Two Legionnaires' disease cases associated with industrial waste water treatment plants: a case report

Kusnetsov, Jaana; Neuvonen, Liisa-Kaarina; Korpio, Timo; Uldum, Søren A.; Mentula, Silja; Putus, Tuula; Minh, Nhu Nguyen Tran; Martimo, Kari-Pekka

doi:10.1186/1471-2334-10-343

Cited by 34 publications

(32 citation statements)

References 19 publications

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“…For example, workers at wastewater treatment plants may be exposed to exceptionally high levels of Legionella aerosols. 61-63 Studies from several countries have also provided evidence suggesting professional drivers to be at increased risk. 59, 64, 65 Further examination of risk for other work-related exposure may reveal increased legionellosis rates associated with other professions having feasible exposure pathways, such as agricultural workers.…”

Section: Introductionmentioning

confidence: 99%

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Prussin

Schwake

Marr

2017

Building and Environment

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Legionella is a genus of pathogenic Gram-negative bacteria responsible for a serious disease known as legionellosis, which is transmitted via inhalation of this pathogen in aerosol form. There are two forms of legionellosis: Legionnaires' disease, which causes pneumonia-like symptoms, and Pontiac fever, which causes influenza-like symptoms. Legionella can be aerosolized from various water sources in the built environment including showers, faucets, hot tubs/swimming pools, cooling towers, and fountains. Incidence of the disease is higher in the summertime, possibly because of increased use of cooling towers for air conditioning systems and differences in water chemistry when outdoor temperatures are higher. Although there have been decades of research related to Legionella transmission, many knowledge gaps remain. While conventional wisdom suggests that showering is an important source of exposure in buildings, existing measurements do not provide strong support for this idea. There has been limited research on the potential for Legionella transmission through heating, ventilation, and air conditioning (HVAC) systems. Epidemiological data suggest a large proportion of legionellosis cases go unreported, as most people who are infected do not seek medical attention. Additionally, controlled laboratory studies examining water-to-air transfer and source tracking are still needed. Herein, we discuss ten questions that spotlight current knowledge about Legionella transmission in the built environment, engineering controls that might prevent future disease outbreaks, and future research that is needed to advance understanding of transmission and control of legionellosis.

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Section: Introductionmentioning

confidence: 99%

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Prussin

Schwake

Marr

2017

Building and Environment

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“…An extensive collection of case studies and research articles dating back Ͼ30 years demonstrates the adaptability and potential of legionellae to colonize man-made aquatic environments ( Fig. 1), from the initial point of water treatment (69)(70)(71)(72)(73) to private homes (74)(75)(76)(77)(78), hospitals (79)(80)(81)(82)(83), restaurants (84,85), bath houses (86)(87)(88)(89), hotels (90)(91)(92), and, eventually, wastewater facilities (93,94). These studies underscore the resiliency and persistence of legionellae.…”

Section: Physiology and Ecologymentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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SUMMARY Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

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“…Workers in cooling towers, ship repair facilities, professional or amateur gardeners have been described among others as risk exposed populations for Legionnaire's disease (Cameron et al, 1991). Moreover, the WWTPs themselves are described as the source of Legionnaires' disease outbreaks in Finland (Kusnetsov et al, 2010). Despite the presence of Acanthamoeba in WWTPs has also been described worldwide (Visvesvara et al, 2007), there are few reports that correlate the water of these plants as a source for Acanthamoeba infection.…”

Section: Discussionmentioning

confidence: 97%

Vectorial role of Acanthamoeba in Legionella propagation in water for human use

Magnet

Peralta

Gomes

et al. 2015

Science of The Total Environment

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Two Legionnaires' disease cases associated with industrial waste water treatment plants: a case report

Abstract: Background: Finnish and Swedish waste water systems used by the forest industry were found to be exceptionally heavily contaminated with legionellae in 2005.

Cited by 34 publications

References 19 publications

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Ten questions concerning the aerosolization and transmission of Legionella in the built environment

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Vectorial role of Acanthamoeba in Legionella propagation in water for human use

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