ABSTRACT
A biologic wastewater treatment plant was identified as a common source for 2 consecutive Legionnaires' disease clusters in the Netherlands in 2016 and 2017. Sequence typing and transmission modeling indicated direct and long-distance transmission of Legionella, indicating this source type should also be investigated in sporadic Legionnaires' disease cases.
Subject(s)
Legionnaires' Disease/epidemiology , Waste Management , Wastewater/microbiology , Water Microbiology , Aged , Aged, 80 and over , Comorbidity , Disease Outbreaks , Female , Geography, Medical , Hospitalization , Humans , Legionnaires' Disease/transmission , Male , Middle Aged , Netherlands/epidemiology , Public Health Surveillance , SeasonsABSTRACT
This case report describes a case of Legionnaires' disease for whom the source of infection was the campervan in which the patient had travelled for 3 months. This case shows that Legionnaires' disease can be acquired by exposure to a relatively new (not previously reported) source that is commonly used as (holiday)transportation vehicle.
Subject(s)
Legionnaires' Disease/diagnosis , Motor Vehicles , Travel , Aged , Anti-Bacterial Agents/administration & dosage , Ceftriaxone/administration & dosage , Fluoroquinolones/administration & dosage , Humans , Legionella pneumophila , Legionnaires' Disease/drug therapy , Male , MoxifloxacinABSTRACT
Legionella bacteria are ubiquitous in natural matrices and man-made systems. However, it is not always clear if these reservoirs can act as source of infection resulting in cases of Legionnaires' disease. This review provides an overview of reservoirs of Legionella reported in the literature, other than drinking water distribution systems. Levels of evidence were developed to discriminate between potential and confirmed sources of Legionella. A total of 17 systems and matrices could be classified as confirmed sources of Legionella. Many other man-made systems or natural matrices were not classified as a confirmed source, since either no patients were linked to these reservoirs or the supporting evidence was weak. However, these systems or matrices could play an important role in the transmission of infectious Legionella bacteria; they might not yet be considered in source investigations, resulting in an underestimation of their importance. To optimize source investigations it is important to have knowledge about all the (potential) sources of Legionella. Further research is needed to unravel what the contribution is of each confirmed source, and possibly also potential sources, to the LD disease burden.
