Legionella Control - Revision history

Tobyvan: /* HISTORY */

2021-05-04T15:46:10Z

HISTORY

Tobyvan at 14:59, 4 May 2021

2021-05-04T14:59:28Z

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	==HISTORY==		==HISTORY==
			[[File:The first Legionnaires’ disease outbreak.png\|thumb\|The first Legionnaires’ disease outbreak]]

			[[File:Gimenez stain- Legionella bacteria.png\|thumb\|Gimenez stain- Legionella bacteria]]
	Legionnaires’ disease was first described after a pneumonia outbreak at an American Legion Convention held in Philadelphia during 1976. In total, 182 delegates were affected and 29 died before workers at the Centers for Disease Control and Prevention (CDC) based in Atlanta, USA isolated the causative organism in January 1977. The organism was placed in the family Legionellaceae, genus Legionella to commemorate the first victims of the disease. The first species was named Legionella pneumophila (Greek for “lung loving”).		Legionnaires’ disease was first described after a pneumonia outbreak at an American Legion Convention held in Philadelphia during 1976. In total, 182 delegates were affected and 29 died before workers at the Centers for Disease Control and Prevention (CDC) based in Atlanta, USA isolated the causative organism in January 1977. The organism was placed in the family Legionellaceae, genus Legionella to commemorate the first victims of the disease. The first species was named Legionella pneumophila (Greek for “lung loving”).

	~~[[File:The first Legionnaires’ disease outbreak.png\|thumb\|The first Legionnaires’ disease outbreak]]~~


	It soon became clear that legionellae were not really new; retrospective studies showed that an organism isolated for the first time in 1944 (called Tatlockia micdadei) actually belonged to the genus Legionella. The first strain of Lpneumophila was isolated already in 1947 from a guinea pig that had previously been inoculated with blood from a patient with what was called an “unknown febrile disease” at the time.		It soon became clear that legionellae were not really new; retrospective studies showed that an organism isolated for the first time in 1944 (called Tatlockia micdadei) actually belonged to the genus Legionella. The first strain of Lpneumophila was isolated already in 1947 from a guinea pig that had previously been inoculated with blood from a patient with what was called an “unknown febrile disease” at the time.

Tobyvan: /* 1.1 HISTORY */

2021-05-04T14:56:47Z

1.1 HISTORY

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	{{Anchor\|Section1}}		{{Anchor\|Section1}}
	==~~Section 1~~==		==INTRODUCTION==

	==~~1.1~~ HISTORY==		==HISTORY==
	Legionnaires’ disease was first described after a pneumonia outbreak at an American Legion Convention held in Philadelphia during 1976. In total, 182 delegates were affected and 29 died before workers at the Centers for Disease Control and Prevention (CDC) based in Atlanta, USA isolated the causative organism in January 1977. The organism was placed in the family Legionellaceae, genus Legionella to commemorate the first victims of the disease. The first species was named Legionella pneumophila (Greek for “lung loving”).		Legionnaires’ disease was first described after a pneumonia outbreak at an American Legion Convention held in Philadelphia during 1976. In total, 182 delegates were affected and 29 died before workers at the Centers for Disease Control and Prevention (CDC) based in Atlanta, USA isolated the causative organism in January 1977. The organism was placed in the family Legionellaceae, genus Legionella to commemorate the first victims of the disease. The first species was named Legionella pneumophila (Greek for “lung loving”).

	It soon became clear that legionellae were not really new; retrospective studies showed that an organism isolated for the first time in 1944 (called Tatlockia micdadei) actually belonged to the genus Legionella. The first strain of Lpneumophila was isolated already in 1947 from a guinea pig that had previously been inoculated with blood from a patient with what was called an “unknown febrile disease” at the time.

