Materiały źródłowe

• #1 Legionnaires’ Disease FAQ

  https://www.health.ny.gov/diseases/communicable/legionellosis/fact_sheet.htm

  Legionnaires’ disease (Legionellosis) is a bacterial disease which may cause pneumonia. […] An outbreak of this disease in Philadelphia in 1976, largely among people attending a state convention of the American Legion, led to the name „Legionnaires’ disease.” Subsequently, the bacterium causing the illness was named Legionella pneumophila and the name of the illness was changed to Legionellosis. […] It is estimated that about 25,000 people develop Legionnaires’ disease in the United States each year. […] The disease appears to be spread through the air from a soil or water source. […] Most healthy individuals do not become infected with Legionella bacteria after exposure. […] Legionella exist naturally in water and moist soil. […] Antibiotics such as erythromycin, levaquin or azithromycin appear to be effective in treating the disease.

• #2 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionella pneumophila is an intracellular, aerobic, gram-negative bacillus and the etiologic agent of Legionnaires disease. […] The etiological agent of most clinical cases is Legionella pneumophila, serogroup 1. […] While more than 15 serogroups of legionellae have been identified, serogroups 1, 4, and 6 are the cause of human disease; serogroup 1 appears to be the etiologic agent of at least 80% of reported cases of L pneumophila pneumonia. […] This intracellular bacterium is acquired from infected environmental sources, soil, or water. […] Legionellae prefer warm water, between 20 C and 42 C; this temperature range facilitates their growth and transmission. […] These contaminated reservoirs are a source of human infection via inhalation of aerosolized contaminated water droplets.

• #3 Legionnaires’ disease – Wikipedia

  https://en.wikipedia.org/wiki/Legionnaires%27_disease

  Legionnaires’ disease is a form of atypical pneumonia caused by any species of Legionella bacteria, quite often Legionella pneumophila. […] Causes Bacteria of the Legionella type (spread by contaminated mist). […] Over 90% of cases of Legionnaires’ disease are caused by Legionella pneumophila. Other types include L. longbeachae, L. feeleii, L. micdadei, and L. anisa. […] Legionnaires’ disease is usually spread by the breathing in of aerosolized water or soil contaminated with the Legionella bacteria. […] Experts have stated that Legionnaires’ disease is not transmitted from person to person. […] The bacteria grow best at warm temperatures and thrive at water temperatures between 25 and 45 C (77 and 113 F), with an optimum temperature of 35 C (95 F). […] Legionella bacteria survive in water as intracellular parasites of water-dwelling protozoa, such as amoebae.

• #4 Legionella Infection: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/965492-overview

  Legionnaires disease (LD) was recognized in 1976 after an outbreak of pneumonia at an American Legion convention in Philadelphia. Soon after, the etiologic agent was identified as a fastidious gram-negative bacillus and named Legionella pneumophila. […] Although more than 70 Legionella serogroups have been identified among 50 species, L pneumophila causes most legionellosis. L pneumophila serogroup 1 alone is responsible for 70-90% of cases in adults. […] Transmission occurs by means of aerosolization or aspiration of water contaminated with Legionella organisms. […] Most nosocomial infections and hospital outbreaks have been linked to contaminated hot water supply. […] Risk factors for children are less well defined than they are in adults. Apparent predisposing factors, from reported cases, include the following: Immunodeficiency (primary or secondary) – Malignancies, severe combined immunodeficiency, chronic granulomatous disease, organ transplantation, and treatment with corticosteroids. […] Rare cases of legionellosis are reported in children who are immunocompetent and who lack predisposing conditions.

• #5 Legionnaires’ disease – Wikipedia

  https://en.wikipedia.org/wiki/Legionnaires%27_disease

  Legionnaires’ disease is a form of atypical pneumonia caused by any species of Legionella bacteria, quite often Legionella pneumophila. […] Causes Bacteria of the Legionella type (spread by contaminated mist). […] Over 90% of cases of Legionnaires’ disease are caused by Legionella pneumophila. Other types include L. longbeachae, L. feeleii, L. micdadei, and L. anisa. […] Legionnaires’ disease is usually spread by the breathing in of aerosolized water or soil contaminated with the Legionella bacteria. […] Experts have stated that Legionnaires’ disease is not transmitted from person to person. […] The bacteria grow best at warm temperatures and thrive at water temperatures between 25 and 45 C (77 and 113 F), with an optimum temperature of 35 C (95 F). […] Legionella bacteria survive in water as intracellular parasites of water-dwelling protozoa, such as amoebae.

• #6

  https://www.health.nsw.gov.au/Infectious/factsheets/Pages/legionnaires_disease.aspx

  Legionnaires’ disease is an infection of the lungs (pneumonia) caused by Legionella bacteria. Infection occurs when a person breathes in bacteria that are commonly found in the environment. […] Legionnaires’ disease can occur after a person breathes in contaminated water droplets or dust. Although there are many different species of Legionella bacteria, the two that most commonly cause disease in NSW are: Legionella pneumophila – these bacteria can contaminate air conditioning cooling towers, whirlpool spas, shower heads and other bodies of water. Legionella longbeachae – these bacteria can contaminate soil or potting mix. […] Legionnaires’ disease most often affects middle-aged and older people, particularly those who smoke or who have chronic lung disease. Also at increased risk are people whose immune systems are suppressed by medications or diseases such as cancer, kidney failure, diabetes or HIV.

