Epidemic Legionnaires' Disease Two Decades Later: Old Sources, New Diagnostic Methods

In July 1995 we investigated a pneumonia outbreak in a Pennsylvania town. We conducted epidemiological and molecular microbiological studies to determine the outbreak source and interrupt transmission of disease. Legionnaires' disease (LD) was quickly identified by urine antigen testing, and a...

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Bibliographic Details
Published in:Clinical infectious diseases 1998-02, Vol.26 (2), p.426-433
Main Authors: Fiore, Anthony E., Nuorti, J. Pekka, Levine, Orin S., Marx, Arthur, Weltman, Andre C., Yeager, Suzanne, Benson, Robert F., Pruckler, Janet, Edelstein, Paul H., Greer, Patricia, Zaki, Sherif R., Fields, Barry S., Butler, Jay C.
Format: Article
Language:English
Subjects:
Adult
Aged
Bacterial diseases
Bacterial diseases of the respiratory system
Biological and medical sciences
Case-Control Studies
Clinical Articles
Cooling towers
Disease Outbreaks
Disease transmission
Diseases
Epidemiology
Female
Health Facility Environment
Human bacterial diseases
Humans
Infectious diseases
Legionella
Legionnaires disease
Legionnaires' Disease - diagnosis
Legionnaires' Disease - epidemiology
Legionnaires' Disease - microbiology
Legionnaires' Disease - prevention & control
Lung diseases
Male
Medical sciences
Middle Aged
Preventive medicine
Respiratory diseases
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Summary:In July 1995 we investigated a pneumonia outbreak in a Pennsylvania town. We conducted epidemiological and molecular microbiological studies to determine the outbreak source and interrupt transmission of disease. Legionnaires' disease (LD) was quickly identified by urine antigen testing, and a newly developed immunohistochemical stain confirmed nosocomial transmission to a hospital inpatient. LD was confirmed in 22 patients. Case-patients were more likely than controls to have been within 1,000 feet of the hospital (matched odds ratio, 21.0; 95% confidence interval, 2.9–368) during the 2 weeks prior to illness. Legionella pneumophila serogroup 1 (Lp-1) was isolated from hospital cooling towers (CTs) and rooftop air samples but not from hospital potable water or community CTs. Hospital CT and air Lp-1 isolates matched all five patient isolates by monoclonal antibody, arbitrarily primed polymerase chain reaction, and pulsed-field gel electrophoresis subtyping. Strategies to prevent LD must include minimizing transmission from CTs.
ISSN:1058-4838
1537-6591
DOI:10.1086/516309