Legionelosis ocupacional en mayores de 18 años: revisión sistemática / Occupational legionella in adults over 18 years pf age: a systematic review

Resumen El objetivo es revisar la literatura científica sobre los problemas de salud derivados de la exposición laboral a Legionella spp. Revisión sistemática de la literatura científica recogida en las bases de datos MEDLINE (Pubmed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library Plus, Literatura Latinoamericana de Información en Ciencias de la Salud (LILACS) y SCOPUS, hasta febrero 2015. Los descriptores utilizados fueron: "Legionnaires' Disease" "Legionellosis" "Occupational Exposure" "Occupational Diseases". Se obtuvieron 222 referencias, que tras aplicar los criterios de inclusión y exclusión, se seleccionaron 13 artículos a texto completo. De ellos 9 artículos describen la aparición de neumonía, 4 Fiebre de Pontiac, 1 legionelosis o presunta legionelosis y 3 muerte. El principal agente causal en los profesionales expuestos fue Legionella pneumophila serogrupo 1. La infección por legionela está ligada a las profesiones donde existe nebulización por agua, principalmente en los trabajadores sometidos a largas exposiciones o incluso a la re-exposición. Los brotes se producen de forma estacional, sobre todo en los meses más cálidos.

Abstract The scope of this paper is to review the available scientific literature about the effects on health of occupational exposure to Legionella spp. A systematic review of the scientific literature retrieved from the MEDLINE (via PubMed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library, LILCAS and SCOPUS databases through February 2015 was conducted. The key words used were ««Legionnaires' Disease¼ «Legionellosis¼ «Occupational Exposure¼ «Occupational Diseases¼. Two hundred and twenty-two references were retrieved of which, after applying inclusion/exclusion criteria, 13 complete articles were selected. Of these, 9 describe pneumonia, 4 list Pontiac Fever, 1 reveals legionellosis and 3 result in death. The main causative agent of disease in workers exposed was Legionella pneumophila serogroup 1. Legionella spp infection is closely related to professions where there is nebulization with water, mainly among workers subjected to long exposure or even re-exposure. Outbreaks occurs seasonally, especially in the hottest months.

[Detection of Legionella pneumophila by sputum culture, direct immunofluorescence and PCR]

Community acquired pneumonia [CAP] is the main cause of mortality and morbidity world wide. Legionella pneumophila is identified as the fourth agent that causes CAP. The aim of this study was to define the prevalence of L. pneumophila among hospitalized children by culture, direct immune-fluorescence, [DFA] and PCR. In this study 210 sputum samples were collected from hospitalized children diagnosed with CAP. Samples were cultured on selective buffered charcoal-yeast extract agar [BCYE]. Existence of L. pneumophila among sputum samples was confirmed by culture, direct immunefluorescence and PCR. Our results for 210 hospitalized children showed that the sputum of 12 children, [5.7%] with acute respiratory infections was positive for L. pneumophila. Of the 12 positive samples 3, [25%] were detected by culture; 5 by DFA, [41.6%]; and 9 by PCR, [75%]. PCR is more sensitive than culture and DFA for detection of Legionella pneumonia in sputum samples

Isolation of Legionella pneumophila from clinical & environmental sources in a tertiary care hospital.

Background & objectives: Legionella pneumophila and other members of this genus are important respiratory pathogens but legionellosis often remains a neglected and under reported condition. Hence, this study was done to find out the presence of this organism in patients admitted to a tertiary care hospital with community-acquired pneumonia (CAP). Methods: A total of 470 lower respiratory tract samples and 24 water samples from hospital outlets were examined. Culture was done on buffered charcoal yeast extract agar with supplements and identification of the isolates was done by microscopy and biochemical tests. Results: L. pneumophila could be isolated from 12 (2.55%) patients suffering from community-acquired lower respiratory tract infection, unassociated with other aetiological agents of bacterial pneumonia. Of the 24 water samples tested, 8 (33.3%) grew the same organism. Interpretation & conclusion: Our study has shown that Legionella is present in the hospital environment and was the aetiological agent of lower respiratory tract infection in 2.55 per cent of patients. A larger study and reports from other parts of the country may help in determining the true significance of legionellosis in India.

