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 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 Legionella longbeachaedetected in an industrial cooling tower linked to a legionellosis outbreak, New Zealand, 2015; possible waterborne transmission?

2017 ◽  
Vol 145 (11) ◽  
pp. 2382-2389 ◽  
Author(s):  
C. N. THORNLEY ◽  
D. J. HARTE ◽  
R. P. WEIR ◽  
L. J. ALLEN ◽  
K. J. KNIGHTBRIDGE ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Cooling Tower ◽  
Industrial Site ◽  
Cooling Towers ◽  
Environmental Isolates ◽  
Routine Monitoring ◽  
Waterborne Transmission ◽  
Pontiac Fever ◽  
Legionnaires Disease ◽  
And Control

SUMMARYA legionellosis outbreak at an industrial site was investigated to identify and control the source. Cases were identified from disease notifications, workplace illness records, and from clinicians. Cases were interviewed for symptoms and risk factors and tested for legionellosis. Implicated environmental sources were sampled and tested for legionella. We identified six cases with Legionnaires’ disease and seven with Pontiac fever; all had been exposed to aerosols from the cooling towers on the site. Nine cases had evidence of infection with eitherLegionella pneumophilaserogroup (sg) 1 orLegionella longbeachaesg1; these organisms were also isolated from the cooling towers. There was 100% DNA sequence homology between cooling tower and clinical isolates ofL. pneumophilasg1 using sequence-based typing analysis; no clinicalL. longbeachaeisolates were available to compare with environmental isolates. Routine monitoring of the towers prior to the outbreak failed to detect any legionella. Data from this outbreak indicate thatL. pneumophilasg1 transmission occurred from the cooling towers; in addition,L. longbeachaetransmission was suggested but remains unproven.L. longbeachaedetection in cooling towers has not been previously reported in association with legionellosis outbreaks. Waterborne transmission should not be discounted in investigations for the source ofL. longbeachaeinfection.

Computational framework for evaluating risk trade-offs in costs associated with Legionnaires’ Disease risk, energy, and scalding risk for hospital hot water systems

2021 ◽  
Author(s):  
Ashley Heida ◽  
Alexis Mraz ◽  
Mark Hamilton ◽  
Mark Weir ◽  
Kerry A Hamilton
Keyword(s):  
Legionella Pneumophila ◽  
Disease Risk ◽  
Disease Outbreaks ◽  
Febrile Illness ◽  
Water Systems ◽  
Hot Water ◽  
Computational Framework ◽  
Trade Offs ◽  
Pontiac Fever ◽  
Legionnaires Disease

Legionella pneumophila are bacteria that when inhaled cause Legionnaires’ Disease (LD) and febrile illness Pontiac Fever. As of 2014, LD is the most frequent cause of waterborne disease outbreaks due...

Early Radiographic and Tomographic Manifestations of Legionnaires' Disease

2017 ◽  
Vol 68 (3) ◽  
pp. 328-333 ◽  
Author(s):  
Rémi Poirier ◽  
Jean Rodrigue ◽  
Jasmin Villeneuve ◽  
Yves Lacasse
Keyword(s):  
Ct Scan ◽  
Legionella Pneumophila ◽  
Community Acquired Pneumonia ◽  
Chest Ct ◽  
Quebec City ◽  
Bacterial Origin ◽  
Increased Risk ◽  
Significant Difference ◽  
Legionnaires Disease ◽  
Chest Ct Scan

Purpose Legionnaires' disease (LD) may occur sporadically or in the course of outbreaks, where the typical radiological manifestations of the disease may better be delineated. We took advantage of a rare community-based epidemic of LD (181 patients) that occurred in 2012 in Quebec City, Canada, to describe the radiographic features of LD and compare the its tomographic presentation with that of community-acquired pneumonia caused by common bacteria other than Legionella pneumophila. Methods From the 181 individuals affected in the outbreak, we obtained the chest radiographs of 159 individuals (mean 63 ± 15 years of age) for detailed analysis; 33 patients had a computed tomography (CT) scan performed during the course of their illness. In a case-control study, we compared the CT scans of patients with LD with those of patients who had received a diagnosis of community-acquired pneumonia caused by a pathogen other than Legionella and confirmed by chest CT scan. Results Overall, LD most often presented as an airspace consolidation involving 1 of the lower lobes. Pleural effusion and mediastinal adenopathies were apparent only in a minority, whereas no pneumothorax or cavitation was noted. We did not find any significant difference in chest CT scan findings in patients with LD vs those with community-acquired pneumonia from other bacterial origin. No radiological finding was clearly associated with an increased risk of intensive care unit admission or mortality. Conclusions The early radiographic and tomographic manifestations of LD are nonspecific and similar to those found in community-acquired pneumonia from other bacterial origin.

scholarly journals A Cluster of Legionnaires' Disease and Associated Pontiac Fever Morbidity in Office Workers, Dublin, June-July 2008

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
M. Ward ◽  
M. Boland ◽  
N. Nicolay ◽  
H. Murphy ◽  
J. McElhiney ◽  
...  
Keyword(s):  
Dublin Hospital ◽  
Office Workers ◽  
Source Of Infection ◽  
Car Park ◽  
Pontiac Fever ◽  
Legionnaires Disease ◽  
Polymerase Chain ◽  
June July ◽  
Time Information