• #7 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionella pneumophila is an intracellular, aerobic, gram-negative bacillus and the etiologic agent of Legionnaires disease. […] The etiological agent of most clinical cases is Legionella pneumophila, serogroup 1. […] While more than 15 serogroups of legionellae have been identified, serogroups 1, 4, and 6 are the cause of human disease; serogroup 1 appears to be the etiologic agent of at least 80% of reported cases of L pneumophila pneumonia. […] This intracellular bacterium is acquired from infected environmental sources, soil, or water. […] Legionellae prefer warm water, between 20 C and 42 C; this temperature range facilitates their growth and transmission. […] These contaminated reservoirs are a source of human infection via inhalation of aerosolized contaminated water droplets.

• #8 Legionella Infection: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/965492-overview

  Legionnaires disease (LD) was recognized in 1976 after an outbreak of pneumonia at an American Legion convention in Philadelphia. Soon after, the etiologic agent was identified as a fastidious gram-negative bacillus and named Legionella pneumophila. […] Although more than 70 Legionella serogroups have been identified among 50 species, L pneumophila causes most legionellosis. L pneumophila serogroup 1 alone is responsible for 70-90% of cases in adults. […] Transmission occurs by means of aerosolization or aspiration of water contaminated with Legionella organisms. […] Most nosocomial infections and hospital outbreaks have been linked to contaminated hot water supply. […] Risk factors for children are less well defined than they are in adults. Apparent predisposing factors, from reported cases, include the following: Immunodeficiency (primary or secondary) – Malignancies, severe combined immunodeficiency, chronic granulomatous disease, organ transplantation, and treatment with corticosteroids. […] Rare cases of legionellosis are reported in children who are immunocompetent and who lack predisposing conditions.

• #9 How Legionella Spreads | Legionella | CDC

  https://www.cdc.gov/legionella/causes/index.html

  Legionella bacteria cause Legionnaires’ disease and Pontiac fever. […] A type of bacteria called Legionella causes Legionnaires’ disease and Pontiac fever. […] Legionella most commonly spreads through devices that use water. […] People can get Legionnaires’ disease or Pontiac fever when they breathe in (inhale) those small droplets containing the bacteria. This is the most common way people get sick. […] Legionella bacteria occur naturally in freshwater environments, like lakes and streams. Generally, the low amounts of these bacteria in freshwater don’t lead to disease. […] However, Legionella can pose a risk to health when it gets into building water systems and grows (increases in numbers).

• #10 Legionnaires’ Disease | Legionella Pneumonia | MedlinePlus

  https://medlineplus.gov/legionnairesdisease.html

  Legionnaires’ disease is a serious type of pneumonia caused by Legionella bacteria. […] Legionella is found naturally in freshwater, such as lakes and rivers. It can also be found in soil. But people usually only get sick from it when if it grows and spreads in man-made water systems. […] You can get the infection by breathing in mist or small drops of water that contain the bacteria. The mist may come from hot tubs, showers, or large building air conditioning units. […] The bacteria don’t spread from person to person. Disease outbreaks happen when many people are exposed to the same water source that contains the bacteria. […] Legionnaires’ disease can cause life-threatening complications such as respiratory failure, kidney failure, and sepsis. […] About 1 out of every 10 people who get sick with Legionnaires’ disease will die from complications of the illness.

• #11 How Legionella Spreads | Legionella | CDC

  https://www.cdc.gov/legionella/causes/index.html

  Legionella bacteria cause Legionnaires’ disease and Pontiac fever. […] A type of bacteria called Legionella causes Legionnaires’ disease and Pontiac fever. […] Legionella most commonly spreads through devices that use water. […] People can get Legionnaires’ disease or Pontiac fever when they breathe in (inhale) those small droplets containing the bacteria. This is the most common way people get sick. […] Legionella bacteria occur naturally in freshwater environments, like lakes and streams. Generally, the low amounts of these bacteria in freshwater don’t lead to disease. […] However, Legionella can pose a risk to health when it gets into building water systems and grows (increases in numbers).

• #12 Legionellosis (Legionnaires’ Disease and Pontiac Fever) | Wisconsin Department of Health Services

  https://www.dhs.wisconsin.gov/disease/legionellosis.htm

  Legionellosis in an infection caused by Legionella bacteria. […] Legionnaires’ disease is not normally spread from person to person. […] Legionella bacteria are found naturally in freshwater and moist environments (e.g., lakes, rivers, groundwater) worldwide. Legionella can become a public health problem in manmade water systems, where it can grow and spread, causing disease. […] Outbreaks of Legionnaires disease are most commonly associated with large or complex water systems (e.g., hospitals, long-term care facilities, hotels, cruise ships). […] People can become sick when they breathe in mist from a water source that has Legionella (water used for showering, cooling towers, decorative fountains, and hot tubs). […] Legionnaires disease is on the rise in Wisconsin and nationally. The rising trend may be related to a combination of factors, such as increased awareness and testing, more people at risk (e.g., aging population, use of immune-suppressing medication), and increased Legionella in the environment.

