Legionella spp. and legionellosis in southeastern Italy: disease epidemiology and environmental surveillance in community and health care facilitiesReportar como inadecuado

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BMC Public Health

, 10:660

First Online: 02 November 2010Received: 15 December 2009Accepted: 02 November 2010DOI: 10.1186-1471-2458-10-660

Cite this article as: Napoli, C., Fasano, F., Iatta, R. et al. BMC Public Health 2010 10: 660. doi:10.1186-1471-2458-10-660


BackgroundFollowing the publication of the Italian Guidelines for the control and prevention of legionellosis an environmental and clinical surveillance has been carried out in Southeastern Italy. The aim of the study is to identify the risk factors for the disease, so allowing better programming of the necessary prevention measures.

MethodsDuring the period January 2000 - December 2009 the environmental surveillance was carried out by water sampling of 129 health care facilities 73 public and 56 private hospitals and 533 buildings within the community 63 private apartments, 305 hotels, 19 offices, 4 churches, 116 gyms, 3 swimming pools and 23 schools. Water sampling and microbiological analysis were carried out following the Italian Guidelines. From January 2005, all facilities were subject to risk analysis through the use of a standardized report; the results were classified as good G, medium M and bad B. As well, all the clinical surveillance forms for legionellosis, which must be compiled by physicians and sent to the Regional Centre for Epidemiology OER, were analyzed.

ResultsLegionella spp. was found in 102 79.1% health care facilities and in 238 44.7% community buildings. The percentages for the contamination levels < 1,000, 1,000-10,000, > 10,000 cfu-L were respectively 33.1%, 53.4% and 13.5% for samples from health care facilities and 33.5%, 43.3% and 23.2% for samples from the community. Both in hospital and community environments, Legionella pneumophila serogroup L. pn sg 2-14 was the most frequently isolate respectively 54.8% and 40.8% of positive samples, followed by L. pn sg 1 respectively 31.3% and 33%. The study showed a significant association between M or B score at the risk analysis and Legionella spp. positive microbiological test results p < 0.001. From clinical surveillance, during the period January 2001 - August 2009, 97 cases of legionellosis were reported to the OER: 88 of community origin and 9 nosocomial. The most frequent symptoms were: fever 93.8%, cough 70.1%, dyspnea 58.8%, shivering 56.7%. Radiological evidence of pneumonia was reported in 68%. The laboratory diagnostic methods used were: urinary antigen 54.3%, single antibody titer 19.8%, only seroconversion 11.1%, other diagnostic methods 14.8%.

ConclusionsOur experience suggests that risk analysis and environmental microbiological surveillance should be carried out more frequently to control the environmental spread of Legionella spp. Furthermore, the laboratory diagnosis of legionellosis cannot be excluded only on the basis of a single negative test: some patients were positive to only one of the diagnostic tests.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-10-660 contains supplementary material, which is available to authorized users.

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Autor: Christian Napoli - Fabrizio Fasano - Roberta Iatta - Giovanna Barbuti - Teresa Cuna - Maria Teresa Montagna

Fuente: https://link.springer.com/

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