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Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nosocomial pneumonia caused by legionella is an increasingly recognized entity. Legionella sp responsible for documented nosocomial disease include Legionella pneumophila, Tatlockia micdadei, Legionella bozemanii, Legionella dumoffi and Legionella oakridgensis. The clinical presentation is nonspecific although diarrhea occurs frequently. Hyponatremia occurs significantly more frequently in legionnaires' disease than pneumonias caused by other agents. Chest roentgenographic findings are nonspecific, although cavitation can be seen in immunosuppressed patients. Laboratory methods require the use of direct fluorescent antibody (DFA) stains, culture using selective media, serologic testing, and detection of antigen in urine. The DFA test is not sensitive; however, it does correlate with the severity of disease. Culture from sputa is now feasible. Bronchoalveolar lavage is a promising technique for obtaining specimens. The ideal specimen for culture is that obtained by transtracheal aspiration, which bypasses oropharyngeal contamination. Combination therapy of erythromycin and rifampin is recommended for selected patients. Because the source of the organism is the hospital water distribution system, we recommend routine environmental surveillance, especially in hospitals in which organ transplants are performed. The role of cooling towers as a vector for dissemination of the organism is disputed. Disinfection of the water supply can be accomplished by using heat eradication. Chlorination has generally proven unsatisfactory because of organism persistence as well as corrosive damage to the plumbing system from the chlorine. Both physician awareness and availability of specialized laboratory testing are necessary for the detection of cases.
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PMID:Legionella species as hospital-acquired respiratory pathogens. 332 Dec 65

In 1981, sixteen cases of nosocomial legionellosis occurred among 456 patients admitted to a new hematology-oncology unit (35 per 1000 admissions). Monoclonal antibody typing and restriction endonuclease plasmid analysis identified a unique strain (09,04) of Legionella pneumophila serogroup 1 isolated from both patients and water outlets. Continuous hyperchlorination of the hot and cold water began in January 1982, and chlorine levels of 3 to 5 mg/L have been maintained most recently. Water samples have been consistently negative for Legionella for more than five years. Four sporadic cases of nosocomial legionellosis have occurred in the hematology-oncology unit during the same period (one per 1000 admissions) associated with a different strain of L pneumophila serogroup 1 (09,00). The environmental reservoir(s) of L pneumophila serogroup 1 in these cases has not been identified. Levels of trihalomethanes (potential carcinogens) were high (greater than 100 micrograms/L) when chlorine levels of hot water exceeded 4 mg/L. Some corrosion damage to the water distribution system has occurred: the average number of leaks per month increased steadily from zero in 1982 to 5.2 in 1986. The chlorinator installation costs were +75,800, and annual operation expenses were +12,500. Continuous hyperchlorination is a promising but still experimental technique for control of nosocomial legionellosis. In our experience, epidemic disease has been controlled, but sporadic cases have continued to occur.
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PMID:Legionnaires' disease associated with a hospital water system. A five-year progress report on continuous hyperchlorination. 335 31

A study was conducted to determine the bactericidal effects of ozone and hydrogen peroxide relative to that of free chlorine on Legionella pneumophila serogroup 1. In laboratory batch-type experiments, organisms seeded at various densities were exposed to different concentrations of these biocides in demand-free buffers. Bactericidal effects were measured by determining the ability of L. pneumophila to grow on buffered charcoal-yeast extract agar supplemented with alpha-ketoglutarate. Ozone was the most potent of the three biocides, with a greater than 99% kill of L. pneumophila occurring during a 5-min exposure to 0.10 to 0.30 micrograms of O3 per ml. The bactericidal action of O3 was not markedly affected by changes in pH or temperature. Concentrations of 0.30 and 0.40 micrograms of free chlorine per ml killed 99% of the L. pneumophila after 30- and 5-min exposures, respectively. A 30-min exposure to 1,000 micrograms of H2O2 per ml was required to effect a 99% reduction of the viable L. pneumophila population. However, no viable L. pneumophila could be detected after a 24-h exposure to 100 or 300 micrograms of H2O2 per ml. Attempts were made to correlate the biocidal effects of O3 and H2O2 with the oxidation of L. pneumophila fatty acids. These tests indicated that certain biocidal concentrations of O3 and H2O2 resulted in a loss or severe reduction of L. pneumophila unsaturated fatty acids.
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PMID:Effects of three oxidizing biocides on Legionella pneumophila serogroup 1. 337 92

