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VIII.78 - Legionnaires’ Disease

from Part VIII - Major Human Diseases Past and Present

Published online by Cambridge University Press:  28 March 2008

Kenneth F. Kiple
Affiliation:
Bowling Green State University, Ohio
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Summary

Legionnaires’ disease is an acute infection of humans, principally manifested by pneumonia, that occurs in a distinctive pattern in epidemics and is caused by bacteria of the genus Legionella. Typically the incubation period – the interval between exposure to the bacterium and the onset of illness – is 2 to 10 days, with an average of 5 to 6 days, and the attack rate – the proportion of people exposed to the bacterium who become ill – is less than 5 percent. Without specific antibiotic treatment, 15 percent or more of the cases are fatal, although the percentage of fatal cases rises sharply in immunosuppressed patients.

Legionnaires’ disease is one form of presentation of Legionella infections, which are generally referred to by the umbrella term legionellosis. Another distinctive clinicoepidemiological pattern of legionellosis is Pontiac fever. Pontiac fever affects 45 to 100 percent of those exposed and has an incubation period of 1 to 2 days. Pneumonia does not occur, and all patients recover. More than 20 species of Legionella have been identified, 10 of which are proven causes of legionellosis in humans. The most common agents of human infection are Legionella pneumophila, Legionella micdadei, Legionella bozemanii, Legionella dumoffii, and Legionella longbeachae.

Legionellae are distinguished from other bacteria in being weakly staining, gram-negative, aerobic rods that do not grow on blood agar or metabolize carbohydrates, and have large proportions of branched-chain fatty acids in their cell walls and major amounts of ubiquinones with more than 10 isoprene units on the side chain.

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Publisher: Cambridge University Press
Print publication year: 1993

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References

Balows, Albert, and Fraser, David W., eds. 1979. International symposium on Legionnaires’ disease. Annals of Internal Medicine 90.Google Scholar
Brenner, Don J. 1986. Classification of Legionellaceae: Current status and remaining questions. Israel Journal of Medical Sciences 22.Google ScholarPubMed
Broome, Claire V., and Fraser, David W.. 1979. Epidemiologic aspects of legionellosis. Epidemiologic Reviews 1.CrossRefGoogle ScholarPubMed
Dondero, Timothy J. Jr., et al. 1980. An outbreak of Legionnaires’ disease associated with a contaminated air-conditioning cooling tower. New England Journal of Medicine 302.CrossRefGoogle ScholarPubMed
Edelstein, P. H. 1987. Laboratory diagnosis of infections caused by legionellae. European Journal of Clinical Microbiology 6.CrossRefGoogle ScholarPubMed
England, A. C., and Fraser, D. W.. 1981. Sporadic and epidemic nosocomial legionellosis in the United States. American Journal of Medicine 70.CrossRefGoogle ScholarPubMed
Fisher-Hoch, S. P., Smith, M. G., and Colbourne, J. S.. 1982. Legionella pneumophila in hospital hot water cylinders. Lancet 2.Google Scholar
Fraser, David W., et al. 1977. Legionnaires’ disease: Description of an epidemic of pneumonia. New England Journal of Medicine 297.CrossRefGoogle ScholarPubMed
Glick, Thomas H., et al. 1978. Pontiac fever. An epidemic of unknown etiology in a health department: I. Clinical and epidemiologic aspects. American Journal of Epidemiology 107.Google Scholar
Kaufmann, Arnold F., et al. 1981. Pontiac fever: Isolation of the etiologic agent (Legionella pneumophila) and demonstration of its mode of transmission. American Journal of Epidemiology 114.CrossRefGoogle ScholarPubMed
Kirby, B. D., et al. 1980. Legionnaires’ disease: Report of sixty-five nosocomically acquired cases and review of the literature. Medicine 59.CrossRefGoogle Scholar
McDade, Joseph E., et al. 1977. Legionnaires’ disease: Isolation of a bacterium and demonstration of its role in other respiratory diseases. New England Journal of Medicine 297.CrossRefGoogle Scholar
Shands, Kathryn N., et al. 1985. Potable water as a source of Legionnaires’ disease. Journal of the American Medical Association 253.Google ScholarPubMed
Thornsberry, Clyde, et al., eds. 1984. Legionella: Proceedings of the 2nd international symposium of the American Society for Microbiology. Washington, D.C..Google Scholar

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