	[[File:The first Legionnaires’ disease outbreak.png\|thumb\|The first Legionnaires’ disease outbreak]]		[[File:The first Legionnaires’ disease outbreak.png\|thumb\|The first Legionnaires’ disease outbreak]]

	~~The two decades following~~ the ~~discovery of the family Legionellaceae was marked by rapid developments~~ in ~~Legionella detection and the identification of numerous new species. Twenty-eight new Legionella species and two “Legionella-like amoebal pathogens”~~ (~~LLAPs~~) ~~(LLAP-1 and LLAP-6) were isolated during~~ the ~~1980s, mostly from sources in the USA~~. The ~~1990s were marked by an increase~~ in ~~Legionella isolation~~ from ~~countries in Europe and Australia~~ with ~~fifteen new Legionella species being described for~~ the ~~first~~ time.		It soon became clear that legionellae were not really new; retrospective studies showed that an organism isolated for the first time in 1944 (called Tatlockia micdadei) actually belonged to the genus Legionella. The first strain of Lpneumophila was isolated already in 1947 from a guinea pig that had previously been inoculated with blood from a patient with what was called an “unknown febrile disease” at the time.

	~~Figure~~ 1.~~2 Intracellular~~ Legionella ~~organisms~~		The two decades following the discovery of the family Legionellaceae was marked by rapid developments in Legionella detection and the identification of numerous new species. Twenty-eight new Legionella species and two “Legionella-like amoebal pathogens” (LLAPs) (LLAP-1 and LLAP-6) were isolated during the 1980s, mostly from sources in the USA. The 1990s were marked by an increase in Legionella isolation from countries in Europe and Australia with fifteen new Legionella species being described for the first time.

	More than half of the currently known Legionella species are potentially pathogenic to humans. L. pneumophila is still implicated in >80% of infections; however, as more species are isolated from environmental sources worldwide, even those species not yet associated with disease should be considered as potentially pathogenic until proven otherwise. For example, L. longbeacheae, often isolated from potting soil, is considered the most common cause of legionellosis in Australia.		More than half of the currently known Legionella species are potentially pathogenic to humans. L. pneumophila is still implicated in >80% of infections; however, as more species are isolated from environmental sources worldwide, even those species not yet associated with disease should be considered as potentially pathogenic until proven otherwise. For example, L. longbeacheae, often isolated from potting soil, is considered the most common cause of legionellosis in Australia.
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	The ability of legionellae to grow in water is influenced by several factors. They can grow at temperatures between 20°C and 60°C, with optimal growth occurring between 37°C and 45°C. They prefer a pH in the range of 5.0 9.5 and only grow in the presence of Lcysteine, HCl and iron salts. Legionella-like amoebal pathogens (LLAPs) are very similar to Legionella species in that they are gram negative, infect amoebae and can survive and multiply intracellularly. However, they cannot be cultured on laboratory media. The first LLAP was isolated 1 from soil in Poland in 1954 and was named Sarcobium lyticum. The next isolation of an LLAP was in England more than 20 years later. Since then, LLAPs have been isolated from various sources, mostly associated with confirmed cases or outbreaks of 2 3 Legionnaires’ disease. Three of the LLAPs have since been reclassified as L. drozanskii, L. rowbothamii and L falloni. The currently known LLAPs are listed in Table 1.2.		The ability of legionellae to grow in water is influenced by several factors. They can grow at temperatures between 20°C and 60°C, with optimal growth occurring between 37°C and 45°C. They prefer a pH in the range of 5.0 9.5 and only grow in the presence of Lcysteine, HCl and iron salts. Legionella-like amoebal pathogens (LLAPs) are very similar to Legionella species in that they are gram negative, infect amoebae and can survive and multiply intracellularly. However, they cannot be cultured on laboratory media. The first LLAP was isolated 1 from soil in Poland in 1954 and was named Sarcobium lyticum. The next isolation of an LLAP was in England more than 20 years later. Since then, LLAPs have been isolated from various sources, mostly associated with confirmed cases or outbreaks of 2 3 Legionnaires’ disease. Three of the LLAPs have since been reclassified as L. drozanskii, L. rowbothamii and L falloni. The currently known LLAPs are listed in Table 1.2.

