Legionellosis

  • David W. Fraser

Abstract

Legionellosis is an acute human infection commonly manifested as pneumonia and caused by any of several species of Legionella, including L. pneumophila, L. bozemanii, L. micdadei, L. dumoffii, L. longbeachae, L. jordanis, L. wadsworthii, L. feeleii, L. maceachernii, L. hackeliae, L. gormanii, L. oakridgensis, L. sainthelensi, L. anisa, L. jamestownensis, L. rubrilucens, L. erythra, L. spiritensis, L. parisiensis, L. cherrii, L. steigerwaltii, L. santicrucis, and L. israelensis, all of which are fastidious gram-negative bacilli and the first ten of which have been confirmed by culture to cause disease in humans. (13)Occurring in clusters and sporadically, the long-incubation-period pneumonic form (Legionnaires’ disease) is frequently mistaken for “viral pneumonia,” which may be a serious error, because specific therapy may prevent death. Nonpneumonic, shortincubation-period legionellosis (Pontiac fever) may also occur in clusters, but this syndrome appears to be self-limited.

Keywords

Nosocomial Pneumonia Respiratory Secretion Acute Bacterial Infection Disease Bacterium Pontiac Fever 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Anderson, R. D., Lauer, B. A., Fraser, D. W., Hayes, P. S., and Mcintosh, K., Infections with Legionella pneumophilain children, J. Infect. Dis. 143:386–390 (1981).CrossRefGoogle Scholar
  2. 2.
    Arnow, P. M., Chou, T., Weil, D., Shapiro, E. N., and Kretzschmar, C., Nosocomial Legionnaires’ disease caused by aerosolized tap water from respiratory devices, J. Infect. Dis. 146:460–467 (1982).PubMedCrossRefGoogle Scholar
  3. 3.
    Arnow, P. M., Boyko, E. J., and Friedman, E. L., Perirectal abscess caused by Legionella pneumophilaand mixed anaerobic bacteria, Ann. Intern. Med. 98:184–185 (1983).PubMedGoogle Scholar
  4. 4.
    Arnow, P. M., Weil, D., and Para, M. F., Prevalence and significance of Legionella pneumophilacontamination of residential hot tap water systems, J. Infect. Dis. 152:145–151 (1985).PubMedCrossRefGoogle Scholar
  5. 5.
    Band, J. D., Laventure, M., Davis, J. P., Mallison, G. F., Skaliy, P., Hayes, P. S., Schell, W. L., Weiss, H., Greenberg, D. J., and Fraser, D. W. Epidemic Legionnaires’ disease: Airborne transmission down a chimney, J.Am. Med. Assoc. 245:2404–2407 (1981).CrossRefGoogle Scholar
  6. 6.
    Barbaree, J. M., Fields, B. S., Feeley, J. C., Gorman, G. W., and Martin, W. T., Isolation of protozoa from water associated with a Legionellosis outbreak and demonstration of intracellular multiplication of Legionella pneumophila, Appl. Environ. Microbiol. 51:422–424 (1986).Google Scholar
  7. 7.
    Bartlett, C. L. R., Swann, R. A., Casal, J., Canada Royo, L., and Taylor, A. G., Recurrent Legionnaires’ disease from a hotel water system, in: Legionella(C. Thornsberry, A. Balows, J. C. Feeley, and W. Jakubowski, eds.), pp. 237–239, American Society for Microbiology, Washington, D.C., 1984.Google Scholar
  8. 8.
    Best, M., Yu, V. L., Stout, J., Goetz, A., Muder, R. R., and Taylor, F., Legionellaceae in the hospital water supply, Lancet 2:307–310 (1983).PubMedCrossRefGoogle Scholar
  9. 9.
    Blackmon, J. A., Hicklin, M. D., Chandler, R. W., and the Special Expert Pathology Panel, Legionnaires’ disease: Pathological and historical aspects of a “new” disease, Arch. Pathol. Lab. Med. 102:337–343 (1978).PubMedGoogle Scholar
  10. 10.
    Boldur, L., Ergaz, M., and Sompolinsky, D., A prevalence study of antibodies to Legionellaspp. in geriatric institutions, J. Hyg. 92:37–43 (1984).CrossRefPubMedGoogle Scholar
  11. 11.
    Bozeman, F. M., Humphries, J. W., and Campbell, J. M., A new group of rickettsia-like agents recovered from guinea pigs, Acta Virol. 12:87–93 (1968).PubMedGoogle Scholar
  12. 12.
    Brabender, W., Hinthorn, D. R., Asher, M., Lindsey, N. J., and Liu, C., Legionella pneumophilawound infection, J. Am. Med. Assoc. 250:3091–3092 (1983).CrossRefGoogle Scholar
  13. 13.
    Brenner, D. J., Classification of Legionellaceae:Current status and remaining questions, Isr. J. Med. Sci. 22:620–632 (1986).PubMedGoogle Scholar
  14. 14.