• #13 Legionnaires Disease: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/220163-overview

  Legionella transmission is thought to occur via inhalation of aerosolized mist from water sources, such as the following, that have been contaminated with the bacterium […] Legionnaires disease (LD) may be travel associated from exposure in aircraft or hotel facilities. Person-to-person transmission, however, has not been documented. […] The highest incidence of LD occurs during late spring and early fall, when air-conditioning systems are used more frequently. […] Nosocomial acquisition likely occurs via aspiration, respiratory therapy equipment, or contaminated water. In addition, transmission has been linked to the use of humidifiers, nebulizers, and items that were rinsed with contaminated tap water. […] The following features increase the likelihood of colonization and amplification of legionellae in human-made water environments: Temperature of 25-42C, Stagnation, Scale and sediment, Presence of certain free-living aquatic amoebae capable of supporting intracellular growth of legionellae.

• #14 Legionnaires’ disease: Symptoms, transmission, and causes

  https://www.medicalnewstoday.com/articles/18413

  Temperatures between 68 and 113 degrees Fahrenheit, or from 20 to 45 degrees Celsius, can be ideal for the bacteria to multiply rapidly and spread. […] An ideal environment also provides the right food. Impurities, such as algae, sludge, rust, and lime scale are types of food for this sort of bacteria. […] The Centers for Disease Control and Prevention (CDC) state that most cases that occur could be prevented through better water management. […] They note that between 2000 and 2014, Almost all outbreaks were caused by problems preventable with more effective water management.

• #15 Legionnaires’ disease – Wikipedia

  https://en.wikipedia.org/wiki/Legionnaires%27_disease

  Legionnaires’ disease is a form of atypical pneumonia caused by any species of Legionella bacteria, quite often Legionella pneumophila. […] Causes Bacteria of the Legionella type (spread by contaminated mist). […] Over 90% of cases of Legionnaires’ disease are caused by Legionella pneumophila. Other types include L. longbeachae, L. feeleii, L. micdadei, and L. anisa. […] Legionnaires’ disease is usually spread by the breathing in of aerosolized water or soil contaminated with the Legionella bacteria. […] Experts have stated that Legionnaires’ disease is not transmitted from person to person. […] The bacteria grow best at warm temperatures and thrive at water temperatures between 25 and 45 C (77 and 113 F), with an optimum temperature of 35 C (95 F). […] Legionella bacteria survive in water as intracellular parasites of water-dwelling protozoa, such as amoebae.

• #16 Legionnaires’ Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/legionnaires-disease-pro

  The bacteria are distributed widely in the environment and can breed in natural and artificial water sources. However, they only become a risk to health when conditions allow their rapid multiplication. […] The bacterium can survive low temperatures and multiplies in water temperatures between 25C and 45C. […] The risk of infection has prompted guidance on the precautions required to minimise this risk of Legionnaires’ disease. […] Legionnaires’ disease is an uncommon form of pneumonia; it is responsible for 2-15% of all community-acquired pneumonias that require hospitalisation in Europe or North America. […] The Public Health England (PHE) data are derived from laboratory-confirmed reports and follow-up questionnaires that collect information on whether the case is community-acquired, hospital-acquired or travel-associated.

• #17 Legionnaires Disease: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/220163-overview

  Legionella transmission is thought to occur via inhalation of aerosolized mist from water sources, such as the following, that have been contaminated with the bacterium […] Legionnaires disease (LD) may be travel associated from exposure in aircraft or hotel facilities. Person-to-person transmission, however, has not been documented. […] The highest incidence of LD occurs during late spring and early fall, when air-conditioning systems are used more frequently. […] Nosocomial acquisition likely occurs via aspiration, respiratory therapy equipment, or contaminated water. In addition, transmission has been linked to the use of humidifiers, nebulizers, and items that were rinsed with contaminated tap water. […] The following features increase the likelihood of colonization and amplification of legionellae in human-made water environments: Temperature of 25-42C, Stagnation, Scale and sediment, Presence of certain free-living aquatic amoebae capable of supporting intracellular growth of legionellae.

• #18 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Causes-of-Legionnaires-disease.aspx

  Legionnaires disease is a pneumonia or lung infection that is commonly caused by Legionella species of bacteria. […] The disease is mostly caused by the Legionella pneumophillia. […] Disease occurs when the bacteria enters the breathing atmosphere as fine particles or as small contaminated water droplets in air. These are inhaled deep into the lungs where they multiply and cause the infections. […] Legionella longbeachae is another causative organism present in soil and compost. Inhaling airborne soil particles that carry Legionella may cause the disease. […] Legionella bacteria grow particularly well in water temperature of between 20-45C (68-113F). The bacteria also prefer water that contains impurities like rust, algae, sludge, amoebae, slime, biolm, lime scale, corrosion products or other organic matter and other bacteria. […] Air conditioning systems, especially if poorly maintained, are usually a common cause of the disease. The disease is not spread from person-to-person.

• #19 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionellae can adapt to human-made water systems in buildings, including healthcare institutions, by forming biofilms and resisting disinfectants. […] The prevention of Legionnaires disease requires proper maintenance and disinfection of water systems to reduce the risk of bacterial growth and exposure.