	===~~1.2~~ INTERACTIONS WITH PROTOZOA===		===INTERACTIONS WITH PROTOZOA===
	Legionellae are slow-growing organisms that require a combination of nutrients for growth. Due to their fastidious nature and lack of antibiotic activity, they may be replaced by faster growing organisms if they do not have an alternative means of survival in aquatic environments. The fact that legionellae are ubiquitous in these environments suggests that protozoa, especially amoebae, play a supportive role in their survival and multiplication. In fact, their natural habitat, parasitic to protist hosts, has now been 4 proven.		Legionellae are slow-growing organisms that require a combination of nutrients for growth. Due to their fastidious nature and lack of antibiotic activity, they may be replaced by faster growing organisms if they do not have an alternative means of survival in aquatic environments. The fact that legionellae are ubiquitous in these environments suggests that protozoa, especially amoebae, play a supportive role in their survival and multiplication. In fact, their natural habitat, parasitic to protist hosts, has now been 4 proven.
	{\| class="wikitable"		{\| class="wikitable"

Tobyvan at 14:55, 4 May 2021

2021-05-04T14:55:23Z

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Tmojanaga: /* PONTIAC FEVER */

2020-11-16T08:53:56Z

PONTIAC FEVER

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Tmojanaga: /* Section 1 */

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Section 1

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 [[Category:Infection Prevention and Control]]
 [[Category:Water Distributions Systems]]

Tmojanaga: /* References */

2020-10-29T04:08:05Z

References

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	==='''SOURCES AND RESERVOIRS'''===		==='''SOURCES AND RESERVOIRS'''===
	Legionellae are natural inhabitants of water, found a wide range of habitats. They are ubiquitous in streams, lakes and rivers. They also survive in dust, soil and mud. In fact, one of the species, ''Legionella longbeacheae'', is so often isolated from potting soil in Australia that soil has been suggested as the natural habitat of this particular species.<ref>Dennis PJ (1993). Potable water systems: insights into control. In: Barbaree JM, Breiman RF and Dufour AP (eds). Legionella: Current status and emerging perspectives. American Society for Microbiology, Washington DC. Pp 223-225.</ref>		Legionellae are natural inhabitants of water, found a wide range of habitats. They are ubiquitous in streams, lakes and rivers. They also survive in dust, soil and mud. In fact, one of the species, ''Legionella longbeacheae'', is so often isolated from potting soil in Australia that soil has been suggested as the natural habitat of this particular species.

	{{Anchor\|Natural sources of Legionella}}		{{Anchor\|Natural sources of Legionella}}
	[[File:Natural sources of Legionella.png\|alt=Natural sources of Legionella\|none\|thumb\|Chain of infection\|450x450px]]		[[File:Natural sources of Legionella.png\|alt=Natural sources of Legionella\|none\|thumb\|Chain of infection\|450x450px]]

	Legionellae from these natural environments can be transmitted to man-made water systems by various means. For example, from raw water, during water treatment, as part of post-treatment after-growths within water distribution systems, during building and construction activities and during plumbing repair.~~<ref>Colbourne JS and Dennis PJ (1985). Distribution and persistence of Legionella in water systems. ''Microbiol. Sc.'' '''2''': 40-43.</ref>~~		Legionellae from these natural environments can be transmitted to man-made water systems by various means. For example, from raw water, during water treatment, as part of post-treatment after-growths within water distribution systems, during building and construction activities and during plumbing repair.


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	In systems that are not regularly cleaned, sludge accumulates in the reservoir and slime adheres to water covered surfaces, resulting in the presence of large concentrations of micro-organisms, including legionellae, on these surfaces. In addition, water temperatures below 60°C, the age and configuration of the system, the pH of the water and the presence of certain metals may also increase the risk of contamination.		In systems that are not regularly cleaned, sludge accumulates in the reservoir and slime adheres to water covered surfaces, resulting in the presence of large concentrations of micro-organisms, including legionellae, on these surfaces. In addition, water temperatures below 60°C, the age and configuration of the system, the pH of the water and the presence of certain metals may also increase the risk of contamination.

