Page 124 - Petelin, Ana, et al. 2019. Eds. Zdravje otrok in mladostnikov / Health of Children and Adolescents. Proceedings. Koper: University of Primorska Press
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avje otrok in mladostnikov | health of children and adolescents 122 and reproduce at temperatures from 25 to 42 oC. In nature and in artificial cul-
tures they can survive even at temperatures from 0 to 63 oC. Their habitats
are protozoa, especially amebae (Gubina and Ihan, 2002; Brooks et al., 2010;
Greenwood et al., 1997). Genus Legionella contains 40 known species and 61
different serological groups. For eighteen (18) species it was shown to be path-
ogenic for humans, and the most of them are able to cause disease. L. pneu-
mophila serological Group 1 most commonly causes legionnaire‘s disease (that
can be easily proven with an urine assay) (Sočan, 2002). Clinical symptoms
caused by infection with Legionella are collectively known as legionellosis. The
most common are Legionnaires‘ disease (pneumonia) and Pontiac fever (Ma-
rolt Gomišček and Radšel Medvešček, 2002).
The purpose of our contribution was to show measures to prevent le-
gionellosis: a) the preventive measures, which reduce the possibility of Le-
gionella growth, b) measures after the detection of Legionella in the swimming
pools and c) measures in the event of illness due to legionellosis.
Epidemiology
Legionella was discovered in 1976, when an outbreak of pneumonia resulted in
221 participants in the Convention of the American legionaries in Philadelphia,
of which 34 had died. That is why they named the pneumonia legionnaire‘s dis-
ease. The bacterium, which was isolated from the lungs of the diseased legion-
aries, was called L. pneumophila. Legionnaire’s pneumonia is acute bacterial
pneumonia and occurs as sporadic disease, as a set of cases and as well as an
outbreak. Bacteria Leigonella spreads in water droplets (aerosols). Usually the
source of the infections is tap water, water for cooling and humidifying the air
and water from swimming pools, in hot spas where the water is swirling and
forming an aerosol. For humans, the most virulent is L. pneumophila. In 85 %
of cases pneumonia is caused by L. pneumophila, particularly serological group
1 (Sočan, 2002; Pond, 2005). The exact incidence of legionellosis is not known,
because the various methods are used for detection of Legionella. Also, report-
ing of the occurrence of Legionella are still not accurate. For example, the L.
pneumophila can be diagnosed by the antigen in the urine of the patient, but
other types of Legionella can not be detected by this method. Some of the tests
for the Legionella detection have low sensitivity, so the results may be falsely
negative. Legionella can not be diagnosed if the patient dies without treatment.
Some of the milder forms of disease, however, are not recognized. Cases of pas-
sengers are not reported to our national system databases (European Centre for
Disease Prevention and Control, 2019).
According to the World Health Organization (WHO) in Europe, Aus-
tralia and the United States about 10 to 15 cases per million inhabitants are re-
ported (World Health Organisation, 2018). The Center for Disease Control and
Prevention in Atlanta in the United States (CDC) reports that the incidence of
legionellosis increased. Since 2003 it has increased from 0.80 to 1.4 cases per
100.000 inhabitants (Centre for Disease Control and Prevention, 2018). In the
tures they can survive even at temperatures from 0 to 63 oC. Their habitats
are protozoa, especially amebae (Gubina and Ihan, 2002; Brooks et al., 2010;
Greenwood et al., 1997). Genus Legionella contains 40 known species and 61
different serological groups. For eighteen (18) species it was shown to be path-
ogenic for humans, and the most of them are able to cause disease. L. pneu-
mophila serological Group 1 most commonly causes legionnaire‘s disease (that
can be easily proven with an urine assay) (Sočan, 2002). Clinical symptoms
caused by infection with Legionella are collectively known as legionellosis. The
most common are Legionnaires‘ disease (pneumonia) and Pontiac fever (Ma-
rolt Gomišček and Radšel Medvešček, 2002).
The purpose of our contribution was to show measures to prevent le-
gionellosis: a) the preventive measures, which reduce the possibility of Le-
gionella growth, b) measures after the detection of Legionella in the swimming
pools and c) measures in the event of illness due to legionellosis.
Epidemiology
Legionella was discovered in 1976, when an outbreak of pneumonia resulted in
221 participants in the Convention of the American legionaries in Philadelphia,
of which 34 had died. That is why they named the pneumonia legionnaire‘s dis-
ease. The bacterium, which was isolated from the lungs of the diseased legion-
aries, was called L. pneumophila. Legionnaire’s pneumonia is acute bacterial
pneumonia and occurs as sporadic disease, as a set of cases and as well as an
outbreak. Bacteria Leigonella spreads in water droplets (aerosols). Usually the
source of the infections is tap water, water for cooling and humidifying the air
and water from swimming pools, in hot spas where the water is swirling and
forming an aerosol. For humans, the most virulent is L. pneumophila. In 85 %
of cases pneumonia is caused by L. pneumophila, particularly serological group
1 (Sočan, 2002; Pond, 2005). The exact incidence of legionellosis is not known,
because the various methods are used for detection of Legionella. Also, report-
ing of the occurrence of Legionella are still not accurate. For example, the L.
pneumophila can be diagnosed by the antigen in the urine of the patient, but
other types of Legionella can not be detected by this method. Some of the tests
for the Legionella detection have low sensitivity, so the results may be falsely
negative. Legionella can not be diagnosed if the patient dies without treatment.
Some of the milder forms of disease, however, are not recognized. Cases of pas-
sengers are not reported to our national system databases (European Centre for
Disease Prevention and Control, 2019).
According to the World Health Organization (WHO) in Europe, Aus-
tralia and the United States about 10 to 15 cases per million inhabitants are re-
ported (World Health Organisation, 2018). The Center for Disease Control and
Prevention in Atlanta in the United States (CDC) reports that the incidence of
legionellosis increased. Since 2003 it has increased from 0.80 to 1.4 cases per
100.000 inhabitants (Centre for Disease Control and Prevention, 2018). In the
