innovative methods to control, investigate, and monitor for legionella : a panel discussion
DESCRIPTION
Innovative Methods to Control, Investigate, and Monitor for Legionella : A Panel Discussion. Introduction—Mark Bergtholdt Water Management Plans—Brooke Winter Investigation as a way of preventing—Mark Bergtholdt Using a Rapid Bacteria Screening Method to Assess Legionella Risk—Lisa Rogers. - PowerPoint PPT PresentationTRANSCRIPT
Innovative Methods to Control, Investigate, and Monitor for
Legionella: A Panel Discussion
• Introduction—Mark Bergtholdt• Water Management Plans—
Brooke Winter• Investigation as a way of
preventing—Mark Bergtholdt• Using a Rapid Bacteria
Screening Method to Assess Legionella Risk—Lisa Rogers
Introduction: What is Legionella and why is it important
Mark Bergtholdt
Discovered in 1976 at an
American Legion Convention
in Philadelphia
Attendees becameill with pneumonia
221
Total Cases
2/3 Hospitalized
34Deaths
Bacteria Legionella pneumophila
were found to be the cause
Legionella:What it is and where does it come from?
Organism CharacterizationLegionella is a bacteria
43 or more identified species of Legionella
Multiple Serogroups, with over 60 serogroups presently identified for the
genus
Legionella Pneu-mophila, Serogroup 1Other L. pneu-mophila serogroups
70%20-30%
5-10%
Grow best at 68 to 115o Fahrenheit(Water supply systems often kept at 77 to
108oF)
Can be found in natural surface waters and in buildings
Infect/replicate in both protozoa and human white blood cells
The protozoa/blood cells infected with Legionella burst and release the bacteria into
the water
Ecology of Legionella
35-46˚C (95-115˚F)
Legionella’s optimalgrowth
temperature
<20˚C (68˚F)Predominantly dormant,
but still viable
60˚C (140˚F)90% Kill in 2
Minutes
Legionella fuses with the amoeba inside a membrane-bound
vacuole and replicates
Legionella releases from the amoeba,
exiting as the amoeba dies
Legionella enters the amoeba
Legionella attaches to biofilm
Replication occurs
Legionella reaches maturation
Some Legionella form new colonies
Others continue to end fixture
Legionella are found in the biofilms thataccumulate in the built environment:
How Legionella causes
human infections
The bacteria travel downstream to locationswhere it is aerosolized, such as:
Susceptible Individual:
Susceptible Individual:50+ years of age
Susceptible Individual:50+ years of ageHas Chronic Lung Disease
Susceptible Individual:• 50+ years of age• Has Chronic Lung Disease• Is a current or former smoker
Susceptible Individual:50+ years of ageHas Chronic Lung DiseaseIs a current or former smokerIs immunocompromised
How does a bacteria that enters an amoeba infect Humans?
The Legionella replicates inside the white blood cellLegionella releases from the white blood cell, exiting as the cell dies.
Legionella is engulfed by the white blood cell
Legionella go on to infect other white blood cells in the lung causing a pneumonia like illness
Incubation Period2 day -14 day
High feverHeadacheChills
Muscle pain
Dry CoughDifficulty breathing
Symptoms are severe; the individual will usually visit a physician
Legionnaires’ disease may be diagnosed as common pneumonia
Sputum culture orurine antigen testis used for positive identification
18,0008,000
Hospitalizations
Annually
to
4,000
Deaths Annually
Legionnaires’ disease is under reported
Legionnaires’ disease is under reported• Patients sometimes recover without medical assistance
Legionnaires’ disease is under reported• Patients sometimes recover without medical assistance
• Patients are not tested for Legionellosis by the physician
Legionnaires’ disease is under reported• Patients sometimes recover without medical assistance
• Patients are not tested for Legionellosis by the physician
• Patients are misdiagnosed
Reporting of Legionellosis
In Summary
• Legionella is a bacteria that needs a host to replicate.
• It is found in water and replicates in warm water
• It infects humans when the water containing the bacteria is aerosolized and inhaled by the person.
• It is an under reported disease