	Water derived from municipal supplies but subsequently stored in cisterns, or conditioned prior to heating, is considered non-potable due to the deterioration in chemical and bacteriological quality during storage. Colonisation of such non-potable sources inside large buildings, such as hotels, factories or hospitals, may be a major cause of legionellosis.<ref>Muraca PW, Stout JE, Yu VL and Yee YC (1988). Mode of transmission of ''Legionella pneumophila''. A critical review. ''Am. J. Hyg. Assoc.'' '''49''': 584-590.</ref><ref>Yamamoto H, Sugiura M, Kusunoki S, Ezaki T, Ikedo M and Yabuuchi E (1992). Factors stimulating propagation of legionellae in cooling tower water. ''Appl. Environ. Microbiol.'' '''58''': 1394-1397</ref><ref name=":0">Freije MR (1996). Legionella control in healthcare facilities: A guide for minimising risk. HC Information Resources, Inc. United States of America. P 8</ref>		Water derived from municipal supplies but subsequently stored in cisterns, or conditioned prior to heating, is considered non-potable due to the deterioration in chemical and bacteriological quality during storage. Colonisation of such non-potable sources inside large buildings, such as hotels, factories or hospitals, may be a major cause of legionellosis.

	====='''Potable (domestic) water distribution systems'''=====		====='''Potable (domestic) water distribution systems'''=====
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	Legionella levels can rise from very low to very high within short periods of time. The factors that give rise to these fluctuations are not well understood and often very hard to determine. These factors include the age and configuration of the pipes, the degree of scaling and sediment and the potential for biofilm formation within the system increase the risk of contamination. Water temperatures of 25 – 42°C, stagnation and the presence of certain free-living amoebae capable of supporting the intracellular growth of legionellae are often mentioned as amplifying factors in published reports. The biofilm and scale that form on surfaces in water distribution systems provide nutrients for legionellae and protect them from hot water and disinfectants. Some materials used in these systems, for example neoprene washers, are more readily colonised than others (See [[Legionella Control#Materials used in the construction of potable water lines and fixtures\|Table]]). Building location may also play a role in the colonisation of potable water with legionellae.		Legionella levels can rise from very low to very high within short periods of time. The factors that give rise to these fluctuations are not well understood and often very hard to determine. These factors include the age and configuration of the pipes, the degree of scaling and sediment and the potential for biofilm formation within the system increase the risk of contamination. Water temperatures of 25 – 42°C, stagnation and the presence of certain free-living amoebae capable of supporting the intracellular growth of legionellae are often mentioned as amplifying factors in published reports. The biofilm and scale that form on surfaces in water distribution systems provide nutrients for legionellae and protect them from hot water and disinfectants. Some materials used in these systems, for example neoprene washers, are more readily colonised than others (See [[Legionella Control#Materials used in the construction of potable water lines and fixtures\|Table]]). Building location may also play a role in the colonisation of potable water with legionellae.

	Hot water tanks are often colonised with legionellae, especially at the bottom where a warm zone may develop and scale and sediment accumulate.~~<ref>MarrieTJ, Haldane D, Bezanson G and Peppard R (1992). Each water outlet is a unique ecological niche for ''Legionella pneumophila''. ''Epid. Infect.'' '''108''': 264-270</ref>~~ Hot water piping, especially dead-legs, presents an additional risk as legionellae thrive in stagnant water.		Hot water tanks are often colonised with legionellae, especially at the bottom where a warm zone may develop and scale and sediment accumulate. Hot water piping, especially dead-legs, presents an additional risk as legionellae thrive in stagnant water.

	====='''Soil'''=====		====='''Soil'''=====
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	Pontiac fever symptoms usually resolve spontaneously within one week, only symptomatic treatment is needed and the chest radiograph is clear. There is no evidence of secondary spread of the infection in Pontiac fever. Diagnosis can only be made by seroconversion, which may be delayed for up to 6 weeks after onset of symptoms. Cases of PF have been linked to ''L pneumophila, L feelei and L anisa''. Complete recovery usually occurs in 2 – 5 days without medical attention.		Pontiac fever symptoms usually resolve spontaneously within one week, only symptomatic treatment is needed and the chest radiograph is clear. There is no evidence of secondary spread of the infection in Pontiac fever. Diagnosis can only be made by seroconversion, which may be delayed for up to 6 weeks after onset of symptoms. Cases of PF have been linked to ''L pneumophila, L feelei and L anisa''. Complete recovery usually occurs in 2 – 5 days without medical attention.