The susceptibility of a strain of Legionella pneumophila to disinfection by an organic halamine, free chlorine, and a mixture of the organic halamine and free chlorine was assessed. The organic halamine was found to have superior stability in solution and to exhibit adequate disinfectant potential over a period of 1 month of repeated reinoculations of fresh bacteria. The combined halamine exhibited great potential for use in maintaining closed-cycle cooling water systems free of L. pneumophila.
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PMID:Inactivation of Legionella pneumophila by hypochlorite and an organic chloramine. 343 50

Nosocomial Legionnaires disease can be acquired by exposure to the organism from the hospital water distribution system. As a result, many hospitals have instituted eradication procedures, including hypercholorination and thermal eradication. We compared the efficacy of ozonation, UV light, hyperchlorination, and heat eradication using a model plumbing system constructed of copper piping, brass spigots, Plexiglas reservoir, electric hot water tank, and a pump. Legionella pneumophila was added to the system at 10(7) CFU/ml. Each method was tested under three conditions; (i) nonturbid water at 25 degrees C, (ii) turbid water at 25 degrees C, and (iii) nonturbid water at 43 degrees C. UV light and heat killed L. pneumophila most rapidly and required minimal maintenance. Both UV light and heat (60 degrees C) produced a 5 log kill in less than 1 h. In contrast, both chlorine and ozone required 5 h of exposure to produce a 5 log decrease. Neither turbidity nor the higher temperature of 43 degrees C impaired the efficacy of any of the disinfectant methods. Surprisingly, higher temperature enhanced the disinfecting efficacy of chlorine. However, higher temperature accelerated the decomposition of the chlorine residual such that an additional 120% volume of chlorine was required. All four methods proved efficacious in eradicating L. pneumophila from a model plumbing system.
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PMID:Comparative assessment of chlorine, heat, ozone, and UV light for killing Legionella pneumophila within a model plumbing system. 356 72

Studies were conducted to investigate the survival and multiplication of Legionella spp. in public drinking water supplies. An attempt was made, over a period of several years, to isolate legionellae from a municipal system. Sampling sites included the river water supply, treatment plant, finished water reservoir system, mains, and distribution taps. Despite the use of several isolation techniques, Legionella spp. could not be detected in any of the samples other than those collected from the river. It was hypothesized that this was due to the maintenance of a chlorine residual throughout the system. To investigate the potential for Legionella growth, additional water samples, collected from throughout the system, were dechlorinated, pasteurized, and inoculated with Legionella pneumophila. Subsequent growth indicated that many of these samples, especially those collected from areas affected by an accumulation of algal materials, exhibited a much greater ability to support Legionella multiplication than did river water prior to treatment. Chemical analyses were also performed on these samples. Correlation of chemical data and experimental growth results indicated that the chemical environment significantly affects the ability of the water to support multiplication, with turbidity, organic carbon, and certain metals being of particular importance. These studies indicate that the potential exists for Legionella growth within municipal systems and support the hypothesis that public water supplies may contaminate the plumbing systems of hospitals and other large buildings. The results also suggest that useful methods to control this contamination include adequate treatment plant filtration, maintenance of a chlorine residual throughout the treatment and distribution network, and effective covering of open reservoirs.
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PMID:Survival and multiplication of Legionella pneumophila in municipal drinking water systems. 360 1