• #20 Legionellosis (Legionnaires’ Disease and Pontiac Fever) – Overview | Occupational Safety and Health Administration

  https://www.osha.gov/legionnaires-disease

  Legionnaires’ disease and Pontiac Fever are collectively known as Legionellosis, a disease caused by Legionella bacteria. […] Although Legionella are usually harmless and found naturally in water and soil, it becomes a potentially deadly human health hazard when it grow in places such as poorly maintained domestic and industrial water systems; cooling towers; or heating, ventilation, and air condition (HVAC) systems. […] Workers may develop Legionellosis if they are exposed to Legionella from these types of sources, especially in water droplets or respirable fine mists small enough to inhale. […] Improperly maintained water systems, such as domestic or industrial water systems or large HVAC systems, are among the leading sources of worker exposure to the bacteria that cause Legionnaires’ disease. […] Legionnaires’ disease is a serious condition with a 10-percent death rate.

• #21 Legionellosis (Legionnaires’ Disease and Pontiac Fever) | Wisconsin Department of Health Services

  https://www.dhs.wisconsin.gov/disease/legionellosis.htm

  Legionellosis in an infection caused by Legionella bacteria. […] Legionnaires’ disease is not normally spread from person to person. […] Legionella bacteria are found naturally in freshwater and moist environments (e.g., lakes, rivers, groundwater) worldwide. Legionella can become a public health problem in manmade water systems, where it can grow and spread, causing disease. […] Outbreaks of Legionnaires disease are most commonly associated with large or complex water systems (e.g., hospitals, long-term care facilities, hotels, cruise ships). […] People can become sick when they breathe in mist from a water source that has Legionella (water used for showering, cooling towers, decorative fountains, and hot tubs). […] Legionnaires disease is on the rise in Wisconsin and nationally. The rising trend may be related to a combination of factors, such as increased awareness and testing, more people at risk (e.g., aging population, use of immune-suppressing medication), and increased Legionella in the environment.

• #22 Legionnaires’ disease

  https://www.nhs.uk/conditions/legionnaires-disease/

  Legionnaires’ disease is a lung infection you can get from inhaling droplets of water from things like air conditioning or hot tubs. […] You can get Legionnaires’ disease if you breathe in tiny droplets of water containing bacteria that cause the infection. […] It’s usually caught in places like hotels, hospitals or offices where the bacteria have got into the water supply. […] You can get Legionnaires’ disease from things like air conditioning systems, humidifiers, spa pools and hot tubs, taps and showers that are not used often.

• #23 Legionnaires Disease: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/220163-overview

  Legionella transmission is thought to occur via inhalation of aerosolized mist from water sources, such as the following, that have been contaminated with the bacterium […] Legionnaires disease (LD) may be travel associated from exposure in aircraft or hotel facilities. Person-to-person transmission, however, has not been documented. […] The highest incidence of LD occurs during late spring and early fall, when air-conditioning systems are used more frequently. […] Nosocomial acquisition likely occurs via aspiration, respiratory therapy equipment, or contaminated water. In addition, transmission has been linked to the use of humidifiers, nebulizers, and items that were rinsed with contaminated tap water. […] The following features increase the likelihood of colonization and amplification of legionellae in human-made water environments: Temperature of 25-42C, Stagnation, Scale and sediment, Presence of certain free-living aquatic amoebae capable of supporting intracellular growth of legionellae.

• #24 Causes of Legionnaires’ Disease | Mercury Legal

  https://www.legionnairesdiseasesolicitors.com/causes-legionnaires-disease/

  The Legionella bacteria responsible for Legionnaires Disease is found naturally in fresh water sources such as rivers, lakes and reservoirs, but very rarely in the quantities or format that causes the disease. Any man-made water system that has a water temperature between 20 and 45 centigrade, that stores or recirculates water or has the capacity to create or spread breathable droplets of contaminated water (water vapour) can be a source of Legionnaires Disease. The most common sources are air-conditioning systems, hot and cold-water systems, and spa baths, but any devices such as humidifiers, air-washers, showers or even ornamental fountains can be a source of the disease. […] When large outbreaks of the disease occur, it is commonly found to have originated within air-conditioning systems that can distribute the contaminated water vapour through large areas. The disease is synonymous with hotels, cruise ships and hospitals all situations where centralised air-conditioning systems have the capacity to spread the bacteria throughout the building, or local area.

• #25 Legionellosis (Legionnaire’s Disease) – Mississippi State Department of Health

  https://msdh.ms.gov/msdhsite/handlers/printcontent.cfm?ContentID=1811&ThisPageURL=http%3A%2F%2Fmsdh%2Ems%2Egov%2Fmsdhsite%2Findex%2Ecfm%2Findex%2Ecfm&EntryCode=1811&GroupID=14

  Legionnaires disease (Legionellosis) is a bacterial infection of the lungs., and causes symptoms similar to pneumonia. Without treatment, illness can be severe or fatal. […] The bacterium that causes Legionellosis is found naturally in freshwater environments like lakes and streams. It can become a health concern when it grows and spreads in human-made water systems like cooling towers, hot tubs that arent drained after each use, large plumbing systems, and other places that hold or process warm water. […] Hot tub displays at temporary events may pose a risk for Legionnaires disease, a type of pneumonia caused by inhaling mist containing Legionella bacteria. […] A hot tub that is not adequately maintained can expose people to Legionella bacteria even if they do not get in it. This makes display hot tubs at temporary events a risk for Legionnaires disease if they contain Legionella bacteria.