In June and July 2008, two office workers were admitted to a Dublin hospital with Legionnaires' disease. Investigations showed that cooling towers in the basement car park were the most likely source of infection. However, positive results from cooling tower samples by polymerase chain reaction (PCR) did not correlate with subsequent culture results. Also, many employees reported Pontiac fever-like morbidity following notification of the second case of Legionnaires' disease. In total, 54 employees attended their general practitioner or emergency department with symptoms of Legionnaires' disease or Pontiac fever. However, all laboratory tests for Legionnaires' disease or Pontiac fever were negative. In this investigation, email was used extensively for active case finding and provision of time information to employees and medical colleagues. We recommend clarification of the role of PCR in the diagnosis of legionellosis and also advocate for a specific laboratory test for the diagnosis of the milder form of legionellosis as in Pontiac fever.

scholarly journals Legionnaires' disease outbreak associated with a cruise liner, August 2003: epidemiological and microbiological findings

2006 ◽  
Vol 135 (5) ◽  
pp. 802-810 ◽  
Author(s):  
K. BEYRER ◽  
S. LAI ◽  
J. DREESMAN ◽  
J. V. LEE ◽  
C. JOSEPH ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Case Control Study ◽  
Prolonged Exposure ◽  
Interdisciplinary Approach ◽  
Case Control ◽  
Case Definition ◽  
Source Of Infection ◽  
Legionnaires Disease ◽  
The Mean ◽  
Control Study

SUMMARYEight cases of Legionnaires' disease were identified among the 215 German passengers after a cruise to the Nordic Sea in August 2003. An unmatched case-control study was conducted to identify risk factors and the source of infection. In total, eight passengers fulfilled the case definition, one of these died. Forty-two passengers served as controls. The attack rate was 4%. The mean age was 60 years for cases and 62 years for controls. Prolonged exposure to the spa pool seemed to be a risk factor of infection (OR 4·85,P=0·09).Legionella pneumophilaserogroup 1, monoclonal antibody (mAb) subgroup ‘Knoxville’ was isolated from clinical and environmental samples. DNA sequence-based typing revealed that these isolates were indistinguishable from each other. The investigation showed the importance of an interdisciplinary approach of microbiology and epidemiology as not all sites on the ship that tested positive forL. pneumophilaactually posed a relevant risk for the passengers.

scholarly journals Legionnaires' disease outbreak in Rome, Italy

2005 ◽  
Vol 133 (5) ◽  
pp. 853-859 ◽  
Author(s):  
M. C. ROTA ◽  
G. PONTRELLI ◽  
M. SCATURRO ◽  
A. BELLA ◽  
A. R. BELLOMO ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Cooling Tower ◽  
Case Control Study ◽  
Hospital Admissions ◽  
Case Control ◽  
Phenotypic Analysis ◽  
Single Strain ◽  
Increased Risk ◽  
Legionnaires Disease ◽  
Control Study

Between August and October 2003, 15 cases of Legionnaires' disease were detected in the 9th district of Rome. To identify possible sources of Legionella exposure, a matched case-control study was conducted and environmental samples were collected. Hospital discharge records were also retrospectively analysed for the period July–November 2003, and results were compared with the same period during the previous 3 years. The case-control study revealed a significantly increased risk of disease among those frequenting a specific department store in the district (OR 9·8, 95% CI 2·1–46·0), and Legionella pneumophila was isolated from the store's cooling tower. Genotypic and phenotypic analysis of human and environmental isolates demonstrated that the cluster was caused by a single strain of L. pneumophila serogroup 1, and that the cooling tower of the store was the source of infection. The increased number of hospital admissions for microbiologically undiagnosed pneumonia during the study period may indicate that some legionellosis cases were not identified.

scholarly journals An unusual outbreak of norovirus associated with a Halloween-themed swimming pool party in England, 2016

2018 ◽  
Vol 23 (44) ◽  
Author(s):  
Karthik Paranthaman ◽  
Ellen Pringle ◽  
Alison Burgess ◽  
Neil Macdonald ◽  
James Sedgwick
Keyword(s):  
Retrospective Cohort ◽  
Multivariable Analysis ◽  
Case Definition ◽  
Swimming Pool ◽  
Test Results ◽  
Pool Water ◽  
Increased Risk ◽  
Definition Of ◽  
Red Dye ◽  
Reduced Risk

In October 2016, an outbreak of norovirus occurred among attendees of a Halloween-themed party at a public swimming pool in the south-east of England. Norovirus genogroup II was confirmed in 11 cases. In the retrospective cohort study of pool users, 68 individuals (37 female and 31 male), with a median age of 11 years (range: 0–50 years), met the case definition of developing diarrhoea or vomiting between 6 and 72 h after the pool visit. Multivariable analysis showed that increasing age was associated with a reduced risk of illness (odds ratio = 0.91; 95% confidence interval: 0.83–0.99). Pool behaviours (swallowing water) and the timing of visit (attending pool party after automatic dosing system was switched off) were independently associated with increased risk. Environmental investigations revealed that the automatic dosing system was switched off to reduce chlorine levels to an intended range of 0.5–1 parts per million to facilitate the use of a commercial red dye. There was a lack of compliance with the operator's own pool operating procedures, particularly on maintaining effective chlorine levels in pool water, recording of test results and recording of actions undertaken. This outbreak highlights the risks of lowering chlorine levels when using pool water colourants.

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.

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