	== Acknowledgements<!-- please acknowledge all primary authors --> ==		==Acknowledgements<!-- please acknowledge all primary authors -->==
	Delene Bartie (CB Scientific)- ~~2020~~		Delene Bartie (CB Scientific)- 2023

	~~==References==~~
	~~<references />~~

	==References Chapter 3<!-- This must be included in the reference list above -->==		==References Chapter 3<!-- This must be included in the reference list above -->==
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	#Pastoris MC, Ciarrochi S, Di Capula A, Temperanza AM. Comparison of phenol- and heat-killed antigens in the indirect immunofluorescence test for serodiagnosis of Legionella pneumophila serogroup 1 antigens. J. Clin. Microbiol. 1984, 20 (4): 780-783.		#Pastoris MC, Ciarrochi S, Di Capula A, Temperanza AM. Comparison of phenol- and heat-killed antigens in the indirect immunofluorescence test for serodiagnosis of Legionella pneumophila serogroup 1 antigens. J. Clin. Microbiol. 1984, 20 (4): 780-783.
	#Kaufmann AF, McDade JE, Patton CM, Bennett JV, Skalyi P, Feeley C, Anderson DC, Potter ME, Newhouse VF, Gregg MB, Brachman PS. Pontiac fever: isolation of the etiologic agent (Legionella pneumophila) and demonstration of its mode of transmission. Am. J. Epid. 1981, 114 (3): 337-347.		#Kaufmann AF, McDade JE, Patton CM, Bennett JV, Skalyi P, Feeley C, Anderson DC, Potter ME, Newhouse VF, Gregg MB, Brachman PS. Pontiac fever: isolation of the etiologic agent (Legionella pneumophila) and demonstration of its mode of transmission. Am. J. Epid. 1981, 114 (3): 337-347.
			#Dennis PJ (1993). Potable water systems: insights into control. In: Barbaree JM, Breiman RF and Dufour AP (eds). Legionella: Current status and emerging perspectives. American Society for Microbiology, Washington DC. Pp 223-225.
			#Colbourne JS and Dennis PJ (1985). Distribution and persistence of Legionella in water systems. ''Microbiol. Sc.'' '''2''': 40-43.
			#Muraca PW, Stout JE, Yu VL and Yee YC (1988). Mode of transmission of ''Legionella pneumophila''. A critical review. ''Am. J. Hyg. Assoc.'' '''49''': 584-590.
			#Yamamoto H, Sugiura M, Kusunoki S, Ezaki T, Ikedo M and Yabuuchi E (1992). Factors stimulating propagation of legionellae in cooling tower water. ''Appl. Environ. Microbiol.'' '''58''': 1394-1397
			#<sup>[[Legionella Control#cite%20ref-:0%205-0\|Jump up to:5.0]]</sup> <sup>[[Legionella Control#cite%20ref-:0%205-1\|5.1]]</sup> Freije MR (1996). Legionella control in healthcare facilities: A guide for minimising risk. HC Information Resources, Inc. United States of America. P 8
			#MarrieTJ, Haldane D, Bezanson G and Peppard R (1992). Each water outlet is a unique ecological niche for ''Legionella pneumophila''. ''Epid. Infect.'' '''108''': 264-270

	[[Category:Legionella Control]]		[[Category:Legionella Control]]
	[[Category:Infection Prevention and Control]]		[[Category:Infection Prevention and Control]]
	[[Category:Water Distributions Systems]]		[[Category:Water Distributions Systems]]

Tobyvan: /* Section 1 */

2020-10-28T11:42:39Z

Section 1

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Tmojanaga: /* 3.4 DIAGNOSIS */

2020-10-22T13:19:08Z

3.4 DIAGNOSIS

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Tmojanaga: /* 3.4 DIAGNOSIS */

2020-10-22T12:48:04Z

3.4 DIAGNOSIS

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