• #26 About Legionnaires’ Disease – MN Dept. of Health

  https://www.health.state.mn.us/diseases/legionellosis/basics.html

  Legionnaires disease is a serious type of pneumonia (lung infection) caused by Legionella bacteria. […] The bacteria are found naturally at low levels in freshwater environments, but they present a risk to human health when they grow and spread from human-made water systems. […] Legionnaires disease is spread by small water droplets in the air that contain Legionella bacteria. […] The bacteria can be spread by devices that create water mist such as hot tubs, showers, decorative fountains, and cooling towers. […] People at increased risk for infection include those age 50 years or older and current or former smokers. […] Other risk factors include chronic health conditions such as lung, kidney, or liver disease, diabetes, cancer, and conditions and medications that affect the immune system.

• #27

  http://www.bccdc.ca/health-info/diseases-conditions/legionnaires-disease

  Legionnaires’ disease and Pontiac fever are both forms of a disease called legionellosis, an uncommon respiratory infection caused by Legionella pneumophila bacteria. Water systems and devices can spread Legionella to people, with one of the most common ways to get sick is by breathing in aerosolized water containing the bacteria. […] The most significant cause of legionellosis is the bacterium Legionella pneumophila. The bacteria are naturally found in the environment, most often in water. People become infected when they breathe in spray or mist coming from contaminated water. Legionella grows best in standing water at 20-50C. Legionella infections are not usually spread from person to person. […] There have been individual cases and outbreaks linked to these water systems and devices: Wet cooling towers (structures that use water and a fan to cool centralized air systems for buildings or industrial processes). Hot tubs, jacuzzis, or whirlpools. Decorative fountains and water features. Aerosol generating equipment (i.e., humidifiers or misters).

• #28 Legionnaires Disease: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/220163-overview

  Legionella transmission is thought to occur via inhalation of aerosolized mist from water sources, such as the following, that have been contaminated with the bacterium […] Legionnaires disease (LD) may be travel associated from exposure in aircraft or hotel facilities. Person-to-person transmission, however, has not been documented. […] The highest incidence of LD occurs during late spring and early fall, when air-conditioning systems are used more frequently. […] Nosocomial acquisition likely occurs via aspiration, respiratory therapy equipment, or contaminated water. In addition, transmission has been linked to the use of humidifiers, nebulizers, and items that were rinsed with contaminated tap water. […] The following features increase the likelihood of colonization and amplification of legionellae in human-made water environments: Temperature of 25-42C, Stagnation, Scale and sediment, Presence of certain free-living aquatic amoebae capable of supporting intracellular growth of legionellae.

• #29 About Legionnaires’ Disease – MN Dept. of Health

  https://www.health.state.mn.us/diseases/legionellosis/basics.html

  Legionnaires disease is a serious type of pneumonia (lung infection) caused by Legionella bacteria. […] The bacteria are found naturally at low levels in freshwater environments, but they present a risk to human health when they grow and spread from human-made water systems. […] Legionnaires disease is spread by small water droplets in the air that contain Legionella bacteria. […] The bacteria can be spread by devices that create water mist such as hot tubs, showers, decorative fountains, and cooling towers. […] People at increased risk for infection include those age 50 years or older and current or former smokers. […] Other risk factors include chronic health conditions such as lung, kidney, or liver disease, diabetes, cancer, and conditions and medications that affect the immune system.

• #30 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionellae can adapt to human-made water systems in buildings, including healthcare institutions, by forming biofilms and resisting disinfectants. […] The prevention of Legionnaires disease requires proper maintenance and disinfection of water systems to reduce the risk of bacterial growth and exposure.

• #31 Legionnaires’ disease: Symptoms, transmission, and causes

  https://www.medicalnewstoday.com/articles/18413

  Temperatures between 68 and 113 degrees Fahrenheit, or from 20 to 45 degrees Celsius, can be ideal for the bacteria to multiply rapidly and spread. […] An ideal environment also provides the right food. Impurities, such as algae, sludge, rust, and lime scale are types of food for this sort of bacteria. […] The Centers for Disease Control and Prevention (CDC) state that most cases that occur could be prevented through better water management. […] They note that between 2000 and 2014, Almost all outbreaks were caused by problems preventable with more effective water management.

• #32 Factsheet about Legionnaires’ disease

  https://www.ecdc.europa.eu/en/legionnaires-disease/facts

  Legionnaires disease is a multisystem disease which causes pneumonia due to gram-negative bacteria (Legionella spp.) found in freshwater environments around the world. Humans are infected by inhalation of aerosols containing Legionella. The infection can be fatal and outbreaks from a common environmental source can occur. […] Legionella bacteria are common and can be found naturally in environmental water sources such as rivers, lakes and reservoirs, usually in low numbers. The bacteria can multiply in man-made aquatic systems like cooling towers, evaporative condensers, humidifiers, decorative fountains, hot water systems and similar systems. […] Experience shows that outbreaks in hotels are mostly associated with hot or cold water distribution systems. If the bacteria is in the water in quantities that can cause infection, someone taking a shower would inhale the bacteria trapped inside the tiny aerosols that are created when the shower water hits the hard surfaces of the shower unit or bath.

• #33 Factsheet about Legionnaires’ disease

  https://www.ecdc.europa.eu/en/legionnaires-disease/facts

  In contrast, large explosive outbreaks in the community are mostly associated with cooling towers. Cooling towers are devices used to cool buildings. They are also called wet air conditioning systems because the process of cooling air involves extensive contact between water and air, thereby creating aerosols. When the Legionella bacteria are present in these systems they can cause Legionnaires’ disease.

