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Legionellosis

Legionellosis is an infection caused by species of the bacterium Legionella, most notably L. pneumophila. At least 46 species and 70 serogroups have been identified. L. pneumophila, a ubiquitous aquatic organism that thrives in warm environments (25 to 45 °C with an optimum around 35 °C) causes over 90 % of Legionnaires Disease. more...

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The disease has two distinct forms:

  • Legionnaires' disease is the name for the more severe form of infection which includes pneumonia
  • Pontiac fever is a milder respiratory illness without pneumonia caused by the same bacterium

Legionnaires' disease acquired its name in 1976 when an outbreak of pneumonia occurred among persons attending a convention of the American Legion in Philadelphia. Later, the bacterium causing the illness was named Legionella.

On January 18, 1977 scientists identified a previously unknown bacterium as the cause of the mysterious "Legionnaires' disease."

An estimated 8,000 to 18,000 people get Legionnaires' disease in the United States each year. Some people can be infected with the Legionella bacterium and have mild symptoms or no illness at all.

Outbreaks of Legionnaires' disease receive significant media attention. However, this disease usually occurs as a single, isolated case not associated with any recognized outbreak. When outbreaks do occur, they are usually recognized in the summer and early fall, but cases may occur year-round. About 5% to 30% of people who have Legionnaires' disease die.

Symptoms

Patients with Legionnaires' disease usually have fever, chills, and a cough, which may be dry or may produce sputum. Some patients also have muscle aches, headache, tiredness, loss of appetite, and, occasionally, diarrhea. Laboratory tests may show that these patients' kidneys are not functioning properly. Chest X-rays often show pneumonia. It is difficult to distinguish Legionnaires' disease from other types of pneumonia by symptoms alone; other tests are required for diagnosis.

Persons with Pontiac fever experience fever and muscle aches and do not have pneumonia. They generally recover in 2 to 5 days without treatment.

The time between the patient's exposure to the bacterium and the onset of illness for Legionnaires' disease is 2 to 10 days; for Pontiac fever, it is shorter, generally a few hours to 2 days.

Infections

Intestinal Infections: These may only occur as part of respiratory infections, where gastrointestinal symptoms have on occasion been described.

Extraintestinal Infections: L. pneumophila is specifically considered as a pathogen of the respiratory tract, where it is a cause of atypical pneumonia, also known as Legionnaires' disease. Other infections have also been reported, including haemodialysis fistulae, pericarditis and wound and skin infections. Bacteraemia is often associated with Legionnaires' disease.

One species Legionella Longbeachae is contracted via inhaling infected compost or soil.

Read more at Wikipedia.org


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Preventive Low Dose Antibiotics Have No Effect On Nosocomial Legionellosis Morbidity - Abstract
From CHEST, 10/1/00 by Marjeta M Tercelj-Zorman

Marjeta M Tercelj-Zorman, MD(*); Franci F Strle, MD and Marija M Seljak, MD. Center for Respiratory Disease, Clinical Hospital of the University of Ljubljana, Ljubljana, Slovenia and Clinic for Infection Disease, Clinical Hospital of the University of Ljubljana, Ljubljana, Slovenia.

PURPOSE: To evaluate a possible effect of antibiotics for prevention of nosocomial legionellosis.

METHODS: During an outbreak of nosocomial legionellosis in the Jesenice Hospital in Slovenia some peculiar epidemiologic features were noted. Previously healthy medical staff of the hospital experienced a very high morbidity while the majority of the bed-ridden and/or immunocompromised patients did not contract legionellosis to the same extent. Due to the panic amongst the medical staff, 21 (29.6%) of the 71 staff started taking antibiotics as a preventive medicine at a dose of 250 mg of roxitromycin every 12 hours, or 250 mg of azitrmycin once every day.

RESULTS: Of the total of 71 staff members, 31 (43.7%) contracted legionellosis during the outbreak. Of the 21 staff talcing "preventive antibiotics", 11 (52.6%) contracted legionellosis, while only 20 (40.0%) of the 50 staff members not taking antibiotics contracted the disease. Therefore there were no significant difference between the incidence of the disease between the two groups, neither were there any differences noted in clinical outcome amongst the staff who cotracted the disease. No staff member died during the outbreak.

CONCLUSION: Antibiotics at these dosages did not prevent the contraction of legionellosis by the previously healthy hospital staff. Also, the drugs did not influence the clinical outcome of the disease.

CLINICAL IMPLICATIONS: Antibiotics did not prevent morbidity in this outbreak. Whether or not these but in therapeutic dosages should be employedas a preventive measure or be reserved solely for clinical suspect cases of legionellosis remains an open question. On average, 20-40% mortality has been reported (1) due-to nosocomial legionellosis. In this outbreak, that would be account for 2-3 deaths in the group of patients taking the antibiotics and 3-6 death amongst those taking the drags. Whether the outcome in this outbreak was a result of a very mild form of legionellosis or some other factors, is not known at this time. 1. Fiore AE, Butler JC. Detecting nosocomial legionnaires' disease. Infect Med 1998;15:625-35.

GRANT SUPPORT: none

COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group

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