling tower at plant A.

scholarly journals An outbreak of Legionnaires' disease in Gloucester

1991 ◽  
Vol 107 (1) ◽  
pp. 133-141 ◽  
Author(s):  
D. A. Hunt ◽  
K. A. V. Cartwright ◽  
M. C. Smith ◽  
J. Middleton ◽  
C. L. R. Bartlett ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Case Control Study ◽  
Case Finding ◽  
Unexpected Finding ◽  
Cooling Towers ◽  
Multiple Sources ◽  
Pontiac Fever ◽  
Legionnaires Disease ◽  
The City ◽  
Control Study

SUMMARYFourteen people living in or near the city of Gloucester fell ill with Legionnaires' disease caused by Legionella pneumophila serogroup (SG) 1 between 27 August and 27 October 1986. Another patient had fallen ill on 30 May. Nine of the 15 were diagnosed retrospectively during a case finding exercise. There were three deaths. Three cases of Pontiac fever were also diagnosed.The source was probably one or more wet cooling towers. Nineteen premises in the city with such towers were identified, and three just outside Gloucester. Samples from 11 of the 22 premises grew Legionella spp.; from nine of these L. pneumophila SG 1 (Pontiac) was isolated. The efficacy of regular addition of biocide in addition to hypochlorite added at the time of disinfection in inhibiting the growth of Legionella spp. was demonstrated.A survey of patients' movements during their likely incubation period showed that there was no single building that all patients had visited, but there were two areas of the city which nearly all had visited or passed through by car. A case-control study demonstrated an association with one of these areas.Cooling towers near both areas may have been sources but the evidence is insufficient to incriminate any single one. The unexpected finding of L. pneumophila SG 1 (Pontiac) in nine towers supports the hypothesis that there may have been multiple sources. Cooling towers may have been contaminated by mains water or by drift from other towers.

scholarly journals The Impact of Storms on Legionella pneumophila in Cooling Tower Water, Implications for Human Health

2020 ◽  
Vol 11 ◽  
Author(s):  
Robin L. Brigmon ◽  
Charles E. Turick ◽  
Anna S. Knox ◽  
Courtney E. Burckhalter
Keyword(s):  
Human Health ◽  
Legionella Pneumophila ◽  
Count Data ◽  
Distribution Systems ◽  
Cooling Tower ◽  
Water Systems ◽  
The Other ◽  
Cooling Towers ◽  
Legionnaires Disease ◽  
The Impact

At the U.S. Department of Energy’s Savannah River Site (SRS) in Aiken, SC, cooling tower water is routinely monitored for Legionella pneumophila concentrations using a direct fluorescent antibody (DFA) technique. Historically, 25–30 operating SRS cooling towers have varying concentrations of Legionella in all seasons of the year, with patterns that are unpredictable. Legionellosis, or Legionnaires’ disease (LD), is a pneumonia caused by Legionella bacteria that thrive both in man-made water distribution systems and natural surface waters including lakes, streams, and wet soil. Legionnaires’ disease is typically contracted by inhaling L. pneumophila, most often in aerosolized mists that contain the bacteria. At the SRS, L. pneumophila is typically found in cooling towers ranging from non-detectable up to 108 cells/L in cooling tower water systems. Extreme weather conditions contributed to elevations in L. pneumophila to 107–108 cells/L in SRS cooling tower water systems in July–August 2017. L. pneumophila concentrations in Cooling Tower 785-A/2A located in SRS A-Area, stayed in the 108 cells/L range despite biocide addition. During this time, other SRS cooling towers did not demonstrate this L. pneumophila increase. No significant difference was observed in the mean L. pneumophila mean concentrations for the towers (p &lt; 0.05). There was a significant variance observed in the 285-2A/A Tower L. pneumophila results (p &lt; 0.05). Looking to see if we could find “effects” led to model development by analyzing 13 months of water chemistry and microbial data for the main factors influencing the L. pneumophila concentrations in five cooling towers for this year. It indicated chlorine and dissolved oxygen had a significant impact (p &lt; 0.0002) on cooling tower 785A/2A. Thus, while the variation in the log count data for the A-area tower is statistically greater than that of the other four towers, the average of the log count data for the A-Area tower was in line with that of the other towers. It was also observed that the location of 785A/2A and basin resulted in more debris entering the system during storm events. Our results suggest that future analyses should evaluate the impact of environmental conditions and cooling tower design on L. pneumophila water concentrations and human health.

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