    Brenner, D. J., Steigerwalt, A. G., and Mcdade, J. E., Classification of the Legionnaires’ disease bacterium: Legionella pneumophila, genus novum, species nova, of the family Legionellaceae, familia nova, Ann. Intern. Med. 90:656–658 (1979).PubMedGoogle Scholar
  15. 15.
    Brenner, D. J., Steigerwalt, A. G., Gorman, G. W., Weaver, R. E., Feeley, J. C., Cordes, L. G., Wilkinson, H. W., Patton, C., Thomason, B. M., and Sasseville, K. R. L., Legionella bozemaniisp. nov. and Legionella dumoffiisp. nov.: Classification of two additional species of Legionellaassociated with human pneumonia, Curr. Microbiol. 4:111–116 (1980).CrossRefGoogle Scholar
  16. 16.
    Broome, C. V., Goings, S. A. J., Thacker, S. B., Vogt, R. L., Beaty, H. N., Fraser, D. W., and Field Investigation Team, The Vermont epidemic of Legionnaires’ disease, Ann. Intern. Med. 90:573–577 (1979).PubMedGoogle Scholar
  17. 17.
    Buehler, J. W., Sikes, R. K., Kuritsky, J. N., Gorman, G. W., Hightower, A. W., and Broome, C. V., Prevalence of antibodies to Legionella pneumophilaamong workers exposed to a contaminated cooling tower, Arch. Environ. Health 40:207–210 (1985).PubMedCrossRefGoogle Scholar
  18. 18.
    Chandler, F. W., Hicklin, M. D., and Blackmon, J. A., Demonstration of the agent of Legionnaires’ disease in tissue, N. Engl. J. Med. 297:1218–1220 (1977).PubMedCrossRefGoogle Scholar
  19. 19.
    Chandler, F. W., Cole, R. M., Hicklin, M. D., Blackmon, J. A., and Callaway, C. S., Ultrastructure of the Legionnaires’ disease bacterium: A study using transmission electron microscopy, Ann. Intern. Med. 90:642–647 (1979).PubMedGoogle Scholar
  20. 20.
    Cherry, W. B., Pittman, B., Harris, P. P., Hebert, G. A., Thomason, B. M., Thacker, L., and Weaver, R. E., Detection of Legionnaires’ disease bacteria by direct immunofluorescent staining, J. Clin. Microbiol. 8:329–338 (1978).PubMedGoogle Scholar
  21. 21.
    Cohen, M. L., Broome, C. V., Paris, A., Martin, W. T., and Allen, J. R., Fatal nosocomial Legionnaires’ disease: Clinical and epidemiologic characteristics, Ann. Intern. Med. 90:611–613 (1979).PubMedGoogle Scholar
  22. 22.
    Colburne, J. S., and Ashworth, J., Rubbers, water and Legionella, Lancet 2:583 (1986).CrossRefGoogle Scholar
  23. 23.
    Colburne, J. S., Dennis, P. J., Lee, J. V., and Bailey, M. R., Legionnaires’ disease: Reduction in risks associated with foaming in evaporative cooling towers, Lancet 1:684 (1987).CrossRefGoogle Scholar
  24. 24.
    Conlan, J. W., Baskerville, A., and Ashworth, L. A. E., Separation of Legionella pneumophilaproteases and purification of a protease which produces lesions like those of Legionnaires’ disease in a guinea pig lung, J. Gen. Microbiol. 132:1565–1574 (1986).PubMedGoogle Scholar
  25. 25.
    Cossar, J. H., Dewar, R. D., Fallon, R. J., Grist, N. R., and Reid, D., Legionella pneumophilain tourists, Practitioner 226:1543–1548 (1982).PubMedGoogle Scholar
  26. 26.
    Deubner, D. C., and Gilliam, D. K., Fever of undetermined origin after cleaning of steam turbine condensers, Arch. Environ. Health 32:116–120 (1977).PubMedGoogle Scholar
  27. 27.
    Dondero, T. J. Jr., Rendtorff, R. C. Mallison, G. F., Weeks, M., Levy, J., Wong, E. W., and Schaffner, W., Outbreak of Legionnaires’ disease associated with a contaminated air conditioning cooling tower, N. Engl. J. Med. 302:425–431 (1980).CrossRefGoogle Scholar
  28. 28.
    Dowling, J. N., Pasculle, A. W., Frola, F. N., Zaphyr, K., and Yee, R. B., Infections caused by Legionella micdadeiand Legionella pneumophilaamong renal transplant recipients, J. Infect. Dis. 149:703–713 (1984).PubMedCrossRefGoogle Scholar
  29. 29.
    Edelstein, P. H., Laboratory diagnosis of infections caused by Legionellae, Eur. J. Clin. Microbiol. 6:4–10 (1987).PubMedCrossRefGoogle Scholar
  30. 30.
