Legionnaires' disease : Clinical, epidemiological, and public health perspectives

摘要: Legionnaires' disease is a modern environmental infectious disease. It stems from the capacity of causative agent, Legionella, to multiply within amoebae in warm water and use, during 20th century, devices that maintain at temperatures produce aerosols. When contaminated with aerosols consisting respirable droplets place bacteria juxtaposition alveolar macrophages, which, as amoebae, they may parasitize, resulting illness susceptible persons. The much more common than previously appreciated least 13,000 cases estimated occur per year United States, based on prospective studies. Two highly specific tests, urinary antigen detection sputum culture, are available for diagnosis illness. With 60% 80% sensitivity, tests rapidly detect antigens Legionella pneumophila serogroup 1, which responsible 70% legionnaires' disease; results can be few hours. Culture 50% sensitive, but several days required growth, many patients do not sputum. Serologic testing, although useful epidemiologic studies when convalescent-phase antibody titers compared acute-phase titers, helpful clinical decision making because low positive predictive value commercially serologic tests. Erythromycins, intravenous azithromycin, levofloxacin currently approved by US Food Drug Administration treatment However, clarithromycin other fluoroquinolones active against also provide effective therapy. Recent recommendations Centers Disease Control Prevention's Hospital Infection Practices Advisory Committee should reducing nosocomial Recommendations or being developed minimize risk variety settings.