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Article: An unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong

TitleAn unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong
Authors
KeywordsCommunity-Acquired Legionellosis
Nosocomial Legionellosis
Outbreak
Issue Date2012
PublisherChinese Medical Association. The Journal's web site is located at http://www.cmj.org/
Citation
Chinese Medical Journal, 2012, v. 125 n. 23, p. 4283-4290 How to Cite?
AbstractBackground The environmental sources associated with community-acquired or nosocomial legionellosis were not always detectable in the mainland of China and Hong Kong, China. The objective of this study was to illustrate the control measures implemented for nosocomial and community outbreaks of legionellosis, and to understand the environmental distribution of legionella in the water system in Hong Kong, China. Methods We investigated the environmental sources of two cases of legionellosis acquired in the hospital and the community by extensive outbreak investigation and sampling of the potable water system using culture and genetic testing at the respective premises. Results The diagnosis of nosocomial legionellosis was suspected in a patient presenting with nosocomial pneumonia not responsive to multiple beta-lactam antibiotics with subsequent confirmation by Legionella pneumophila serogroup 1 antigenuria. High counts of Legionella pneumophila were detected in the potable water supply of the 70-year-old hospital building. Another patient on continuous ambulatory peritoneal dialysis presenting with acute community-acquired pneumonia and severe diarrhoea was positive for Legionella pneumophila serogroup 1 by polymerase chain reaction (PCR) testing on both sputum and nasopharyngeal aspirate despite negative antigenuria. Paradoxically the source of the second case was traced to the water system of a newly commissioned office building complex. No further cases were detected after shock hyperchlorination with or without superheating of the water systems. Subsequent legionella counts were drastically reduced. Point-of-care infection control by off-boiled or sterile water for mouth care and installation of water filter for showers in the hospital wards for immunocompromised patients was instituted. Territory wide investigation of the community potable water supply showed that 22.1% of the household water supply was positive at a mean legionella count of 108.56 CFU/ml (range 0.10 to 639.30 CFU/ml). Conclusions Potable water systems are open systems which are inevitably colonized by bacterial biofilms containing Legionella species. High bacterial counts related to human cases may occur with stagnation of flow in both old or newly commissioned buildings. Vigilance against legionellosis is important in healthcare settings with dense population of highly susceptible hosts.
Persistent Identifierhttp://hdl.handle.net/10722/182358
ISSN
2015 Impact Factor: 0.957
2015 SCImago Journal Rankings: 0.428
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheng, VCCen_US
dc.contributor.authorWong, SSYen_US
dc.contributor.authorChen, JHKen_US
dc.contributor.authorChan, JFWen_US
dc.contributor.authorTo, KKWen_US
dc.contributor.authorPoon, RWSen_US
dc.contributor.authorWong, SCYen_US
dc.contributor.authorChan, KHen_US
dc.contributor.authorTai, JWMen_US
dc.contributor.authorHo, PLen_US
dc.contributor.authorTsang, THFen_US
dc.contributor.authorYuen, KYen_US
dc.date.accessioned2013-04-23T08:20:04Z-
dc.date.available2013-04-23T08:20:04Z-
dc.date.issued2012en_US
dc.identifier.citationChinese Medical Journal, 2012, v. 125 n. 23, p. 4283-4290en_US
dc.identifier.issn0366-6999en_US
dc.identifier.urihttp://hdl.handle.net/10722/182358-
dc.description.abstractBackground The environmental sources associated with community-acquired or nosocomial legionellosis were not always detectable in the mainland of China and Hong Kong, China. The objective of this study was to illustrate the control measures implemented for nosocomial and community outbreaks of legionellosis, and to understand the environmental distribution of legionella in the water system in Hong Kong, China. Methods We investigated the environmental sources of two cases of legionellosis acquired in the hospital and the community by extensive outbreak investigation and sampling of the potable water system using culture and genetic testing at the respective premises. Results The diagnosis of nosocomial legionellosis was suspected in a patient presenting with nosocomial pneumonia not responsive to multiple beta-lactam antibiotics with subsequent confirmation by Legionella pneumophila serogroup 1 antigenuria. High counts of Legionella pneumophila were detected in the potable water supply of the 70-year-old hospital building. Another patient on continuous ambulatory peritoneal dialysis presenting with acute community-acquired pneumonia and severe diarrhoea was positive for Legionella pneumophila serogroup 1 by polymerase chain reaction (PCR) testing on both sputum and nasopharyngeal aspirate despite negative antigenuria. Paradoxically the source of the second case was traced to the water system of a newly commissioned office building complex. No further cases were detected after shock hyperchlorination with or without superheating of the water systems. Subsequent legionella counts were drastically reduced. Point-of-care infection control by off-boiled or sterile water for mouth care and installation of water filter for showers in the hospital wards for immunocompromised patients was instituted. Territory wide investigation of the community potable water supply showed that 22.1% of the household water supply was positive at a mean legionella count of 108.56 CFU/ml (range 0.10 to 639.30 CFU/ml). Conclusions Potable water systems are open systems which are inevitably colonized by bacterial biofilms containing Legionella species. High bacterial counts related to human cases may occur with stagnation of flow in both old or newly commissioned buildings. Vigilance against legionellosis is important in healthcare settings with dense population of highly susceptible hosts.en_US
dc.languageengen_US
dc.publisherChinese Medical Association. The Journal's web site is located at http://www.cmj.org/en_US
dc.relation.ispartofChinese Medical Journalen_US
dc.subjectCommunity-Acquired Legionellosisen_US
dc.subjectNosocomial Legionellosisen_US
dc.subjectOutbreaken_US
dc.titleAn unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kongen_US
dc.typeArticleen_US
dc.identifier.emailChan, JFW: jfwchan@hku.hken_US
dc.identifier.emailTo, KKW: kelvinto@hkucc.hku.hken_US
dc.identifier.emailYuen, KY: kyyuen@hkucc.hku.hken_US
dc.identifier.authorityChan, JFW=rp01736en_US
dc.identifier.authorityTo, KKW=rp01384en_US
dc.identifier.authorityYuen, KY=rp00366en_US
dc.description.naturelink_to_OA_fulltexten_US
dc.identifier.doi10.3760/cma.j.issn.0366-6999.2012.23.022en_US
dc.identifier.pmid23217401-
dc.identifier.scopuseid_2-s2.0-84870749625en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-84870749625&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume125en_US
dc.identifier.issue23en_US
dc.identifier.spage4283en_US
dc.identifier.epage4290en_US
dc.identifier.isiWOS:000312748200022-
dc.publisher.placeChinaen_US
dc.identifier.scopusauthoridCheng, VCC=23670479400en_US
dc.identifier.scopusauthoridWong, SSY=55259895800en_US
dc.identifier.scopusauthoridChen, JHK=35085819900en_US
dc.identifier.scopusauthoridChan, JFW=24278817900en_US
dc.identifier.scopusauthoridTo, KKW=14323807300en_US
dc.identifier.scopusauthoridPoon, RWS=9334879200en_US
dc.identifier.scopusauthoridWong, SCY=55388445000en_US
dc.identifier.scopusauthoridChan, KH=7406034307en_US
dc.identifier.scopusauthoridTai, JWM=7101993154en_US
dc.identifier.scopusauthoridHo, PL=55362714400en_US
dc.identifier.scopusauthoridTsang, THF=7101832378en_US
dc.identifier.scopusauthoridYuen, KY=36078079100en_US

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