    Edelstein, P. H., Meyer, R. D., and Finegold, S. M. Laboratory diagnosis of Legionnaires’ disease, Am. Rev. Respir. Dis. 121:317–327 (1980).PubMedGoogle Scholar
  31. 31.
    Fallon, R. J., Legionella infections, Br. Med. J. 293:1175 (1986).CrossRefGoogle Scholar
  32. 32.
    Finland, M., “Legionnaires’ disease”: They came, saw, and conquered, Ann. Intern. Med. 90:710–713 (1979).PubMedGoogle Scholar
  33. 33.
    Fisher-Hoch, S. P., Bartlett, C. L. R., Tobin, J. O., Gillett, M. B., Nelson, A. M., Pritchard, J. E., Smith, M. G., Swann, R. A., Talbot, J. M., and Thomas, J. A., Investigation and control of an outbreak of Legionnaires’ disease in a district general hospital, Lancet 1:932–936 (1981).PubMedCrossRefGoogle Scholar
  34. 34.
    Foy, H. M., Broome, C. V., Hayes, P. S., Allan, I., and Tobe, R., Legionnaires’ disease in a prepaid medical care group in Seattle (1963–1975), Lancet 1:767–770 (1979).PubMedCrossRefGoogle Scholar
  35. 35.
    Fraser, D. W., Unpublished data.Google Scholar
  36. 36.
    Fraser, D. W., Tsai, T. F., Orenstein, W., Parkin, W. E., Beecham, H. J., Sharrar, R. G., Harris, J., Mallison, G. F., Martin, S. M., Mcdade, J. E., Shepard, C. C., Brachman, P. S., and The Field Investigation Team, Legionnaires’ disease: Description of an epidemic of pneumonia, N. Engl. J. Med. 297:1189–1197 (1977).PubMedCrossRefGoogle Scholar
  37. 37.
    Fraser, D. W., Deubner, D. C., Hill, D. L., and Gilliam, D. K., Nonpneumonic, short-incubation-period legionellosis (Pontiac fever) in men who cleaned a steam turbine condenser, Science 205:690–691 (1979).PubMedCrossRefGoogle Scholar
  38. 38.
    Garbe, P. L., Davis, B. J., Weisfeld, J. S., Markowitz, L., Miner, P., Garrity, F., Barbaree, J. M., and Reingold, A. L., Nosocomial Legionnaires’ disease: Epidemiologic demonstration of cooling towers as a source, J. Am. Med. Assoc. 254:521–524 (1985).CrossRefGoogle Scholar
  39. 39.
    Glick, T. H., Gregg, M. B., Berman, B., Mallison, G. F., Rhodes, W. W., Jr., and Kassanoff, I., Pontiac fever: An epidemic of unknown etiology in a health department. Clinical and epidemiologic aspects, Am. J. Epidemiol. 107:149–160 (1978).PubMedGoogle Scholar
  40. 40.
    Haley, C. E., Cohen, M. L., Halter, J., and Meyer, R. D., Nosocomial Legionnaires’ disease: A continuing common-source epidemic at Wadsworth Medical Center, Ann. Intern. Med. 90:583–586 (1979).PubMedGoogle Scholar
  41. 41.
    Hanrahan, J. P., Morse, D. L., Scharf, V. B., Debbie, J. G., Schmid, G. P., Mckinney, R. M., and Shayegani, M., Community hospital legionellosis outbreak linked to hotwater showers, in: Legionella(C. Thornsberry, A. Balows, J. C. Feeley, and W. Jakubowski, eds.), pp. 224–225, American Society for Microbiology, Washington, D.C., 1984.Google Scholar
  42. 42.
    Hebert, G. A., Steigerwalt, A. G., and Brenner, D. J., Legionella micdadeispecies nova: Classification of a third species of Legionellaassociated with human pneumonia, Curr. Microbiol. 3:255–257 (1980).CrossRefGoogle Scholar
  43. 43.
    Helms, C. M., Viner, J. P., Sturm, R. H., Renner, E. D., and Johnson, W., Comparative features of pneumococcal, mycoplasmal, and Legionnaires’ disease pneumonias, Ann. Intern. Med. 90:543–547 (1979).PubMedGoogle Scholar
  44. 44.
    Helms, C. M., Viner, J. P., Weisenburger, D. D., Chiu, L. C., Renner, E. D., and Johnson, W., Sporadic Legionnaires’ disease: Clinical observations on 87 nosocomial and community-acquired cases, Am. J. Med. Sci. 288:2–12 (1984).PubMedCrossRefGoogle Scholar
  45. 45.
    Herwaldt, L. A., Gorman, G. W., Mcgrath, T., Toma, S., Brake, B., Hightower, A. W., Jones, J., Reingold, A. L., Boxer, P. A., Tang, P. W., Moss, C. W., Wilkinson, H. W., Brenner, D. J., Steigerwalt, A. G., and Broome, C. V., A new Legionellaspecies, Legionella feeleiispecies nova, causes Pontiac fever in an automobile plant, Ann. Intern. Med. 100:333–338 (1984).PubMedGoogle Scholar
  46. 46.