Legionellosis in the EMR: alerts from other countries

During January 2007 and January 2009 the European Working Group for Legionel la Infect ions Network [EWGLINET] reported 20 confirmed cluster of cases of legionnaires' disease that have been associated with travel and stay in known hotels in some countries in the Eastern Mediterranean region [EMR]. Alerts were reported from six different European countries, Australia and the USA

Seroprevalence of Legionella pneumophila in pneumonia patients in four major hospitals in Trinidad and Tobago / Seroprevalencia de la legionella pneumophila en pacientes con neumonía en los cuatro hospitales principales de Trinidad

Trinidad and Tobago is an island-state in the Caribbean with a size of 5,128 square kilometers and a population of 1.3 million. Pneumonia is a leading cause of death in Trinidad. This project determined the frequency of Legionella pneumophila in patients with pneumonia, investigated the relationship between pneumonia and selected risk factors. Serum and demographic data were collected from 123 patients, diagnosed with pneumonia. Sera were tested for L pneumophila Ig G/M/A and IgM. All analyses were done using the SPSS statistical package. Of a total of 123 serum samples tested, 39 (31.7) were positive for L pneumophila IgM/G/A while 2 (1.6) were positive for IgM only. Hospitals, gender and ethnicity did not significantly (p > 0.05; chi-squared) affect the seroprevalence of L pneumophila. Overall, the prevalence of L pneumophila assayed was not significantly (p > 0.05, chi-squared) affected by co-morbidities.

Trinidad and Tobago es una isla del Caribe que posee una extension de 4828 kilometros cuadrados y una poblacion de 1.3 millones. La neumonia es una de las principales causas de muerte en Trinidad. Este proyecto determino la frecuencia de Legionella pneumophila en pacientes con neumonia, e investigo la relacion entre la neumonia y los factores de riesgo seleccionados. Se recopilaron datos sericos y demograficos de 123 pacientes, diagnosticados con neumonia. Los sueros fueron sometidos a analisis a fin de determinar la presencia de L. pneumophila Ig G/M/A y Ig M. Todos los analisis se realizaron usando el paquete estadistico SPSS (Statistical Package for the Social Sciences). De un total de 123 muestras de suero analizadas, 39 (31.7%) dieron positivas frente a L. pneumophila Ig M/G/A, mientras que 2 (1.6%) dieron positivo frente a Ig M solamente. Los hospitales, el genero y la etnicidad no afectaron significativamente la seroprevalencia de L. pneumophila (p > 0.05; c2). En general, la prevalencia de L. pneumophila ensayada no fue afectada significativamente por comorbidades (p > 0.05, c2).

Detección de infección aguda por Legionella pneumophila en pacientes con neumonia adquirida en la comunidad en la ciudad de Buenos Aires / [Detection of acute infection due to legionella pneumophila in patient with community acquired pneumonia in Buenos Aires city]

Community-acquired pneumonia (CAP) is caused by different microorganisms, their frequency varying in each community. Legionella pneumophila has been reported as etiologic agent of CAP. The aim of our study was to determine the incidence of acute infection due to Legionella pneumophila in a group of adult patients in Buenos Aires city. Adults of both sexes with CAP diagnosis were included and two serum samples, acute and convalescence (2-4 weeks apart from each other), were tested to detect antibodies against Legionella pneumophila by indirect immunofluorescence (IFI) (Organon Teknica, NC, USA). Ninety-two of the enrolled patients were evaluable, average age 56 years, 55

) fulfilled the serologic diagnostic criteria for Legionella pneumophila acute infection. None of them were confirmed by microorganism isolation. The actual incidence of CAP caused by Legionella pneumophila in Argentina has not yet been established. It will require studies including larger numbers of patients and the use of simple and sensitive tests, such as Legionella pneumophila urinary antigen detection, to establish the exact role of this pathogen in our community.

Legionnaires' disease: a rare entity in Puerto Rico?

Legionnaires' disease is a severe, often fatal pneumonia, caused by Legionella pneumophila. Its incidence is reported about 6. In Puerto Rico, there is no data available of the prevalence of Legionnaires' disease. A case of Legionnaires' is presented as well as data to support that the prevalence in our Island is higher than the reported elsewhere.

