A Large, Travel-Associated Outbreak of Legionellosis among Hotel Guests: Utility of the Urine Antigen Assay in Confirming Pontiac Fever

Burnsed, Laurence; Hicks, Lauri A.; Smithee, Laura M. K.; Fields, Barry S.; Bradley, Kristy; Pascoe, Neil; Richards, Shawn; Mallonee, Sue; Littrell, Lisa; Benson, Robert F.; Moore, Matthew R.; Team, Legionellosis Outbreak Investigation

doi:10.1086/510387

Cited by 41 publications

(25 citation statements)

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“…26 However, the high frequency of urine antigen positivity (36%) in an Oklahoma City Pontiac fever outbreak provided reasonable evidence that the Pontiac fever outbreak was due, in part, to inhalation of live or dead L. pneumophila serogroup 1 and not just from inhalation of non-Legionella bacterial endotoxin. 25 Cases of LD may be sporadic or occur as part of an outbreak. Sporadic cases are reported throughout the year, but most cases of epidemic infection occur in the summer and autumn, presumably because warmer weather encourages proliferation of the bacteria in water.…”

Section: Microbiologymentioning

confidence: 99%

Legionella spp. and Legionnaires' disease

Diederen

2008

Journal of Infection

377

348

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Section: Microbiologymentioning

confidence: 99%

Legionella spp. and Legionnaires' disease

Diederen

2008

Journal of Infection

377

348

View full text Add to dashboard Cite

“…The challenges of culturing the organism make identification of other serogroups and other species uncommon. Pontiac fever is a self-limited hypersensitivity illness that occurs in immunocompetent hosts who are exposed to Legionella -containing aerosols, and can have positive urine antigen assays, but do not develop pneumonia [6]. …”

Section: Legionellamentioning

confidence: 99%

The role of water in healthcare-associated infections

Decker

Palmore

2013

Current Opinion in Infectious Diseases

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Purpose of review The aim is to discuss the epidemiology of infections that arise from contaminated water in healthcare settings, including Legionnaire’s disease, other Gram-negative pathogens, nontuberculous mycobacteria, and fungi. Recent findings Legionella can colonize a hospital water system and infect patients despite use of preventive disinfectants. Evidence-based measures are available for secondary prevention. Vulnerable patients can develop care-associated infections with waterborne organisms that are transmitted by colonization of plumbing systems, including sinks and their fixtures. Room humidifiers and decorative fountains have been implicated in serious outbreaks, and pose unwarranted risks in healthcare settings. Summary Design of hospital plumbing must be purposeful and thoughtful to avoid the features that foster growth and dissemination of Legionella and other pathogens. Exposure of patients who have central venous catheters and other invasive devices to tap water poses a risk for infection with waterborne pathogens. Healthcare facilities must conduct aggressive clinical surveillance for Legionnaire’s disease and other waterborne infections in order to detect and remediate an outbreak promptly. Hand hygiene is the most important measure to prevent transmission of other Gram-negative waterborne pathogens in the healthcare setting.

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“…Human infection with Legionella [4] has two distinct forms – Legionnaires' disease , a more severe form of infection which includes pneumonia, and Pontiac Fever , a milder febrile flu-like illness without pneumonia [5]. …”

Section: Introductionmentioning

confidence: 99%

Laboratory-based evaluation of legionellosis epidemiology in Ontario, Canada, 1978 to 2006

Tang²,

Jamieson

et al. 2009

BMC Infect Dis

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BackgroundLegionellosis is a common cause of severe community acquired pneumonia and respiratory disease outbreaks. The Ontario Public Health Laboratory (OPHL) has conducted most testing for Legionella species in the Canadian province of Ontario since 1978, and represents a multi-decade repository of population-based data on legionellosis epidemiology. We sought to provide a laboratory-based review of the epidemiology of legionellosis in Ontario over the past 3 decades, with a focus on changing rates of disease and species associated with legionellosis during that time period.MethodsWe analyzed cases that were submitted and tested positive for legionellosis from 1978 to 2006 using Poisson regression models incorporating temporal, spatial, and demographic covariates. Predictors of infection with culture-confirmed L. pneumophila serogroup 1 (LP1) were evaluated with logistic regression models.Results1,401 cases of legionellosis tested positive from 1978 to 2006. As in other studies, we found a late summer to early autumn seasonality in disease occurrence with disease risk increasing with age and in males. In contrast to other studies, we found a decreasing trend in cases in the recent decade (IRR 0.93, 95% CI 0.91 to 0.95, P-value = 0.001); only 66% of culture-confirmed isolates were found to be LP1.ConclusionDespite similarities with disease epidemiology in other regions, legionellosis appears to have declined in the past decade in Ontario, in contrast to trends observed in the United States and parts of Europe. Furthermore, a different range of Legionella species is responsible for illness, suggesting a distinctive legionellosis epidemiology in this North American region.

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A Large, Travel-Associated Outbreak of Legionellosis among Hotel Guests: Utility of the Urine Antigen Assay in Confirming Pontiac Fever

Abstract: Urine antigen testing, with or without serologic testing, can be used to confirm outbreak-associated cases of Pontiac fever caused by L. pneumophila serogroup 1.

Cited by 41 publications

References 30 publications

Legionella spp. and Legionnaires' disease

Legionella spp. and Legionnaires' disease

The role of water in healthcare-associated infections

Laboratory-based evaluation of legionellosis epidemiology in Ontario, Canada, 1978 to 2006

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