    Horwitz, M. A., Cell mediated immunity in Legionnaires’ disease, J. Clin. Invest. 71:1686–1697 (1983).PubMedCrossRefGoogle Scholar
  47. 47.
    Horwitz, M. A., Phagocytosis of the Legionnaires’ disease bacterium (Legionella pneumophila) occurs by a novel mechanism: Engulfment within a pseudopod coil, Cell 36:27–33 (1984).PubMedCrossRefGoogle Scholar
  48. 48.
    Horwitz, M. A., and Silverstein, S. C., Legionnaires’ disease bacterium (Legionella pneumophila)multiplies intracellularly in human monocytes, J. Clin. Invest. 66:441–450 (1980).PubMedCrossRefGoogle Scholar
  49. 49.
    Johnson, J. T., Yu, V. L., Wagner, R. L., and Best, M. G., Nosocomial Legionella pneumonia (sic) ina population of head and neck cancer patients, Laryngoscope 95:1468–1471 (1985).PubMedCrossRefGoogle Scholar
  50. 50.
    Joly, J. R., Dery, P., Gauvreau, L., Cote, L., and Trepanier, C., Legionnaires’ disease caused by Legionella dumoffiiin distilled water, Can. Med. Assoc. J. 135:1274–1277 (1986).Google Scholar
  51. 51.
    Kaan, J. A., Simoons-Smit, A. M., and Maclaren, D. M., Another source of aerosol causing nosocomial Legionnaires’ disease, J. Infect. 11:145–148 (1985).PubMedCrossRefGoogle Scholar
  52. 52.
    Kaufmann, A. F., Mcdade, J. E., Patton, C. M., Bennett, J. V., Skaliy, P., Feeley, J. C., Anderson, D. C., Potter, M. E., Newhouse, V. F., Gregg, M. B., and Brachman, P. S., Pontiac fever: Isolation of the etiologic agent (Legionella pneumophila)and demonstration of its mode of transmission, Am. J. Epidemiol. 114:337–347 (1981).PubMedGoogle Scholar
  53. 53.
    Klaucke, D. N., Vogt, R. L., Larue, D., Witherell, L. N., Orciari, L. A., Spitalny, K. C., Pelletier, R., Cherry, W. B., and Novick, L. F., Legionnaires’ disease: The epidemiology of two outbreaks in Burlington, Vermont, 1980, Am. J. Epidemiol. 119:382–391 (1984).PubMedGoogle Scholar
  54. 54.
    Kohler, R. B., Antigen detection for the rapid diagnosis of mycoplasma and Legionellapneumonia, Diagn. Microbiol. Infect. Dis. 4:47S–59S (1986).PubMedCrossRefGoogle Scholar
  55. 55.
    Kohler, R. B., Winn, W. C., Jr., and Wheat, L. J., Onset and duration of urinary antigen excretion in Legionnaires’ disease, J. Clin. Microbiol. 20:605–607 (1984).PubMedGoogle Scholar
  56. 56.
    Kugler, J. W., Armitage, J. O., Helms, C. M., Klassen, L. W., Goeken, N. E., Ahmann, G. B., Gingrich, R. D., Johnson, W., and Gilchris, M. J., Nosocomial Legionnaires’ disease: Occurrence in recipients of bone marrow transplants, Am. J. Med. 74:281–288 (1983).PubMedCrossRefGoogle Scholar
  57. 57.
    Kuritsky, J. N., Reingold, A. L., Hightower, A. W., and Broome, C. V., Sporadic legionellosis in the United States, 1970 to 1982, in: Legionella(C. Thornsberry, A. Balows, J. C. Feeley, and W. Jakubowski, eds.), pp. 243–245, American Society for Microbiology, Washington, D.C., 1984.Google Scholar
  58. 58.
    Kurtz, J. B., Bartlett, C. L. R., Newton, V. A., White, R. A., and Jones, N. L., Legionella pneumophilain cooling water systems, J. Hyg. 88:369–381 (1982).CrossRefPubMedGoogle Scholar
  59. 59.
    L’age, M., Horbach, I., Ulmrich, W., Weyer, H., and Fehrenbach, F. J., Legionerskrankheit bei einer Inland-Reisegruppe, Dtsch. Med. Wochenschr. 108:288–292 (1983).PubMedCrossRefGoogle Scholar
  60. 60.
    Lattimer, G. L., Rhodes, L. V., III, Salventi, J. S., Galgon, J. P., Stonebraker, V., Boley, S., and Haas, G., The Philadelphia epidemic of Legionnaires’ disease: Clinical, pulmonary, and serologic findings two years later, Ann. Intern. Med. 90:522–526 (1979).PubMedGoogle Scholar
  61. 61.
