title: A community outbreak of Legionnaires' disease from an industrial cooling tower: assessment of clinical features and diagnostic procedures.
abstract: An outbreak of Legionnaires' disease (LD) occurred in Lidköping, Sweden, in August 2004. A cooling tower was identified as the probable source of infection. During the outbreak period an unexpected 3-6-fold increase in pneumonia patients was noted at the local hospital. During 7 weeks LD was diagnosed in 15 patients by urinary antigen and/or sputum culture. Additionally, 15 LD patients were diagnosed later by serology. Patients with LD were generally younger, more healthy, and more often smokers compared to other pneumonia patients. On admittance they had more severe symptoms with high fever and raised CRP levels, and more often hyponatraemia, gastrointestinal and CNS symptoms. A causative agent besides Legionella was found in 2 patients only. A significant titre rise for Mycoplasma and/or Chlamydophila pneumoniae was found in 13 of 29 tested patients with confirmed LD. We conclude that the clinical diagnosis of LD is difficult and that available diagnostic methods detect only a minority of patients in the acute phase. Therefore in severe pneumonia, empirically targeted therapy should be instituted on clinical grounds irrespective of the results of diagnostic tests. The observation of increased antibody levels for M. and C. pneumoniae suggests an unspecific immune reaction and merits further study.
authors: Department of Medicine, Uppsala University Hospital. Uppsala, Sweden.
authors: Anna
authors: A
authors: Hugosson
authors: Martin
authors: M
authors: Hjorth
authors: Sverker
authors: S
authors: Bernander
authors: Berndt E B
authors: BE
authors: Claesson
authors: Agneta
authors: A
authors: Johansson
authors: Helena
authors: H
authors: Larsson
authors: Peter
authors: P
authors: Nolskog
authors: Judit
authors: J
authors: Pap
authors: Nils
authors: N
authors: Svensson
authors: Peter
authors: P
authors: Ulleryd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000389:Air Conditioning / Q000009:adverse effects*; D000942:Antigens, Bacterial / Q000652:urine; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007221:Industry; D016952:Legionella pneumophila / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology; D013183:Sputum / Q000382:microbiology; D013548:Sweden / Q000453:epidemiology; D014871:Water Microbiology
chemical_list: D000942:Antigens, Bacterial