scholarly journals Large community-acquired Legionnaires’ disease outbreak caused by Legionella pneumophila serogroup 1, Italy, July to August 2018

2020 ◽  
Vol 25 (20) ◽  
Author(s):  
Marino Faccini ◽  
Antonio Giampiero Russo ◽  
Maira Bonini ◽  
Sara Tunesi ◽  
Rossella Murtas ◽  
...  
Keyword(s):  
Crossover Study ◽  
Legionella Pneumophila ◽  
Case Control Study ◽  
Dispersion Model ◽  
Case Control ◽  
Case Crossover ◽  
Large Outbreak ◽  
Legionnaires Disease ◽  
Aerosol Dispersion ◽  
Control Study

In July 2018, a large outbreak of Legionnaires’ disease (LD) caused by Legionella pneumophila serogroup 1 (Lp1) occurred in Bresso, Italy. Fifty-two cases were diagnosed, including five deaths. We performed an epidemiological investigation and prepared a map of the places cases visited during the incubation period. All sites identified as potential sources were investigated and sampled. Association between heavy rainfall and LD cases was evaluated in a case-crossover study. We also performed a case–control study and an aerosol dispersion investigation model. Lp1 was isolated from 22 of 598 analysed water samples; four clinical isolates were typed using monoclonal antibodies and sequence-based typing. Four Lp1 human strains were ST23, of which two were Philadelphia and two were France-Allentown subgroup. Lp1 ST23 France-Allentown was isolated only from a public fountain. In the case-crossover study, extreme precipitation 5–6 days before symptom onset was associated with increased LD risk. The aerosol dispersion model showed that the fountain matched the case distribution best. The case–control study demonstrated a significant eightfold increase in risk for cases residing near the public fountain. The three studies and the matching of clinical and environmental Lp1 strains identified the fountain as the source responsible for the epidemic.

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 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 An outbreak of legionnaires’ disease in a municipality in northern Portugal

2001 ◽  
Vol 6 (7) ◽  
pp. 121-124 ◽  
Author(s):  
A M Correia ◽  
G Gonçalves ◽  
J Reis ◽  
J M Cruz ◽  
J A Castro e Freitas
Keyword(s):  
Legionella Pneumophila ◽  
Case Control Study ◽  
District Hospital ◽  
Case Control ◽  
Northern Portugal ◽  
Legionnaires Disease ◽  
Control Study

Eleven cases of legionnaires´ disease, all patients living in the same municipality, were admitted to a district hospital in northern Portugal. Preliminary investigations suggested an association with the events of the annual festivities in that municipality. Legionella pneumophila was not isolated from any of the suspected sources, but evidence from a case control study suggested that an aerosol produced by a decorative fountain in the main square during the night of a rock concert was the likely vehicle of infection. The prevalence of smoking was higher among cases than controls.

scholarly journals Legionnaires' disease and the sick-building syndrome

1989 ◽  
Vol 103 (2) ◽  
pp. 285-292 ◽  
Author(s):  
M. O'Mahony ◽  
A. Lakhani ◽  
A. Stephens ◽  
J. G. Wallace ◽  
E. R. Youngs ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Local Community ◽  
Cooling Tower ◽  
Case Control Study ◽  
Sick Building Syndrome ◽  
Air Conditioning System ◽  
Sick Building ◽  
Air Intake ◽  
Legionnaires Disease ◽  
Control Study

SUMMARYIn October 1985, six cases of legionnaires' disease were associated with a police headquarters building. Four were amongst staff who worked in or visited the communications wing of the headquarters and two cases occurred in the local community. A case-control study implicated the operations room of the communications wing as the main area associated with infection. This wing was air-conditioned and smoke tracer studies showed that drift from the exhaust as well as from the base of the cooling tower entered the main air-intake which serviced the air-conditioning system.Legionella pneumophilaserogroup 1 subgroup pontiac was isolated from water and sludge in the cooling tower pond. Contaminated drift from the top of the cooling tower was probably responsible for the two community cases. An additional discovery was that symptoms suggestive of the sick-building syndrome were associated with working in this wing.

A population-based case-crossover and case-control study of alcohol and the risk of injury.

2003 ◽  
Vol 64 (3) ◽  
pp. 358-366 ◽  
Author(s):  
Daniel C Vinson ◽  
Malcolm Maclure ◽  
Carol Reidinger ◽  
Gordon S Smith
Keyword(s):  
Case Control Study ◽  
Population Based ◽  
Case Control ◽  
Case Crossover ◽  
Risk Of Injury ◽  
Control Study

scholarly journals Restaurant outbreak of Legionnaires' disease associated with a decorative fountain: an environmental and case-control study

2007 ◽  
Vol 7 (1) ◽  
Author(s):  
Rosalyn E O'Loughlin ◽  
Lon Kightlinger ◽  
Matthew C Werpy ◽  
Ellen Brown ◽  
Valerie Stevens ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Legionnaires Disease ◽  
Control Study

scholarly journals Control of endemic nosocomial Legionnaires' disease by using sterile potable water for high risk patients