    Marks, J. S., Tsai, T. F., Martone, W. J., Baron, R. C., Kennicott, J., Holtzhauer, F. J., Baird, I., Fay, D., Feeley, J. C., Mallison, G. F., Fraser, D. W., and Halpin, T. J., Nosocomial Legionnaires’ disease-Columbus, Ohio, Ann. Intern. Med. 90:565–569 (1979).PubMedGoogle Scholar
  62. 62.
    Mcdade, J. E., and Shepard, C. C., Virulent to avirulent conversion of Legionnaires’ disease bacterium (Legionella pneumophila)-Its effecton isolation techniques, J. Infect. Dis. 139:707–711 (1979).PubMedCrossRefGoogle Scholar
  63. 63.
    Mcdade, J. E., Shepard, C. C., Fraser, D. W., Tsai, T. F., Redus, M. A., Dowdle, W. R., and The Laboratory Investigation Team, Legionnaires’ disease: Isolation of a bacterium and demonstration of its role in other respiratory disease, N. Engl. J. Med. 297:1197–1203 (1977).PubMedCrossRefGoogle Scholar
  64. 64.
    Mcdade, J. E., Brenner, D. J., and Bozeman, F. M., Legionnaires’ disease bacterium isolated in 1947, Ann. Intern. Med. 90:659–661 (1979).PubMedGoogle Scholar
  65. 65.
    Meyer, R. D., Legionnaires’ disease: Aspects of nosocomial infection, Am. J. Med. 76:657–663 (1984).PubMedCrossRefGoogle Scholar
  66. 66.
    Meyer, R. D., Shimizu, G. H., Fuller, R., Sayre, J., Chapman, J., and Edelstein, P. H., Prospective survey of acquisition of Legionnaires’ disease, in: Legionella(C. Thornsberry, A. Balows, J. C. Feeley, and W. Jakubowski, eds.), pp. 218–219, American Society for Microbiology, Washington, D.C., 1984.Google Scholar
  67. 67.
    Miller, A. C., Early clinical differentiation between Legionnaires’ disease and other sporadic pneumonias, Ann. Intern. Med. 90:526–528 (1979).PubMedGoogle Scholar
  68. 68.
    Miller, R. P., Cooling towers and evaporative condensers, Ann. Intern. Med. 90:667–670 (1979).PubMedGoogle Scholar
  69. 69.
    Morris, G. K., Patton, C. M., Feeley, J. C., Johnson, S. E., Gorman, G. W., Martin, W. T., Skaliy, P., Mallison, G. F., Politi, B. D., and Mackel, D. C., Isolation of Legionnaires’ disease bacterium from environmental samples, Ann. Intern. Med. 90:664–666 (1979).PubMedGoogle Scholar
  70. 70.
    Morton, S., Bartlett, C. L. R., Bibby, L. F., Hutchinson, D. N., Dyer, J. V., and Dennis, P. J., Outbreak of Legionnaires’ disease from a cooling water system in a power station, Br. J. Ind. Med. 43:630–635 (1986).PubMedGoogle Scholar
  71. 71.
    Muder, R. R., Yu, V. L., Mcclure, J. K., Kroboth, F. J., Kominos, S. D., and Lumish, R. M., Nosocomial Legionnaires’ disease uncovered in a prospective pneumonia study: Implications for underdiagnosis, J. Am. Med. Assoc. 249:3184–3188 (1983).CrossRefGoogle Scholar
  72. 72.
    Muraca, P., Stout, J. E., and Yu, V. L., Comparative assessment of chlorine, heat, ozone, and Uv light for killing Legionella pneumophilawithin a model plumbing system, Appl. Environ. Microbiol. 53:447–453 (1987).PubMedGoogle Scholar
  73. 73.
    Nash, T. W., Libby, D. M., and Horwitz, M. A., Interaction between the Legionnaires’ disease bacterium (Legionella pneumophila)and human alveolar macrophages. Influence of antibody, lymphokines and hydrocortisone, J. Clin. Invest. 74:771–782 (1984).PubMedCrossRefGoogle Scholar
  74. 74.
    Neill, M. A., Gorman, G. W., Gibert, C., Roussel, A., Hightower, A. W., Mckinney, R. M., and Broome, C. V., Nosocomial legionellosis, Paris, France: Evidence for transmission by potable water, Am. J. Med. 78:581–588 (1985).PubMedCrossRefGoogle Scholar
  75. 75.
    Niedeveld, C. J., Pet, F. M., and Meenhorst, P. L., Effect of rubbers and their constituents on proliferation of Legionella pneumophilain naturally contaminated hot water, Lancet 2:180–184 (1986).PubMedCrossRefGoogle Scholar
  76. 76.
    Osterholm, M. T., Chin, T. D. Y., Osborne, D. O., Dull, H. B., Dean, A. G., Fraser, D. W., Hayes, P. S., and Hall, W. N., A 1957 outbreak of Legionnaires’ disease associated with a meat packing plant, Am. J. Epidemiol. 117:60–67 (1983).PubMedGoogle Scholar
  77. 77.
