Innovative Methods to Control, Investigate, and Monitor for Legionella : A Panel Discussion

1. Innovative Methods to Control, Investigate, and Monitor for Legionella: A Panel Discussion

2. Introduction—Mark Bergtholdt • Water Management Plans—Brooke Winter • Investigation as a way of preventing—Mark Bergtholdt • Using a Rapid Bacteria Screening Method to Assess Legionella Risk—Lisa Rogers

3. Introduction: What is Legionella and why is it important Mark Bergtholdt

4. Discovered in 1976 at an American Legion Convention in Philadelphia Attendees became ill with pneumonia

5. 221 Total Cases 2/3 Hospitalized 34 Deaths

6. Bacteria Legionellapneumophila were found to be the cause

7. Legionella: What it is and where does it come from?

8. Organism Characterization Legionellais a bacteria 43 or more identified species of Legionella Multiple Serogroups, with over 60 serogroups presently identified for the genus

9. 5- 10% 20- 30% 70%

10. Ecology of Legionella Grow best at 68 to 115oFahrenheit (Water supply systems often kept at 77 to 108oF) Can be found in natural surface waters and in buildings Infect/replicate in both protozoa and human white blood cells The protozoa/blood cells infected with Legionella burst and release the bacteria into the water

11. 35-46˚C (95-115˚F) Legionella’s optimal growth temperature

12. 60˚C (140˚F) 90% Kill in 2 Minutes <20˚C (68˚F) Predominantly dormant, but still viable

13. Legionella enters the amoeba Legionella fuses with the amoeba inside a membrane-bound vacuole and replicates Legionellareleases from the amoeba, exiting as the amoeba dies

14. Legionella attaches to biofilm

15. Replication occurs

16. Legionella reaches maturation

17. Some Legionellaform new colonies

18. Others continue to end fixture

19. Legionella are found in the biofilms that accumulate in the built environment:

20. How Legionellacauseshuman infections

21. The bacteria travel downstream to locations where it is aerosolized, such as:

22. Susceptible Individual:

23. Susceptible Individual: 50+ years of age

24. Susceptible Individual: • 50+ years of age • Has Chronic Lung Disease

25. Susceptible Individual: • 50+ years of age • Has Chronic Lung Disease • Is a current or former smoker

26. Susceptible Individual: • 50+ years of age • Has Chronic Lung Disease • Is a current or former smoker • Is immunocompromised

27. How does a bacteria that enters an amoeba infect Humans?

28. Legionella is engulfed by the white blood cell The Legionella replicates inside the white blood cell Legionellareleases from the white blood cell, exiting as the cell dies. Legionellago on to infect other white blood cells in the lung causing a pneumonia like illness

29. 2 day -14 day Incubation Period

30. High fever Headache Chills Muscle pain Dry Cough Difficulty breathing

31. Symptoms are severe; the individual will usually visit a physician Legionnaires’ disease may be diagnosed as common pneumonia

32. Sputum culture or urine antigen test is used for positive identification

33. to 8,000 18,000 Hospitalizations Annually

34. 4,000 • Deaths Annually

35. Legionnaires’ disease is under reported

36. Legionnaires’ disease is under reported • Patients sometimes recover without medical assistance

37. Legionnaires’ disease is under reported • Patients sometimes recover without medical assistance • Patients are not tested for Legionellosis by the physician

38. Legionnaires’ disease is under reported • Patients sometimes recover without medical assistance • Patients are not tested for Legionellosis by the physician • Patients are misdiagnosed

39. In Summary Reporting of Legionellosis • Legionella is a bacteria that needs a host to replicate. • It is found in water and replicates in warm water • It infects humans when the water containing the bacteria is aerosolized and inhaled by the person. • It is an under reported disease