• #34 Legionellosis (Legionnaires’ Disease and Pontiac Fever) | Wisconsin Department of Health Services

  https://www.dhs.wisconsin.gov/disease/legionellosis.htm

  Legionellosis in an infection caused by Legionella bacteria. […] Legionnaires’ disease is not normally spread from person to person. […] Legionella bacteria are found naturally in freshwater and moist environments (e.g., lakes, rivers, groundwater) worldwide. Legionella can become a public health problem in manmade water systems, where it can grow and spread, causing disease. […] Outbreaks of Legionnaires disease are most commonly associated with large or complex water systems (e.g., hospitals, long-term care facilities, hotels, cruise ships). […] People can become sick when they breathe in mist from a water source that has Legionella (water used for showering, cooling towers, decorative fountains, and hot tubs). […] Legionnaires disease is on the rise in Wisconsin and nationally. The rising trend may be related to a combination of factors, such as increased awareness and testing, more people at risk (e.g., aging population, use of immune-suppressing medication), and increased Legionella in the environment.

• #35 Causes of Legionnaires’ Disease | Mercury Legal

  https://www.legionnairesdiseasesolicitors.com/causes-legionnaires-disease/

  The Legionella bacteria responsible for Legionnaires Disease is found naturally in fresh water sources such as rivers, lakes and reservoirs, but very rarely in the quantities or format that causes the disease. Any man-made water system that has a water temperature between 20 and 45 centigrade, that stores or recirculates water or has the capacity to create or spread breathable droplets of contaminated water (water vapour) can be a source of Legionnaires Disease. The most common sources are air-conditioning systems, hot and cold-water systems, and spa baths, but any devices such as humidifiers, air-washers, showers or even ornamental fountains can be a source of the disease. […] When large outbreaks of the disease occur, it is commonly found to have originated within air-conditioning systems that can distribute the contaminated water vapour through large areas. The disease is synonymous with hotels, cruise ships and hospitals all situations where centralised air-conditioning systems have the capacity to spread the bacteria throughout the building, or local area.

• #36 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionellae are ubiquitous and transmitted to humans via aerosolized contaminated water from the environment or building water systems. […] The true incidence of Legionnaires disease is unknown; many countries lack appropriate diagnostic, surveillance, or reporting methods. […] Legionnaires disease has been reported as a travel-associated infection, most commonly associated with hotels with contaminated water systems or hot tubs. […] The reported incidence of travel-related or healthcare-associated legionellosis in the United States is 20%. […] Legionellae enter the lungs by aspiration of contaminated water or inhaling aerosolized contaminated water or soil. […] Legionellae enter alveolar macrophages and epithelial cells via phagocytosis. […] This intracellular bacterium is acquired from infected environmental sources, soil, or water.

• #37 Legionnaires’ Disease: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17750-legionnaires-disease

  Legionnaires disease is a serious type of pneumonia you get when Legionella bacteria infect your lungs. […] You get Legionnaires disease when Legionella infects your lungs. […] Legionella bacteria causes Legionnaires disease. While there are at least 60 species of Legionella, Legionnaires disease is most often caused by Legionella pneumophila. […] You can get Legionnaires disease by breathing in mist (aerosolized water) contaminated with bacteria or from getting contaminated water in your lungs (aspirating). […] You can get Legionnaires disease from hot tubs, shower heads, faucets, humidifiers, decorative water features, heating and cooling systems (usually only in large buildings), intubation during surgery, and dirt (soil). […] Legionnaires disease is treated with antibiotics. […] Legionnaires disease is very serious, but most people survive. If treated, lung infections with Legionella are fatal about 5% to 10% of the time. If not treated, Legionnaires disease is fatal 30% to 80% of the time.

• #38 Legionnaires’ disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legionnaires-disease/symptoms-causes/syc-20351747

  Legionnaires’ disease is a severe form of a lung infection called pneumonia. It’s caused by a bacterium known as legionella. […] The bacterium Legionella pneumophila causes most cases of Legionnaires’ disease. Outdoors, legionella bacteria live in soil and water. In those places the bacteria rarely cause infections. But legionella bacteria can grow in water systems made by humans, such as air conditioners. […] Most people become infected when they breathe in tiny water droplets that have legionella bacteria. This might be from the spray from a shower, sink or hot tub. Or it might be from water from the system that cools large buildings. […] The infection can spread in other ways besides breathing in water droplets. The infection can spread by: Aspiration. This occurs when liquids enter the lungs by accident, most often because of coughing or choking while drinking. Aspirating water that has legionella bacteria can cause Legionnaires’ disease. […] A few people have gotten Legionnaires’ disease after working in a garden or using potting soil that had the bacteria in it.

• #39 About Legionnaires’ Disease | Legionella | CDC

  https://www.cdc.gov/legionella/about/index.html

  Legionnaires’ disease is a serious type of pneumonia caused by Legionella bacteria. […] A type of bacteria called Legionella causes Legionnaires’ disease. People can get Legionnaires’ disease when they breathe in mist that contains the bacteria. […] The key to preventing Legionnaires’ disease is to reduce the risk of Legionella growth and spread.