    Parry, M. F., Stampleman, L., Hutchinson, J. H., Folta, D., Steinberg, M. G., and Krasnogor, L. J., Waterborne Legionella bozemaniiand nosocomial pneumonia in immunosuppressed patients, Ann. Intern. Med. 103:205–210 (1985).PubMedGoogle Scholar
  78. 78.
    Pasculle, A. W., Myerowitz, R. L., and Rinaldo, C. R., Jr., New bacterial agent of pneumonia isolated from renal-transplant recipients, Lancet 2:58–61 (1979).PubMedCrossRefGoogle Scholar
  79. 79.
    Peel, M. M., Harkness, J. L., Colwell, J. M., Rouch, G. J., and Christopher, P. J., Legionella pneumophilaand water temperatures in Australian hospitals, Aust. N. Z. J. Med. 15:38–41 (1985).PubMedCrossRefGoogle Scholar
  80. 80.
    Pope, D. H., Eichler, L. W., Coates, T. F., Kramer, J. F., and Soracco, R. J., The effect of ozone on Legionella pneumophilaand other bacterial populations in cooling towers, Curr. Microbiol. 10:89–94 (1984).CrossRefGoogle Scholar
  81. 81.
    Redd, S. C., and Cohen, M. L., Legionellain water: What should be done. J. Am. Med. Assoc. 257:1221–1222 (1987).CrossRefGoogle Scholar
  82. 82.
    Reid, D., Grist, N. R., and Najera, R., Illness associated with “package tours ”: A combined Spanish-Scottish study, Bull. WHO 56:117–122 (1978).PubMedGoogle Scholar
  83. 83.
    Reingold, A. L., Thomason, B. M., Brake, B. J., Thacker, L., Wilkinson, H. W., and Kuritsky, J. N., Legionella pneumonia in the United States: The distribution of serogroups causing human illness, J. Infect. Dis. 149:819 (1984).PubMedCrossRefGoogle Scholar
  84. 84.
    Reinhardt, J. F., Nakahama, C., and Edelstein, P. H., Comparison of blood culture methods for recovery of Legionella pneumophilafrom the blood of guinea pigs with experimental infection, J. Clin. Microbiol. 25:719–721 (1987).PubMedGoogle Scholar
  85. 85.
    Renner, E. D., Helms, C. M., Hierholzer, W. J., Jr., Hall, N., Wong, Y. W., Viner, J. P., Johnson, W., and Hausler, W. J., Jr., Legionnaires’ disease in pneumonia patients in Iowa: A retrospective seroepidemiologic study, 1972–1977, Ann. Intern. Med. 90:603–606 (1979).PubMedGoogle Scholar
  86. 86.
    Rosenfeld, J. S., Kueppers F., Newkirk, T., Tamada, R., Meissler, J. J., Jr., and Eisenstein, T. K., A protease from Legionella pneumophilawith cytotoxic and dermal ulcerative activity, FEMS Microbiol. Lett. 37:51–58 (1986).CrossRefGoogle Scholar
  87. 87.
    Rosmini, F., Castellani-Pastoris, M., Mazzotti, M. F., Forastiere, F., Gavazzoni, A., Greco, D., Ruckdeschel, G., Tartagni, E., Zampieri, A., and Baine, W. B., Febrile illness in successive cohorts of tourists at a hotel on the Italian Adriatic coast: Evidence for a persistent focus of Legionellainfection, Am. J. Epidemiol. 119:124–134 (1984).PubMedGoogle Scholar
  88. 88.
    Ryan, M. E., Feldman, S., Pruitt, B., and Fraser, D. W., Legionnaires’ disease in a child with cancer, Pediatrics 64:951–953 (1979).PubMedGoogle Scholar
  89. 89.
    Saravolatz, L. D., Arking, L., Wentworth, B., and Quinn, E., Prevalence of antibody to Legionnaires’ disease bacterium in hospital employees, Ann. Intern. Med. 90:601–603 (1979).PubMedGoogle Scholar
  90. 90.
    Schlech, W. F., III, Gorman, G. W., Payne, M. C., and Broome, C. V., Legionnaires’ disease in the Caribbean: An outbreak associated with a resort hotel, Arch. Intern. Med. 145:2076–2079 (1985).PubMedCrossRefGoogle Scholar
  91. 91.
    Shands, K. N., Ho, J. O., Meyer, R. D., Gorman, G. W., Edelstein, P. H., Mallison, G. F., Finegold, S. M., and Fraser, D. W., Potable water as a source of Legionnaires’ disease, J. Am. Med. Assoc. 253:1412–1416 (1985).CrossRefGoogle Scholar
  92. 92.
    Sharrar, R. G., Friedman, H. M., Miller, W. T., Yanak, M. J., and Abrutyn, E., Summertime pneumonias in Philadelphia in 1976: An epidemiologic study, Ann. Intern. Med. 90:577–580 (1979).PubMedGoogle Scholar
  93. 93.
