An Outbreak of Pontiac Fever with Respiratory Distress among Workers Performing High‐Pressure Cleaning at a Sugar‐Beet Processing Plant

Abstract

Outbreak features were consistent with Pontiac fever. Respiratory symptoms, which are atypical for Pontiac fever, could be attributed to a high exposure dose of L. pneumophila from confined-space aerosolization or to endotoxin exposure. This outbreak demonstrates the potential occupational hazards for those performing high-pressure cleaning in confined spaces.

Urine Antigen Tests Positive for Pontiac Fever: Implications for Diagnosis and Pathogenesis

“…One child with Pontiac fever had a tracheal culture positive for L. pneumophila, providing some support for the role of inhalation of live L. pneumophila in the pathogenesis of Pontiac fever [10]. Pontiac fever shares many similarities to illness caused by bacterial endotoxin inhalation, and 2 of 3 recent Pontiac fever investigations that looked for airborne endotoxin have shown elevated endotoxin levels at outbreak sites [11][12][13][14]. L. pneumophila makes a poorly pyrogenic endotoxin that is unable to bind to CD14, a major cellular endotoxin receptor, making this endotoxin an unlikely disease culprit [15].…”

“…As might be expected, none of 91 patients in 4 different Pontiac fever outbreaks associated with Legionella species other than L. pneumophila had tests positive for L. pneumophila serogroup 1 antigenuria [4,5,12,18]. Only 4 of the 45 patients with Pontiac fever in 4 different outbreaks associated with L. pneumophila serogroup 1 had positive test results, and all 4 positive test results (4 [22%] of 18 tests) were from outbreaks associated with the Pontiac monoclonal subtype of L. pneumophila serogroup 1 [10,11,19,20]. The urine antigen test is significantly more sensitive for the detection of Pontiac subtype legionnaires disease than for legionnaires disease due to other monoclonal types of L. pneumophila serogroup 1 [21].…”

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

“…As we now know, these two syndromes may coexist within an exposed population ( Fig. 1) (16)(17)(18), but it is unclear whether Pontiac fever is one potential outcome in the spectrum of disease severity or whether it is due to the presence of nonviable legionellae, amoebal pathogens, and/or high levels of bacterial endotoxin (19)(20)(21)(22)(23).…”

Adsorption of Endotoxin from Aqueous Solution Using Bone Char

“…The potential pathways of water-associated endotoxin exposure in humans include direct introduction in to the blood stream via semi permeable dialysis membranes and inhalation of moisture-saturated air in showers, swimming pools, hot tubs, saunas, and dental offices (Anderson et al 2007). Exposure to endotoxins by drinking water used for preparation or dilution of solutions for intravenous injection or dialysis may be even more serious (Castor et al 2005). Several other settings for endotoxin exposure include sawmills, paper recycling plants (repulping and deinking), fiberglass manufacturing, animal handling, cotton/textile milling, hemp processing and potato sorting (Sarantila et al 2001;Anderson et al 2007).…”