• #40 Legionellosis (Legionnaires’ Disease and Pontiac Fever) – Overview | Occupational Safety and Health Administration

  https://www.osha.gov/legionnaires-disease

  Legionnaires’ disease and Pontiac Fever are collectively known as Legionellosis, a disease caused by Legionella bacteria. […] Although Legionella are usually harmless and found naturally in water and soil, it becomes a potentially deadly human health hazard when it grow in places such as poorly maintained domestic and industrial water systems; cooling towers; or heating, ventilation, and air condition (HVAC) systems. […] Workers may develop Legionellosis if they are exposed to Legionella from these types of sources, especially in water droplets or respirable fine mists small enough to inhale. […] Improperly maintained water systems, such as domestic or industrial water systems or large HVAC systems, are among the leading sources of worker exposure to the bacteria that cause Legionnaires’ disease. […] Legionnaires’ disease is a serious condition with a 10-percent death rate.

• #41 Legionnaires’ disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legionnaires-disease/symptoms-causes/syc-20351747

  Legionnaires’ disease is a severe form of a lung infection called pneumonia. It’s caused by a bacterium known as legionella. […] The bacterium Legionella pneumophila causes most cases of Legionnaires’ disease. Outdoors, legionella bacteria live in soil and water. In those places the bacteria rarely cause infections. But legionella bacteria can grow in water systems made by humans, such as air conditioners. […] Most people become infected when they breathe in tiny water droplets that have legionella bacteria. This might be from the spray from a shower, sink or hot tub. Or it might be from water from the system that cools large buildings. […] The infection can spread in other ways besides breathing in water droplets. The infection can spread by: Aspiration. This occurs when liquids enter the lungs by accident, most often because of coughing or choking while drinking. Aspirating water that has legionella bacteria can cause Legionnaires’ disease. […] A few people have gotten Legionnaires’ disease after working in a garden or using potting soil that had the bacteria in it.

• #42 Legionnaires’ Disease: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17750-legionnaires-disease

  Legionnaires disease is a serious type of pneumonia you get when Legionella bacteria infect your lungs. […] You get Legionnaires disease when Legionella infects your lungs. […] Legionella bacteria causes Legionnaires disease. While there are at least 60 species of Legionella, Legionnaires disease is most often caused by Legionella pneumophila. […] You can get Legionnaires disease by breathing in mist (aerosolized water) contaminated with bacteria or from getting contaminated water in your lungs (aspirating). […] You can get Legionnaires disease from hot tubs, shower heads, faucets, humidifiers, decorative water features, heating and cooling systems (usually only in large buildings), intubation during surgery, and dirt (soil). […] Legionnaires disease is treated with antibiotics. […] Legionnaires disease is very serious, but most people survive. If treated, lung infections with Legionella are fatal about 5% to 10% of the time. If not treated, Legionnaires disease is fatal 30% to 80% of the time.

• #43 Legionnaires’ disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legionnaires-disease/symptoms-causes/syc-20351747

  Legionnaires’ disease is a severe form of a lung infection called pneumonia. It’s caused by a bacterium known as legionella. […] The bacterium Legionella pneumophila causes most cases of Legionnaires’ disease. Outdoors, legionella bacteria live in soil and water. In those places the bacteria rarely cause infections. But legionella bacteria can grow in water systems made by humans, such as air conditioners. […] Most people become infected when they breathe in tiny water droplets that have legionella bacteria. This might be from the spray from a shower, sink or hot tub. Or it might be from water from the system that cools large buildings. […] The infection can spread in other ways besides breathing in water droplets. The infection can spread by: Aspiration. This occurs when liquids enter the lungs by accident, most often because of coughing or choking while drinking. Aspirating water that has legionella bacteria can cause Legionnaires’ disease. […] A few people have gotten Legionnaires’ disease after working in a garden or using potting soil that had the bacteria in it.

• #44

  https://www.health.nsw.gov.au/Infectious/factsheets/Pages/legionnaires_disease.aspx

  Legionnaires’ disease is an infection of the lungs (pneumonia) caused by Legionella bacteria. Infection occurs when a person breathes in bacteria that are commonly found in the environment. […] Legionnaires’ disease can occur after a person breathes in contaminated water droplets or dust. Although there are many different species of Legionella bacteria, the two that most commonly cause disease in NSW are: Legionella pneumophila – these bacteria can contaminate air conditioning cooling towers, whirlpool spas, shower heads and other bodies of water. Legionella longbeachae – these bacteria can contaminate soil or potting mix. […] Legionnaires’ disease most often affects middle-aged and older people, particularly those who smoke or who have chronic lung disease. Also at increased risk are people whose immune systems are suppressed by medications or diseases such as cancer, kidney failure, diabetes or HIV.

• #45 Legionnaires’ Disease | Legionella Pneumonia | MedlinePlus

  https://medlineplus.gov/legionnairesdisease.html

  Legionnaires’ disease is a serious type of pneumonia caused by Legionella bacteria. […] Legionella is found naturally in freshwater, such as lakes and rivers. It can also be found in soil. But people usually only get sick from it when if it grows and spreads in man-made water systems. […] You can get the infection by breathing in mist or small drops of water that contain the bacteria. The mist may come from hot tubs, showers, or large building air conditioning units. […] The bacteria don’t spread from person to person. Disease outbreaks happen when many people are exposed to the same water source that contains the bacteria. […] Legionnaires’ disease can cause life-threatening complications such as respiratory failure, kidney failure, and sepsis. […] About 1 out of every 10 people who get sick with Legionnaires’ disease will die from complications of the illness.