    Skaliy, P., and Mceachern, H. V., Survival of the Legionnaires’ disease bacterium in water, Ann. Intern. Med. 90:662–663 (1979).PubMedGoogle Scholar
  94. 94.
    Snowman, W. R., Holtzhauer, F. J., Halpin, T. J., and Correa-Villasenor, A., The role of indoor and outdoor occupations in the seroepidemiology of Legionella pneumophila, J. Infect. Dis. 145:275 (1982).CrossRefGoogle Scholar
  95. 95.
    States, S. J., Conley, L. F., Ceraso, M., Stephenson, T. E., Wolford, R. S., Wadowsky, R. M., Mcnamara, A. M., and Yee, R. B., Effect of metals on Legionella pneumophilagrowth in drinking water plumbing systems, Appl. Environ. Microbiol. 50:1149–1154 (1985).PubMedGoogle Scholar
  96. 96.
    Storch, G., Baine, W. B., Fraser, D. W., Broome, C. V., Clegg, H. W., II, Cohen, M. L., Goings, S. A. J., Politi, B. D., Terranova, W. A., Tsai, T. F., Plikaytis, B. D., Shepard, C. C., and Bennett, J. V., Sporadic community-acquired Legionnaires’ disease in the United States: A case-control study, Ann. Intern. Med. 90:596–600 (1979).PubMedGoogle Scholar
  97. 97.
    Storch, G., Hayes, P. S., Hill, D. L., and Baine, W. B., Prevalence of antibody to Legionnaires’ disease bacterium in middle-aged and elderly Americans, J. Infect. Dis. 140:784–788 (1979).PubMedCrossRefGoogle Scholar
  98. 98.
    Tang, P. W., and Toma, S., Broad-spectrum enzymelinked immunosorbent assay for detection of Legionellasoluble antigens, J. Clin. Microbiol. 24:556–558 (1986).PubMedGoogle Scholar
  99. 99.
    Tatlock, H., A rickettsia-like organism recovered from guinea pigs, Proc. Soc. Exp. Biol. Med. 57:95–99 (1944).Google Scholar
  100. 100.
    Terranova, W., Cohen, M. L., and Fraser, D. W., 1974 outbreak of Legionnaires’ disease diagnosed in 1977: Clinical and epidemiological features, Lancet 2:122–124 (1978).PubMedCrossRefGoogle Scholar
  101. 101.
    Thacker, S. B., Bennett, J. V., Tsai, T. F., Fraser, D. W., Mcdade, J. E., Shepard, C. C., Williams, K. H., Jr., Stuart, W. H., Dull, H. B., and Eickhoff, T. C., An outbreak in 1965 of severe respiratory illness caused by the Legionnaires’ disease bacterium, J. Infect. Dis. 138:512–519 (1978).PubMedCrossRefGoogle Scholar
  102. 102.
    Thacker, W. L., Wilkinson, H. W., Benson, R. F., and Brenner, D. J., Legionella pneumophilaserogroup 12 isolated from human and environmental sources, J. Clin. Microbiol. 25:569–570 (1987).PubMedGoogle Scholar
  103. 103.
    Tobin, J. O., Beare, J. Dunnill, M. S., Fisher-Hoch, S. P., French, M., Mitchell, R. G., Morns, P. J., and Myers, M. F., Legionnaires’ disease in a transplant unit: Isolation of the causative agent from shower baths, Lancet 2:118–121 (1981).Google Scholar
  104. 104.
    Tsai, T. F., and Fraser, D. W., The diagnosis of Legionnaires’ disease, Ann. Intern. Med. 89:413–414 (1978).PubMedGoogle Scholar
  105. 105.
    Tsai, T. F., Finn, D. R., Plikaytis, B. D., Mccauley, W., Martin, S. M., and Fraser, D. W., Legionnaires’ disease: Clinical features of the epidemic in Philadelphia, Ann. Intern. Med. 90:509–517 (1979).PubMedGoogle Scholar
  106. 106.
    Vereerstraeten, P., Stolear, J. C., Schoutens-Serruys, E., Maes, N., Thys, J. P., Liesnard, C., Rost, F., Kinnaert, P., and Toussaint, C., Erythromycin prophylaxis for Legionnaires’ disease in immunosuppressed patients in a contaminated hospital environment, Transplantation 41:52–54 (1986).PubMedCrossRefGoogle Scholar
  107. 107.
    Wang, W. L. L., Blaser, M. J., Cravens, J., and Johnson, M. A., Growth, survival and resistance of the Legionnaires’ disease bacterium, Ann. Intern. Med. 90:614–618 (1979).PubMedGoogle Scholar
  108. 108.