Tourism and emerging and re-emerging infectious diseases in the Americas: What physicians must remember for patient diagnosis and care

Emerging diseases are those which have shown an increased in humans over the last 20 years. Re-emerging diseases are those which have reappeared after a period of significant decrease in incidence. The etiological agents of these diseases in the Western Hemisphere are viroses (HIV, dengue, oroupuche, sabia, guanarito, or hanta), bacteria (Vibrio cholera, Borrellia burgdorferi, Legionella pneumofila, Escherichia coli O157:H7, or other bacteria with a new pattern of antibiotic resistence), or parasites (Cryptosporidia, Cyclosporidia or drug resistant Plasmodium falciparum). Due to the widespread geographical distribution of these infectious diseases in the Americas, and an increasing number of travellers (more than 87 milion persons within the region in 1997), there are many opportunities to contract an infection when travelling in developed or undeveloped countries. The infections may present with symptoms during the trip, or following the traveler's return to his or her place of origin. However, too often practicing physicians do not inquire about the travel history of their patients and, when they do, they often lack the information about diseases relevant to travelers. From the regional perspective, the emerging or reemerging agents that pose a higher risk to tourists or travelers are: 1) those that cause enteric infections; 2) sexually transmitted diseases; and 3) vector-borne diseases, including those present in ecotourism areas. Emerging and re-emerging diseases that physicians may encounter in their clinical practice while caring for travelers returning from different countries of the Western Hemisphere are briefly described (Lyme diseases, legionellosis, dengue, yellow fever, P. falciparum malaria, cyclosporidiosis and cryptosporidiosis). This report attempts to draw attention to the fact that new clinical and etiological entities are present in several geographical areas of the Americas; to place each of the these entities into an epidemiological context; and to end the misconception that only travel to poor coutries carries a risk of acquiring an infection. By knowing which infectious agents occur in each area and the incubation period of each disease, the treating physician can often patients sucessfully. Health care professionals must be aware of the organisms circulating in the region so that they have them in mind during their clinical practice.

Seroprevalencia de legionella pneumophila en Santiago: evidencias de exposición durante la infancia / Seroprevalence of legionella pneumophila in Santiago: evidence of exposure during chilhood

Se evaluó la exposición previa a legionella pneumophila de un grupo de 120 sujetos chilenos, sanos, menores de 20 años, estratificados según nivel socioeconómico. Las muestras de suero fueron analizadas, para la detección de anticuerpos de legionella pneumophila serogrupos 1 a 6, por técnica de inmunofluorescencia indirecta considerando positivos títulos iguales o mayores a 1:64. Doce de los 120 sujetos fueron positivos (10 por ciento); se observaron distintos grados de seroprevalencia según niveles socioeconómicos: 0/40 para el mas bajo; 2/40 (5 por ciento) en el nivel medio y 10/49 (25 por ciento) alto. El mayor título registrado fue 1:128. El nivel socioeconómico alto está asociado con la prevalencia mas alta de anticuerpos anti-legionella pneumophila en población chilena

Legionnaires'disease in the renal transplant unit of Hospital das Clinicas FMUSP: during a five year period (1988-1993)

Embora varios trabalhos tem mostrado a presenca de Legionella pneumophila associado a pneumopatias infecciosas em transplantados renais, tal associacao nao fora antes realizado de maneira sistematica no Brasil. Os autores julgaram oportuno a determinacao da incidencia por comprovacao sorologica da Legionella pneumophila sorogrupo 1 em transplantados renais num periodo de 5 anos. Para tanto amostras de soros de 70 pacientes com pneumopatia infecciosa internados na UTR do HC-FMUSP, colhidos na fase aguda e convalescente da infeccao, foram submetidas a reacao de imunofluorescencia indireta para pesquisa de anticorpos anti-Legionella pneumophila sorogrupo 1....

Isolation of Legionella pneumophila from patients of respiratory tract disease & environmental samples.

In this preliminary study 45 patients suffering from pneumonia were screened for L. pneumophila. Also 17 random environmental samples viz., water from cooling system used for air-conditioning units and samples from respirator-humidifier were screened. Four of 45 (9%) clinical specimens and 13 of 17 (76%) environmental samples showed presence of L. pneumophila. This is the first report from India of the isolation on L. pneumophila.

Pneumonia por Legionella pneumophila: relato do segundo caso brasileiro / Pneumonia caused by Legionella pneumophila: report of the 2nd brazilian case

Relata-se um caso de pneumonia por Legionella pneumophila, diagnosticado pela primeira vez em Porto Alegre, Rio Grande do Sul. A hipótese diagnóstica foi confirmada por imunofluorescência indireta nas amostras de soro do paciente enviadas ao C.D.C. (Atlanta - E. U. A.), com títulos de 1:128 na amostra da fase aguda e 1:512 na amostra da fase de convalescença