A community outbreak of Legionnaires' disease from an industrial cooling tower: assessment of clinical features and diagnostic procedures.

• An outbreak of Legionnaires' disease (LD) occurred in Lidköping, Sweden, in August 2004. A cooling tower was identified as the probable source of infection. During the outbreak period an unexpected 3-6-fold increase in pneumonia patients was noted at the local hospital. During 7 weeks LD was diagnosed in 15 patients by urinary antigen and/or sputum culture. Additionally, 15 LD patients were diagnosed later by serology. Patients with LD were generally younger, more healthy, and more often smokers compared to other pneumonia patients. On admittance they had more severe symptoms with high fever and raised CRP levels, and more often hyponatraemia, gastrointestinal and CNS symptoms. A causative agent besides Legionella was found in 2 patients only. A significant titre rise for Mycoplasma and/or Chlamydophila pneumoniae was found in 13 of 29 tested patients with confirmed LD. We conclude that the clinical diagnosis of LD is difficult and that available diagnostic methods detect only a minority of patients in the acute phase. Therefore in severe pneumonia, empirically targeted therapy should be instituted on clinical grounds irrespective of the results of diagnostic tests. The observation of increased antibody levels for M. and C. pneumoniae suggests an unspecific immune reaction and merits further study.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Infektionsmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Infectious Medicine (hsv//eng)

Nyckelord

Adult

Aged

Aged

80 and over

Air Conditioning

adverse effects

Antigens

Bacterial

urine

Chlamydophila pneumoniae

isolation & purification

Community-Acquired Infections

diagnosis

epidemiology

microbiology

Diagnosis

Differential

Disease Outbreaks

Female

Humans

Industry

Legionella pneumophila

isolation & purification

Legionnaires' Disease

diagnosis

epidemiology

microbiology

Male

Middle Aged

Mycoplasma pneumoniae

isolation & purification

Pneumonia

Bacterial

diagnosis

microbiology

Sputum

microbiology

Sweden

epidemiology

Water Microbiology

Legionella

MEDICINE

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)