    Wilkinson, H. W., Fikes, B. J., and Cruce, D. D., Indirect immunofluorescence test for serodiagnosis of Legionnaires’ disease: Evidence for serogroup diversity of Legionnaires’ disease bacterial antigens and for multiple specificity of human antibodies, J. Clin. Microbiol. 9:379–383 (1979).PubMedGoogle Scholar
  109. 109.
    Wilkinson, H. W., Cruce, D. D., and Broome, C. V., Validation of Legionella pneumophilaindirect immunofluorescence assay with epidemic sera, J. Clin. Microbiol. 13:139–146 (1981).PubMedGoogle Scholar
  110. 110.
    Wilkinson, H. W., Reingold, A. L., Brake, B. J., Mcgiboney, D. L., Gorman, G. W., and Broome, C. V., Reactivity of serum from patients with suspected legionellosis against 29 antigens of Legionellaceaeand Legionella-likeorganisms by indirect immunofluorescence assay, J. Infect. Dis. 147:23–31 (1983).PubMedCrossRefGoogle Scholar
  111. 111.
    Wilkinson, H. W., Sampson, J. S., and Plikaytis, B. D., Evaluation of a commercial gene probe for identification of Legionellacultures, J. Clin. Microbiol. 23:217–220 (1986).PubMedGoogle Scholar
  112. 112.
    Winn, W. C., Jr., and Myerowitz, R. L., The pathology of the Legionella pneumonias: A review of 74 cases and the literature, Hum. Pathol. 12:401–422 (1981).PubMedCrossRefGoogle Scholar
  113. 113.
    Winn, W. C., Jr., Glavin, F. L., Perl, D. P., and Craighead, J. E., Macroscopic pathology of the lung in Legionnaires’ disease, Ann. Intern. Med. 90:548–551 (1979).PubMedGoogle Scholar
  114. 114.
    Wong, K. H., Mcmaster, R. B., Feeley, J. C., Arko, R. J., Schalla, W. O., and Chandler, F. W., Detection of hypersensitivity to Legionella pneumophilain guinea pigs by skin test, Curr. Microbiol. 4:105–116 (1980).CrossRefGoogle Scholar
  115. 115.
    Woodhead, M. A., and Macfarlane, J. T., Legionnaires’ disease: A review of 79 community acquired cases in Nottingham, Thorax 41:635–640 (1986).PubMedCrossRefGoogle Scholar
  116. 116.
    Yu, V. L., Zuravleff, J. J., Gavlik, L., and Magnussen, M. H., Lack of evidence for person-to-person transmission of Legionnaires’ disease, J. Infect. Dis. 147:362 (1983).PubMedCrossRefGoogle Scholar
  117. 117.
    Zuravleff, J. J., Yu, V. L., Shonnard, J. W., Davis, B. K., and Rihs, J. D., Diagnosis of Legionnaires’ disease, J. Am. Med. Assoc. 250:1981–1985 (1983).CrossRefGoogle Scholar

Suggested Reading

  1. Brenner, D. J., Classification of Legionellaceae:Current status and remaining questions, Isr. J. Med. Sci. 22:620–632 (1986).PubMedGoogle Scholar
  2. Edelstein, P. H., Laboratory diagnosis of infections caused by Legionellae, Eur. J. Clin. Microbiol. 6:4–10 (1987).PubMedCrossRefGoogle Scholar
  3. Fraser, D. W., Tsai, T. F., Orenstein, W., Parkin, W. E., Beecham, H. J., Sharrar, R. G., Harris, J., Mallison, G. F., Martin, S. M., Mcdade, J. E., Shepard, C. C., Brachman, P. S., and The Field Investigation Team, Legionnaires’ disease: Description of an epidemic of pneumonia, N. Engl. J. Med. 297:1189–1197 (1977).PubMedCrossRefGoogle Scholar
  4. Glick, T. H., Gregg, M. B., Berman, B., Mallison, G. F., Rhodes, W. W., Jr., and Kassanoff, I., Pontiac fever: An epidemic of unknown etiology in a health department. I. Clinical and epidemiologic aspects, Am. J. Epidemiol. 107:149–160 (1978).PubMedGoogle Scholar
  5. Mcdade, J. E., Shepard, C. C., Fraser, D. W., Tsai, T. F., Redus, M. A., Dowdle, W. R., and The Laboratory Investigation Team, Legionnaires’ disease: Isolation of a bacterium and demonstration of its role in other respiratory disease, N. Engl. J. Med. 297:1197–1203 (1977).PubMedCrossRefGoogle Scholar
  6. Muder, R. R., Yu, V. L., and Woo, A. H., Mode of transmission of Legionella pneumophila:A critical review, Arch. Intern. Med. 146:1607–1612 (1986).PubMedCrossRefGoogle Scholar
  7. Thornsberry, C., Balows, A., Feeley, J. C., and Jakubowski, W. (eds.), Legionella, American Society for Microbiology, Washington, D.C., 1984.Google Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • David W. Fraser
    • 1
  1. 1.Office of the PresidentSwarthmore CollegeSwarthmoreUSA

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