An outbreak of Legionnaires’ Disease in a Swedish Hospital

Darelid, Johan; Bengtsson, Lars Ph.; Gästrin, B.; Hallander, Hans O.; Löfgren, Sture; Malmvall, Bo‐Eric; Olinder-Nielsen, Ann-Margareth; Thelin, Ann-Christin

doi:10.3109/00365549409008615

Cited by 36 publications

(14 citation statements)

References 21 publications

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“…The Legionella outbreak in Lidkö ping is 1 of the 3 largest known outbreaks in Sweden of which the other 2 occurred in Västerås, 1979 [14] and in Värnamo, 1990 [15]. The likely source of infection in the present outbreak was found to be a cooling tower, which is 1 of the most frequently encountered sources of community-acquired outbreaks internationally [1,2].…”

Section: Discussionmentioning

confidence: 67%

A community outbreak of Legionnaires’ disease from an industrial cooling tower: Assessment of clinical features and diagnostic procedures

Hugosson

Hjorth

Bernander

et al. 2007

Scandinavian Journal of Infectious Diseases

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An outbreak of Legionnaires' disease (LD) occurred in Lidköping, Sweden, in August 2004. A cooling tower was identified as the probable source of infection. During the outbreak period an unexpected 3-6-fold increase in pneumonia patients was noted at the local hospital. During 7 weeks LD was diagnosed in 15 patients by urinary antigen and/or sputum culture. Additionally, 15 LD patients were diagnosed later by serology. Patients with LD were generally younger, more healthy, and more often smokers compared to other pneumonia patients. On admittance they had more severe symptoms with high fever and raised CRP levels, and more often hyponatraemia, gastrointestinal and CNS symptoms. A causative agent besides Legionella was found in 2 patients only. A significant titre rise for Mycoplasma and/or Chlamydophila pneumoniae was found in 13 of 29 tested patients with confirmed LD. We conclude that the clinical diagnosis of LD is difficult and that available diagnostic methods detect only a minority of patients in the acute phase. Therefore in severe pneumonia, empirically targeted therapy should be instituted on clinical grounds irrespective of the results of diagnostic tests. The observation of increased antibody levels for M. and C. pneumoniae suggests an unspecific immune reaction and merits further study.

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Section: Discussionmentioning

confidence: 67%

A community outbreak of Legionnaires’ disease from an industrial cooling tower: Assessment of clinical features and diagnostic procedures

Hugosson

Hjorth

Bernander

et al. 2007

Scandinavian Journal of Infectious Diseases

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“…A Medline search from 1966 to 2001 found 43 such outbreaks, of which 69% (29) could be linked by epidemiological and molecular evidence to biofilms (a community of microorganisms growing as a slimy layer on surfaces immersed in a liquid) in water storage tanks, tap water, and water from showers. [229][230][231][232] Pathogens identified in waterborne nosocomial infections include: Legionella spp., P. aeruginosa, 233,234 Stenotrophomonas maltophilia, 235 Mycobacterium avium, 236 M. fortuitum, 237 M. chelonae, 238 Fusarium spp., 239 and A. fumigatus. 240 Even if hand hygiene practices are in place, a plausible route for transmitting these organisms from water to patient could be through HCWs' hands if contaminated water is used to wash them.…”

Section: Microbially-contaminated Tap Water In Health-care Institutionsmentioning

confidence: 99%

Hand Hygiene

Longtin¹,

Sax²,

Allegranzi³

et al. 2011

N Engl J Med

107

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“…[17 Á/ 19,26,30], although outbreaks with C. pneumoniae [31] and Legionella spp. [32] occur (Ib). Chlamydophila psittaci, Gram-negative enteric bacilli and Staphylococcus aureus are uncommon aetiologies [17 Á/19,26] (Ib).…”

Section: Incidence and Mortalitymentioning

confidence: 99%

Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults

Hedlund

Strålin

Örtqvist

et al. 2005

Scandinavian Journal of Infectious Diseases

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This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.

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An outbreak of Legionnaires’ Disease in a Swedish Hospital

Cited by 36 publications

References 21 publications

A community outbreak of Legionnaires’ disease from an industrial cooling tower: Assessment of clinical features and diagnostic procedures

A community outbreak of Legionnaires’ disease from an industrial cooling tower: Assessment of clinical features and diagnostic procedures

Hand Hygiene

Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults

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