Legionnaires’ Disease: Clinicoradiological Comparison of Sporadic Versus Outbreak Cases

Hashmi, Hafiz Rizwan Talib; Saladi, Lakshmi; Petersen, Frances; Khaja, Misbahuddin; Diaz‐Fuentes, Gilda

doi:10.1177/1179548417711941

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…The 38% rate of gastrointestinal symptoms in this cohort was only slightly higher than the range of 18-32% seen in the same outbreak and sporadic groups noted. Rhabdomyolysis rates of 20-26% have been documented in sporadic case series, while our neighboring Bronx hospital found Rhabdomyolysis in 43% of their LD cases during this outbreak [52][53][54]. This is similar to the 31% rate in our cohort.…”

Section: Hospital Responsesupporting

confidence: 87%

A Review of the Public Health and Municipal Hospital Response to the Bronx County, New York Legionnaires' Disease Outbreak

Skelly¹,

Mohammad²,

Jaime³

et al. 2020

J Infect Dis Epidemiol

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Background: The second largest outbreak of Legionnaires' disease in United States history began in July, 2015 in Bronx County, NY. It was initially described as a single outbreak affecting 138 patients with 16 deaths. Subsequently, additional cases were noted in the same area and time period, officially attributed to different exposures, making the final total 155 patients and 17 deaths before ending in September, 2015. The largest portion of cases was seen at Lincoln Medical and Mental Health Center with 48 patients treated. Methods: We reviewed the hospital and public health timeline regarding the official response to the outbreak and performed performed a study of all patients who presented to Lincoln Medical and Mental Health Center from July 8 to August 03, 2015 with laboratory confirmed Legionella infection. The overall mortality was evaluated as well as risk factors for disease and clinical presentation. Results: The standard use of Legionella urine antigen testing for community acquired pneumonia allowed for early identification of the outbreak prior to public health notification. The type of public health service investigations varied by location due to non-uniform application of Centers for Disease Control guidelines. Of the 48 patients with laboratory confirmed disease, median age was 55 years. Patients presented most commonly with tachycardia (88%), fever (79%), and cough (79%). The most common clinical findings were hyponatremia (52%), rhabdomyolysis (42%) and respiratory failure (31%). Antibiotic therapy was initiated within 6 hours for 31 of 48 (65%) patients. Two patients (4%) died during this outbreak. Conclusions: Divergence from Centers for Disease Control guidelines may have limited the investigators' abilities to more accurately determine the sources for the outbreak and may have prevented this from being seen as one rolling epidemic instead of three separate events. Standard use of Legionella urine antigen testing in community acquired pneumonia by Lincoln Medical and Mental Health Center allowed for identification of the outbreak prior to the public health authorities and neighboring hospitals. Rapid diagnosis and prompt treatment led to an overall mortality of 4%.

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Section: Hospital Responsesupporting

confidence: 87%

A Review of the Public Health and Municipal Hospital Response to the Bronx County, New York Legionnaires' Disease Outbreak

Skelly¹,

Mohammad²,

Jaime³

et al. 2020

J Infect Dis Epidemiol

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“…LD is the pneumonic form of legionellosis, with a case-fatality rate of 10% (25% for healthcare-associated infections). Mortality is higher in admitted patients and immunosuppressed patients, reaching 80% ever with proper treatment (2,3). In developed countries, the incidence has increased largely due to the introduction of clinical diagnostic tests, such as the test for detection of Legionella pneumophila serogroup 1 antigen in urine samples (2).…”

Section: Introductionmentioning

confidence: 99%

Frequency of use of terminal points as an important risk factor for Legionella colonization in hospitals

Ortí-Lucas

Luciano

2019

Preprint

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Background: Hospitals have a different structure than domestic buildings. Legionella is a bacterium that can colonize the hospital water causing many outbreaks. It’s a Public Health problem and its prevention and control are essential to avoid nosocomial infections. The aims of this study are to evaluate several risk factors and parameters that can contribute to Legionella colonization in a hospital, thereby improving Legionella risk assessment process. Methods A total of 136 water samples (hot water and cold water) was investigated from different points of a hospital water network. These samples were tested for Legionella sp by three laboratories using different diagnostic tests: culture, polymerase chain reaction (PCR) and a method based on immunomagnetic separation (IMS). The results for these three techniques were combined and interpreted by three microbiologists with the aim of defining a new standard index. A multivariate analysis was performed by logistic regression to estimate the adjusted risk associated with the type of water, length of the pipe, chlorine, temperature, type of terminal point, period of the year, type of health care (ambulatory or hospital) and the frequency of use of the terminal point. Results: There was no statistically significant difference, on the basis of the new standard index, neither between laboratories nor between diagnostic tests. Positive results of this index were significantly correlated with the outpatient medical consultations, shower, frequency of use of the terminal points, and temperature. Logistic regression model revealed that outpatient medical consultations (p=0.058), shower (p=0.007) and the frequency of use of the terminal points (p=0.001) are predictors of Legionella colonization. Conclusions: The inclusion of rapid techniques (IMS, PCR) in the development of a new standard index offer increased sensitivity of Legionella detection improving classical control strategies usually based on the culture method. The proportion of hospital water-system sites testing positive, according to the defined standard index, was well correlated with the frequency of use of terminal points and the temperature, suggesting that the control of these factors may help prevent legionnaires' disease in the hospital.

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Environmental surveillance and in vitro activity of antimicrobial agents against Legionella pneumophila isolated from hospital water systems in Campania, South Italy: a 5-year study

Torre

Alfano

Borriello

et al. 2018

Environmental Research

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Legionnaires’ Disease: Clinicoradiological Comparison of Sporadic Versus Outbreak Cases

Cited by 4 publications

References 23 publications

A Review of the Public Health and Municipal Hospital Response to the Bronx County, New York Legionnaires' Disease Outbreak

A Review of the Public Health and Municipal Hospital Response to the Bronx County, New York Legionnaires' Disease Outbreak

Frequency of use of terminal points as an important risk factor for Legionella colonization in hospitals

Environmental surveillance and in vitro activity of antimicrobial agents against Legionella pneumophila isolated from hospital water systems in Campania, South Italy: a 5-year study

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