Community-Acquired Legionnaires' Disease Associated With a Cooling Tower: Evidence for Longer-Distance Transport of Legionella Pneumophila

Addiss, David G.; Davis, Jeffrey P.; LaVenture, Martin; Wand, Philip J.; Hutchmson, Margaret A.; McKinney, Roger M.

doi:10.1093/oxfordjournals.aje.a115370

Cited by 103 publications

(63 citation statements)

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“…These samples correspond to cold domestic waters or well deep waters known to be free of Legionella. Eight samples analyzed in singular (samples 1,3,10,11,19,36,37) or in duplicates (sample 23) were positive by the IDS method but negative in culture, whereas the opposite was never found. It is interesting that the sampling temperature of these water samples (excepting samples 1 and 37) exceeded 45°C.…”

Section: Resultsmentioning

confidence: 93%

“…Second, the application domain of the IDS method is limited as yet to filterable water. Cooling tower water, frequently cited as a source of infection in outbreaks of Legionnaires' disease (1,15,27,57), cannot be easily analyzed by the IDS procedure due to interferences. The presence of particulate material that accumulates during the concentration procedure interferes with microscopic analysis.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Method for Enumeration of Viable Legionella pneumophila and Other Legionella spp. in Water

Delgado‐Viscogliosi

Simonart

Parent

et al. 2005

Appl Environ Microbiol

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A sensitive and specific method has been developed to enumerate viable L. pneumophila and other Legionella spp. in water by epifluorescence microscopy in a short period of time (a few hours). This method allows the quantification of L. pneumophila or other Legionella spp. as well as the discrimination between viable and nonviable Legionella. It simultaneously combines the specific detection of Legionella cells using antibodies and a bacterial viability marker (ChemChrome V6), the enumeration being achieved by epifluorescence microscopy. The performance of this immunological double-staining (IDS) method was investigated in 38 natural filterable water samples from different aquatic sources, and the viable Legionella counts were compared with those obtained by the standard culture method. The recovery rate of the IDS method is similar to, or higher than, that of the conventional culture method. Under our experimental conditions, the limit of detection of the IDS method was <176 Legionella cells per liter. The examination of several samples in duplicates for the presence of L. pneumophila and other Legionella spp. indicated that the IDS method exhibits an excellent intralaboratory reproducibility, better than that of the standard culture method. This immunological approach allows rapid measurements in emergency situations, such as monitoring the efficacy of disinfection shock treatments. Although its field of application is as yet limited to filterable waters, the double-staining method may be an interesting alternative (not equivalent) to the conventional standard culture methods for enumerating viable Legionella when rapid detection is required.

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Section: Resultsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Rapid Method for Enumeration of Viable Legionella pneumophila and Other Legionella spp. in Water

Delgado‐Viscogliosi

Simonart

Parent

et al. 2005

Appl Environ Microbiol

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“…Also, 2 of the 9 subjects in group A, and 7 of the 19 in group B did not use the car park. Legionella infection can occur up to 2 miles from the source [31,32]. Thus the Legionnaires' disease cases identified during the outbreak and the additional suspected cases found in the cross-sectional study probably represent only a small fraction of all those in the community who were infected.…”

Section: Discussionmentioning

confidence: 99%

Legionellosis linked with a hotel car park – how many were infected?

Bell

Jorm²,

Williamson³

et al. 1996

Epidemiol. Infect.

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SUMMARYAn outbreak of legionellosis associated with a hotel in Sydney, Australia, and the subsequent epidemiological and environmental investigations are described. Four cases of Legionnaires' disease were notified to the Public Health Unit. A cross-sectional study of 184 people who attended a seminar at the hotel was carried out. Serological and questionnaire data were obtained for 152 (83 %) of these. Twenty-eight (18 %) respondents reported symptoms compatible with legionellosis. Thirty-three subjects (22 %) had indirect fluorescent antibody (IFA) titres to Legionella pneumophila serogroup 1 (Lp-1) of 128 or higher. The only site which those with symptoms of legionellosis and IFA titre > 128 were more likely to have visited than controls was the hotel car park (adjusted odds ratio [OR] 14 7, 95 % confidence interval [CI]: 1 8-123 1). Those with symptoms compatible with legionellosis, but whose IFA titres were < 128 were also more likely to have visited the hotel car park (adjusted OR 4-4, 95 % CI: 1 5-12 9). Seroprevalence of Lp-I antibodies was higher in those who attended the seminar than in a population sample of similar age. Findings suggested that the 4 cases represented a small fraction of all those infected, and highlighted difficulties in defining illness caused by Lp-1 and in interpreting serology.

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“…In general, an infection is contracted by inhalation of contaminated water containing Legionella cells in aerosols. Some sources of transmission which have led to outbreaks of disease have been reported to be cooling towers, natural hot spas, evaporative condensers, hot and cold water systems in hotels and hospitals, showers, soil and potting soil, a whirlpool bath, and protozoans (1,11,18,19,31,35,36,44,47,50,51).…”

mentioning

confidence: 99%

Molecular Characterization ofLegionellaPopulations Present within Slow Sand Filters Used for Fungal Plant Pathogen Suppression in Horticultural Crops

Calvo-Bado¹,

Morgan²,

Sergeant³

et al. 2003

Appl Environ Microbiol

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The total bacterial community of an experimental slow sand filter (SSF) was analyzed by denaturing gradient gel electrophoresis (DGGE) of partial 16S rRNA gene PCR products. One dominant band had sequence homology to Legionella species, indicating that these bacteria were a large component of the SSF bacterial community. Populations within experimental and commercial SSF units were studied by using Legionella-specific PCR primers, and products were studied by DGGE and quantitative PCR analyses. In the experimental SSF unit, the DGGE profiles for sand column, reservoir, storage tank, and headwater tank samples each contained at least one intense band, indicating that a single Legionella strain was predominant in each sample. Greater numbers of DGGE bands of equal intensity were detected in the outflow water sample. Sequence analysis of these PCR products showed that several Legionella species were present and that the organisms exhibited similarity to strains isolated from environmental and clinical samples. Quantitative PCR analysis of the SSF samples showed that from the headwater sample through the sand column, the number of Legionella cells decreased, resulting in a lower number of cells in the outflow water. In the commercial SSF, legionellae were also detected in the sand column samples. Storing prefilter water or locating SSF units within greenhouses, which are often maintained at temperatures that are higher than the ambient temperature, increases the risk of growth of Legionella and should be avoided. Care should also be taken when used filter sand is handled or replaced, and regular monitoring of outflow water would be useful, especially if the water is used for misting or overhead irrigation.

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Community-Acquired Legionnaires' Disease Associated With a Cooling Tower: Evidence for Longer-Distance Transport of Legionella Pneumophila

Cited by 103 publications

References 0 publications

Rapid Method for Enumeration of Viable Legionella pneumophila and Other Legionella spp. in Water

Rapid Method for Enumeration of Viable Legionella pneumophila and Other Legionella spp. in Water

Legionellosis linked with a hotel car park – how many were infected?

Molecular Characterization ofLegionellaPopulations Present within Slow Sand Filters Used for Fungal Plant Pathogen Suppression in Horticultural Crops

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