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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1370-1371
Prevention and control of legionellosis: A public health perspective


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

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Date of Web Publication6-Nov-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Prevention and control of legionellosis: A public health perspective. Ann Trop Med Public Health 2017;10:1370-1

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Prevention and control of legionellosis: A public health perspective. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 13];10:1370-1. Available from: http://www.atmph.org/text.asp?2017/10/5/1370/196627


Dear Sir,

Legionellosis refers to a group of infections, which were first detected in the late 1970s of the 19th century, manifesting in variable forms ranging from mild to life-threatening types of pneumonia.[1] Even though, the disease is global in distribution, the current available trends suggest it is a predominant public health concern in developed nations, with the incidence being 10 to 15 cases per million populations in Australia, Europe, and the United States of America.[1] However, this is a major underestimation of the actual problem as developing nations also have favorable environmental factors, susceptible populations, and are plagued by the problem of serious shortcomings in the quality of their surveillance, notification, and diagnosis-related activities.[1],[2]

The infection can be acquired through the inhalation of contaminated aerosols or by the aspiration of contaminated water or ice in susceptible admitted cases, or during water births.[2] Despite the fact that the infection can affect anyone, the disease is quite prevalent among people aged more than 50 years and in males, and might presents as community-acquired or travel-associated pneumonia among people with a positive history of smoking, heavy drinking, respiratory or renal illnesses, and immuno-compromised state (including beneficiaries of organ transplant or on steroid therapy).[1],[2],[3] However, attributes like being recently operated, evidence of intubation or mechanical ventilation or Ryle's tube, and history of aspiration, predisposes people for hospital-acquired pneumonia.[3]

Moreover, the disease outbreaks have been observed in poorly maintained artificial water system, especially associated with air conditioning and industrial cooling, and water systems in public and private buildings.[2],[3] The clinical manifestations of the disease depend on the severity of the illness, and the outcome can be fatal if there is a delay in the diagnosis or administration of the desired treatment owing to the fact that illness worsens within the first 7 days, elderly people, and in the presence of coexisting illnesses, or host factors such as immune-suppression.[1],[3] Furthermore, the overall disease-associated fatality ranges from 5% to 10% because of respiratory failure or shock or multiorgan failure and is determined by the settings from which infection is acquired and the infective dose.[1] However, among untreated immune-compromised individuals the death rates can be as high as 40% to 80%.[1]

Although, patients with mild disease are treated symptomatically, the pneumonic forms have to be compulsorily treated with antibiotics after the confirmation of diagnosis.[2] In the absence of an effective vaccine, and the fact that it is impossible to eradicate the source of infection, the need of the hour is to reduce the risk of acquiring the infection by minimizing the growth of organism and risk of dissemination of aerosols.[4] The approved measures predominantly comprise of implementation of the water safety plans specific to the setting like proper maintenance of devices, including regular cleaning and disinfection and using other physical (sustaining a temperature outside the range of 20°C to 50°C) or chemical measures to reduce the growth of bacteria.[4],[5]

In addition, ensuring periodic monitoring of control measures, proper vigilance by the health professionals to detect the cases at the earliest, promotion of diagnostic and other research-related work, and improvement in the surveillance and the mandatory notification of the cases has been advocated for the better control of the disease.[1],[4],[5]

To conclude, Legionellosis is an important global public health concern and is associated with high fatality in the absence of timely detection and appropriate treatment. Thus, there is a great need to minimize the risk of acquisition of infection and ensure proper management of the diagnosed cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health OrganizationLegionellosis – Fact sheet; 2016. Available from: http://who.int/mediacentre/factsheets/fs285/en/. [Last Accessed on 2016 Jun 11].  Back to cited text no. 1
    
2.
Kruse EB, Wehner A, Wisplinghoff H. Prevalence and distribution of Legionella spp in potable water systems in Germany, risk factors associated with contamination, and effectiveness of thermal disinfection. Am J Infect Control 2016;44:470-4.  Back to cited text no. 2
[PUBMED]    
3.
Saliou P, Fangous MS, Uguen M, Le Bars H, Narbonne V, Payan C. Investigation of Legionella pneumophila outbreak: Effectiveness of clinical and genomic methods. Clin Infect Dis 2016;62:1614-5.  Back to cited text no. 3
    
4.
Den Boer JW, Euser SM, Brandsema P, Reijnen L, Bruin JP. Prevention of Legionella pneumonia in the Netherlands: Results from the Legionella source identification unit, 2002-2012. Ned Tijdschr Geneeskd 2016;160:A9867.  Back to cited text no. 4
[PUBMED]    
5.
Armstrong C, Preventing scalding/controlling Legionella. Health Estate 2015;69:53-6.  Back to cited text no. 5
    

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Correspondence Address:
Saurabh R Shrivastava
Department of Community Medicine, 3rd floor, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196627

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