Association of shower use with Legionnaire's disease: possible role of amoebae

Article Abstract:

Legionnaires' disease (LD) is a serious and frequently fatal disease caused by a type of bacteria known as Legionella pneumophila. The symptoms include pneumonia, a dry cough, muscle aches and occasionally digestive disorders. Major organs, including the heart, may be damaged as the disease continues. When outbreaks of LD have occurred, the specific source of the bacteria has been sought; examples of confirmed sources include humidifiers, evaporative condensers, cooling towers, whirlpool spas, and respiratory therapy equipment. It has also been suggested that L. pneumophila might be transmitted through a shower, but no such case has been reported to date. The bacteria need nutrients in order to survive and multiply, and it has been found that they can live in water that contains live amoebae. At a hospital in South Dakota, there were 26 cases of hospital-acquired LD over a period of 3.5 years; 10 of the patients died. Investigation of these cases linked them to use of the showers; patients who took showers were at increased risk for contracting LD while those who took sponge-baths were at lower risk. It was suggested that the shower heads had been colonized by the bacteria, but replacement of these devices did not end the LD outbreak. It was concluded that persistent colonies of the bacteria survived in the hot water supply for the 3.5-year period. It also appeared that amoebae in the water supply helped the bacteria to survive. Further research will be needed to better understand the relationship between L. pneumophila bacteria and amoebae; disinfection methods that kill the amoebae may be effective at preventing Legionnaires' disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hospitals, Microbial contamination, Respiratory tract diseases

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Role of air sampling in investigation of an outbreak of Legionnaires' disease associated with exposure to aerosols from an evaporative condenser

Article Abstract:

The transmission of Legionnaires' disease (LD) has been found to be largely due to the inhalation of infected aerosols from air conditioning cooling towers, cascades, showers, whirlpools, humidifiers, respiratory equipment and hot potable water systems. A recent series of infections was traced to the humidifiers in use in the produce sections of supermarkets. Most epidemiologic studies use shower aerosols in tracing LD causes. Although the organism Legionella pneumophila (Lp) can be identified from air sampling, this method has not been widely used in epidemiological investigations. The use of this technique could be used to confirm the role played by evaporative condensers (EC) in the transmission of Ld. In a recent outbreak in a senior citizens' facility, both the evaporative condenser and the potable hot water system were suspect. Five residents and an employee developed the disease within a two-week period in July 1988. There were common areas (dining room, lounge, etc.) on the first two floors. Living quarters, each with shower facilities, were on the upper floors. The exhaust from a newly installed EC was less than 65 feet from the air intake for the air conditioning (AC) system. A case control study (review of historical events or records) established the relationship between the illness and the dispersal of contaminated aerosols from the EC. Monoclonal antibody subtype patterns confirmed the source of the implicated strains. Aerosolized water from residential showers did not disseminate the disease organism, despite the fact that Lp was isolated from both water sources. (Consumer Summary produced by Reliance Medical Information, Inc.)

Environmental aspects, Pollution, Air pollution, Long-term care facilities, Long term care facilities

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Nosocomial legionnaires' disease and use of medication nebulizers

Article Abstract:

Legionnaires' disease has been found to be caused by airborne water droplets formed in cooling towers such as humidifiers, showers, and respiratory equipment. The infectious agent, Legionella pneumophila, colonizes these towers and is transmitted through the air. The resultant illness is a form of pneumonia in humans that can lead to death. As a result, it was suggested by the Centers for Disease Control (CDC) that only sterile water be used in such devices. Thirteen cases of pneumonia due to Legionella pneumophila have been identified. Twelve of the patients had chronic pulmonary disease and nine died. Evidence was found that the nebulizers used to deliver medication to the patients carried the infection because they had been washed in tap water that was contaminated. The findings of this study confirm the need to use only sterile fluids in cleaning respiratory care equipment despite recommendations from the American Association for Respiratory therapy that use of tap water is acceptable if water is regularly tested for contamination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Nosocomial infections, Cross infection, Nebulizers and vaporizers, Nebulizers (Medicine), Vaporizers

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