1991 ◽  
Vol 107 (3) ◽  
pp. 591-605 ◽  
Author(s):  
T. J. Marrie ◽  
D. Haldane ◽  
S. Macdonald ◽  
K. Clarke ◽  
C. Fanning ◽  
...  
Keyword(s):  
High Risk ◽  
Potable Water ◽  
Case Control Study ◽  
Case Control ◽  
Sterile Water ◽  
Nasogastric Tubes ◽  
Before And After ◽  
Risk Patients ◽  
Legionnaires Disease ◽  
Control Study

SUMMARYIn a setting where potable water is contaminated with Legionella pneumophila serogroup 1, we performed two case control studies. The first case control study consisted of 17 cases of nosocomial Legionnaires' disease (LD) and 33 control (the patients who were admitted to the ward where the case was admitted immediately before and after the case) subjects. Cases had a higher mortality rate 65% vs 12% (P < 0.004); were more likely to have received assisted ventilation (P < 0.00001); to have nasogastric tubes (P < 0.0004) and to be receiving corticosteroids or other immunosuppressive therapy (P < 0.0001). Based on the results of this study, sterile water was used to flush nasogastric tubes and to dilute nasogastric feeds. Only 3 cases of nosocomial LD occurred during the next year compared with 12 the previous year (P < 0.0001). Nine cases subsequently occurred and formed the basis for the second case-control study. Eighteen control subjects were those patients admitted to the same unit where the case developed LD, immediately before and after the case. The mortality rate for the cases was 89% vs 6% for controls (P < 0.00003). The only other significant difference was that cases were more likely to be receiving corticosteroids or other immunosuppressive therapy 89% vs 39% ( < 0.01). We hypothesized that microaspiration of contaminated potable water by immunocompromised patients was a risk factor for nosocomial Legionnaires' disease. From 17 March 1989 onwards such patients were given only sterile potable water. Only two cases of nosocomial LD occurred from June 1989 to September 1990 and both occurred on units where the sterile water policy was not in effect. We conclude that aspiration of contaminated potable water is a possible route for acquisition of nosocomial LD in our hospital and that provision of sterile potable water to high risk patients (those who are receiving corticosteroids or other immunosuppressive drugs; organ transplant recipients or hospitalized in an intensive care unit) should be mandatory.

scholarly journals An outbreak investigation of Legionella non-pneumophila Legionnaires’ disease in Sweden, April to August 2018: Gardening and use of commercial bagged soil associated with infections

2021 ◽  
Vol 26 (7) ◽  
Author(s):  
Emma Löf ◽  
Fanny Chereau ◽  
Pontus Jureen ◽  
Sabina Andersson ◽  
Kristina Rizzardi ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Soil Samples ◽  
Outbreak Investigation ◽  
Joint Analysis ◽  
Whole Genome ◽  
Legionnaires Disease ◽  
Dry Soil ◽  
Control Study ◽  
Different Soils

In early June 2018, an increase in non-travel-related cases of Legionella non-pneumophila Legionnaires’ disease (LD) was observed in Sweden and a national outbreak investigation was started. Outbreak cases were defined as notified confirmed or probable cases of L. non-pneumophila LD, with symptom onset after 1 April 2018. From April to August 2018, 41 cases were reported, 30 of whom were identified as L. longbeachae. We conducted a case–control study with 27 cases and 182 matched controls. Results from the case–control study indicated that gardening and handling commercial bagged soil, especially dusty dry soil, were associated with disease. L. longbeachae was isolated in soils from cases’ homes or gardens, but joint analysis of soil and human specimens did not identify any genetic clonality. Substantial polyclonality was noted between and within soil samples, which made finding a genetic match between soil and human specimens unlikely. Therefore, whole genome sequencing may be of limited use to confirm a specific soil as a vehicle of transmission for L. longbeachae. Handling soil for residential gardening was associated with disease and the isolation of L. longbeachae in different soils provided further evidence for Legionella non-pneumophila infection from soil.

scholarly journals Large outbreak of verocytotoxin-producingEscherichia coliO157 infection in visitors to a petting farm in South East England, 2009

2011 ◽  
Vol 140 (8) ◽  
pp. 1400-1413 ◽  
Author(s):  
C. IHEKWEAZU ◽  
K. CARROLL ◽  
B. ADAK ◽  
G. SMITH ◽  
G. C. PRITCHARD ◽  
...  
Keyword(s):  
Physical Environment ◽  
Case Control Study ◽  
Case Control ◽  
Farm Animals ◽  
Causative Organism ◽  
Management Procedures ◽  
Large Outbreak ◽  
South East England ◽  
Farm Livestock ◽  
Control Study

SUMMARYIn the summer of 2009, an outbreak of verocytotoxigenicEscherichia coliO157 (VTEC O157) was identified in visitors to a large petting farm in South East England. The peak attack rate was 6/1000 visitors, and highest in those aged <2 years (16/1000). We conducted a case-control study with associated microbiological investigations, on human, animal and environmental samples. We identified 93 cases; 65 primary, 13 secondary and 15 asymptomatic. Cases were more likely to have visited a specific barn, stayed for prolonged periods and be infrequent farm visitors. The causative organism was identified as VTEC O157 PT21/28 with the same VNTR profile as that isolated in faecal specimens from farm animals and the physical environment, mostly in the same barn. Contact with farm livestock, especially ruminants, should be urgently reviewed at the earliest suspicion of a farm-related VTEC O157 outbreak and appropriate risk management procedures implemented without delay.

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