Nosocomial legionnaires' disease: Aspiration as a primary mode of disease acquisition

Blatt, Stephen P.; Parkinson, Michael; Pace, Emily A.; Hoffman, Patricia; Dolan, Donna M.; Lauderdale, Patricia; Zajac, Robert A.; Melcher, Gregory P.

doi:10.1016/0002-9343(93)90227-g

Cited by 154 publications

(72 citation statements)

References 29 publications

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“…In this outbreak, typing by pulsed-field gel electrophoresis revealed that the B. pseudomallei strains isolated from six of the nine patients showed restriction digestion patterns identical to that for a strain isolated from the community water supply but not for soil isolates (4). This is in line with the evidence that B. pseudomallei bacteria, similar to Legionella pneumophila bacteria, have the ability to survive as endosymbionts in free-living amebae (7), and water supply has been quoted as a major reservoir and source of legionellosis (2). Further studies should be carried out to ascertain the importance of water supplies as reservoirs of B. pseudomallei, which would have important implications for infection control measures that have to be taken.…”

supporting

confidence: 73%

Seronegative Bacteremic Melioidosis Caused by Burkholderia pseudomallei with Ambiguous Biochemical Profile: Clinical Importance of Accurate Identification by 16S rRNA Gene and groEL Gene Sequencing

et al. 2003

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An aerobic gram-negative bacterium was isolated from the blood and sputum of an 84-year-old, chair-bound nursing home resident with acute bacteremic pneumonia. Although the phenotypic characteristics suggested that the bacterium could be Burkholderia pseudomallei, the Vitek 1 system (GNI؉), which can successfully identify 99% of B. pseudomallei strains, showed that the bacterium was "unidentified." Immunoglobulin G against the lipopolysaccharide (LPS) of B. pseudomallei, as detected by an LPS-based enzyme-linked immunosorbent assay with 95% sensitivity, was negative in both the acute-phase and convalescent-phase sera.

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supporting

confidence: 73%

Seronegative Bacteremic Melioidosis Caused by Burkholderia pseudomallei with Ambiguous Biochemical Profile: Clinical Importance of Accurate Identification by 16S rRNA Gene and groEL Gene Sequencing

et al. 2003

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“…Further links between L. longbeachae infection and potting mix have been made in Australia, Japan and the United States, through case-series and laboratory evidence [6][7][8][9]. Transmission of L. longbeachae has been proposed through mechanisms common to other Legionella species, specifically inhalation of contaminated aerosols, and ingestion (via contaminated hands) then microaspiration of organisms [10,11].…”

Section: Introductionmentioning

confidence: 99%

Does using potting mix make you sick? Results from a Legionella longbeachae case-control study in South Australia

et al. 2006

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SUMMARYA case-control study was performed in South Australia to determine if L. longbeachae infection was associated with recent handling of commercial potting mix and to examine possible modes of transmission. Twenty-five laboratory-confirmed cases and 75 matched controls were enrolled between April 1997 and March 1999. Information on underlying illness, smoking, gardening exposures and behaviours was obtained by telephone interviews. Recent use of potting mix was associated with illness (OR 4 . 74, 95% CI 1 . 65-13 . 55, P=0 . 004) in bivariate analysis only. Better predictors of illness in multivariate analysis included poor hand-washing practices after gardening, long-term smoking and being near dripping hanging flower pots. Awareness of a possible health risk with potting mix protected against illness. Results are consistent with inhalation and ingestion as possible modes of transmission. Exposure to aerosolized organisms and poor gardening hygiene may be important predisposing factors to L. longbeachae infection.

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“…6 Acquisition of legionnaires' disease usually occurs following the aspiration or inhalation of aerosols from contaminated potable water or cooling towers. [7][8][9][10][11][12][13][14] Most hospital-acquired outbreaks of legionnaires' disease have been associated with the contamination of hospital drinking water with Legionella species. 15 Efforts to prevent hospital-acquired legionnaires' disease have focused on increasing the temperature of hot water and the supplemental chlorination of drinking water.…”

mentioning

confidence: 99%

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

Heffelfinger

Kool²,

Fridkin³

et al. 2003

Infect. Control Hosp. Epidemiol.

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Objective:To measure the association between the disinfection of municipal drinking water with monochloramine and the occurrence of hospital-acquired legionnaires' disease (LD).Setting:One hundred sixty-six U.S. hospitals.Design:Survey of 459 members of the Society for Healthcare Epidemiology of America (SHEA) for hospital features; endemic- and outbreak-related, hospital-acquired LD; the source of the hospital water supply; and the methods of disinfection used by the hospitals and municipal water treatment plants.Results:SHEA members representing 166 (36%) of 459 hospitals responded; 33 (20%) reported one or more episodes of hospital-acquired LD during the period from 1994 to 1998 and 23 (14%) reported an outbreak of hospital-acquired LD during the period from 1989 to 1998. Hospitals with an occurrence of hospital-acquired LD had a higher census (median, 319 vs 221;P= .03), more acute care beds (median, 500 vs 376;P= .04), and more intensive care unit beds (median, 42 vs 24;P= .009) than did other hospitals. They were also more likely to have a transplant service (74% vs 42%;P= .001) and to perform surveillance for hospital-acquired disease (92% vs 61%;P= .001). After adjustment for the presence of a transplant program and surveillance for legionnaires' disease, hospitals supplied with drinking water disinfected with monochloramine by municipal plants were less likely to have sporadic cases or outbreaks of hospital-acquired LD (odds ratio, 0.20; 95% confidence interval, 0.07 to 0.56) than were other hospitals.Conclusion:Water disinfection with monochloramine by municipal water treatment plants significantly reduces the risk of hospital-acquired LD.

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Nosocomial legionnaires' disease: Aspiration as a primary mode of disease acquisition

Cited by 154 publications

References 29 publications

Seronegative Bacteremic Melioidosis Caused by Burkholderia pseudomallei with Ambiguous Biochemical Profile: Clinical Importance of Accurate Identification by 16S rRNA Gene and groEL Gene Sequencing

Seronegative Bacteremic Melioidosis Caused by Burkholderia pseudomallei with Ambiguous Biochemical Profile: Clinical Importance of Accurate Identification by 16S rRNA Gene and groEL Gene Sequencing

Does using potting mix make you sick? Results from a Legionella longbeachae case-control study in South Australia

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

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