Earlier field and laboratory studies have shown that Legionella species survive and multiply in the pH range 5.5 to 9.2. Additionally, the technical feasibility of operating cooling towers at elevated alkalinities and pH has previously been documented by published guidelines. The guidelines indicate that these conditions facilitate corrosion control and favor chlorine persistence which enhances the effectiveness of continuous chlorination in biofouling control. This information suggests that control of Legionella species in cooling towers can be accomplished by operating the towers under alkaline conditions. To test this possibility, we collected water samples over a period of months from a hospital cooling tower. The samples were analyzed for a variety of chemical parameters. Subsamples were pasteurized and inoculated with non-agar-passaged Legionella pneumophila which had been maintained in tap water. Correlation of subsequent Legionella growth with corresponding pH and alkalinity values revealed statistically significant inverse associations. These data support the hypothesis that operating cooling towers outside of the optimal conditions for Legionella growth (e.g., at elevated alkalinities and a pH greater than 9) may be a useful approach to controlling growth in this habitat.
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PMID:An alkaline approach to treating cooling towers for control of Legionella pneumophila. 366 15

The use of epidemiological markers for a survey is essential because of the ubiquity of legionellae, particularly L. pneumophila serogroup (SG) 1. The two settings under study were an administrative building associated with a fatal Legionnaires' Disease (LD) case due to L. pneumophila SG 1, and a hospital with 11 cases due to L. pneumophila SG 1 and 3 cases due to L. anisa. Monoclonal antibody serotyping allowed us to establish a link between the outbreaks of LD and the contamination of the hot water supply systems. Two subtypes of L. pneumophila SG 1 and L. anisa were detected in the hospital water system. However the finding of only one subtype of L. pneumophila SG 1 in the patients raised the problem of the difference in virulence of each Legionella strain. By means of aerosol tests on normal and cyclophosphamide-immunosuppressed guinea pigs, we demonstrated the potential pathogenicity of hospital water in the immunosuppressed animals. Two decontamination methods were applied: chlorination and a rise in hot water temperature. Time-limited control measures in the hospital were inadequate, resulting in only temporary eradication, followed by a rapid recolonization of legionellae and the appearance of new nosocomial cases. Decontamination of the administrative building was found to be effective when a constant concentration of 5 ppm free chlorine was obtained at tap outlets, and the water temperature was maintained at 55 C.
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PMID:Epidemiological evidence of legionellosis transmission through domestic hot water supply systems and possibilities of control. 379 49

Previous studies have shown that bacteria maintained in a low-nutrient "natural" environment such as swimming pool water are much more resistant to disinfection by various chemical agents than strains maintained on rich media. In the present study a comparison was made of the chlorine (Cl2) susceptibility of hot-water tank isolates of Legionella pneumophila maintained in tap water and strains passaged on either nonselective buffered charcoal-yeast extract or selective differential glycine-vancomycin-polymyxin agar medium. Our earlier work has shown that environmental and clinical isolates of L. pneumophila maintained on agar medium are much more resistant to Cl2 than coliforms are. Under the present experimental conditions (21 degrees C, pH 7.6 to 8.0, and 0.25 mg of free residual Cl2 per liter, we found the tap water-maintained L. pneumophila strains to be even more resistant than the agar-passaged isolates. Under these conditions, 99% kill of tap water-maintained strains of L. pneumophila was usually achieved within 60 to 90 min compared with 10 min for agar-passaged strains. Samples from plumbing fixtures in a hospital yielded legionellae which were "super"-chlorine resistant when assayed under natural conditions. After one agar passage their resistance dropped to levels of comparable strains which had not been previously exposed to additional chlorination. These studies more closely approximate natural conditions than our previous work and show that tap water-maintained L. pneumophila is even more resistant to Cl2 than its already resistant agar medium-passaged counterpart.
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PMID:Enhanced chlorine resistance of tap water-adapted Legionella pneumophila as compared with agar medium-passaged strains. 389 42

Water samples from 52 whirlpools (jacuzzi), water temperature 35-40 degrees C, and from 50 swimming pools, water temperature 8-30 degrees C, were investigated for the presence of Legionella pneumophila. This was isolated from 11 of 28 whirlpools with free available chlorine less than 0.3 mg/l. No legionellas were detected in 23 whirlpools with free available chlorine over 0.3 mg/l. Legionella pneumophila was found in two swimming pools. The results indicate that 0.3 mg/l of free available chlorine is sufficient to eliminate legionellas from whirlpools.
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PMID:A note on legionellas in whirlpools. 400 72


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