• #46 Legionnaires’ Disease – NYC Health

  https://www.nyc.gov/site/doh/health/health-topics/legionnaires-disease.page

  Legionnaires disease is a type of pneumonia. It is caused by bacteria (Legionella) that grow in warm water. […] People who inhale mist that contains Legionella bacteria can get sick. Sources of water with Legionella contamination may include cooling towers, showers and hot tubs. […] Most people who are exposed to the bacteria do not develop Legionnaires disease, and it is not contagious you cannot get it from someone else. […] You cannot get Legionnaires disease by drinking the water. […] There is no vaccine or medicine that can prevent Legionnaires disease. The best way to prevent it is through the proper maintenance of water systems where Legionella may grow. […] The Health Department investigates clusters of Legionnaires disease cases to find the source of the contamination in order to prevent other people from getting sick.

• #47 Legionellosis (Legionella) | Tompkins County

  https://www.tompkinscountyny.gov/All-Departments/Whole-Health/Community-Health-Services/Communicable-Disease/Legionellosis-Legionella

  Most healthy individuals do not become infected with Legionella bacteria after exposure. […] People at higher risk of getting sick are those 50 years of age or older, current or former smokers, those with a chronic lung disease (like COPD or emphysema), those with a weak immune system from diseases like cancer, diabetes, or kidney failure, and people who take drugs that suppress (weaken) the immune system (like after a transplant operation or chemotherapy). […] Legionnaires’ disease often causes symptoms similar to those caused by other organisms, including influenza virus and other types of bacterial pneumonia. […] The diagnosis depends on very specialized laboratory tests involving culture of the patient’s sputum or detecting the organism in urine. Routine laboratory tests will not identify the Legionella bacteria.

• #48 Legionnaires’ Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/legionnaires-disease-pro

  LD is 2 to 5 times more common in men than in women. […] The death rate from diagnosed infections is 10-15% (representing about 10% in previously well individuals and up to 80% in the elderly). […] 40-50% of all cases are related to travel, usually abroad, where air-conditioning systems and stored water may be less well regulated. […] Older people, smokers and those with reduced immunity are more likely to be infected and are more likely to die. […] Public outbreaks of illness linked to recreational water use such as whirlpool spas or hot tubs have been found to be caused by Legionella species in 42% of cases. […] Legionella spp. are ubiquitous in water supplies and the role of hospital water supplies in the spread of nosocomial infection is unclear.

• #49 About Legionnaires’ Disease – MN Dept. of Health

  https://www.health.state.mn.us/diseases/legionellosis/basics.html

  Legionnaires disease is a serious type of pneumonia (lung infection) caused by Legionella bacteria. […] The bacteria are found naturally at low levels in freshwater environments, but they present a risk to human health when they grow and spread from human-made water systems. […] Legionnaires disease is spread by small water droplets in the air that contain Legionella bacteria. […] The bacteria can be spread by devices that create water mist such as hot tubs, showers, decorative fountains, and cooling towers. […] People at increased risk for infection include those age 50 years or older and current or former smokers. […] Other risk factors include chronic health conditions such as lung, kidney, or liver disease, diabetes, cancer, and conditions and medications that affect the immune system.

• #50 Legionnaires’ Disease – Causes and Prevention – MSU Extension

  https://www.canr.msu.edu/news/legionnaires_disease_causes_and_prevention

  Legionnaires disease is a type of pneumonia that affects the lungs. It is a very serious infection that is caused by a bacteria called legionella. […] Legionella bacteria thrive in water. The bacteria can grow in building water systems that are not properly maintained. […] Legionnaires disease is not spread through drinking water, but may be contracted through aspiration. […] Most people who are exposed to legionella bacteria wont get sick because they have resistance to the disease. […] According to the CDC, there are some factors that may increase the risk of a person getting sick, including: Being a smoker, or a former smoker; Being 50 years or older; Having a chronic lung or respiratory condition, like emphysema or chronic obstructive pulmonary disease (COPD); Having other medical conditions such as cancer, diabetes or HIV/AIDS; Taking drugs that reduce the ability to fight infections, such as steroids.

• #51 Legionnaires’ Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/legionnaires-disease-pro

  LD is 2 to 5 times more common in men than in women. […] The death rate from diagnosed infections is 10-15% (representing about 10% in previously well individuals and up to 80% in the elderly). […] 40-50% of all cases are related to travel, usually abroad, where air-conditioning systems and stored water may be less well regulated. […] Older people, smokers and those with reduced immunity are more likely to be infected and are more likely to die. […] Public outbreaks of illness linked to recreational water use such as whirlpool spas or hot tubs have been found to be caused by Legionella species in 42% of cases. […] Legionella spp. are ubiquitous in water supplies and the role of hospital water supplies in the spread of nosocomial infection is unclear.

• #52 Legionnaires’ Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/legionnaires-disease-pro

  LD is 2 to 5 times more common in men than in women. […] The death rate from diagnosed infections is 10-15% (representing about 10% in previously well individuals and up to 80% in the elderly). […] 40-50% of all cases are related to travel, usually abroad, where air-conditioning systems and stored water may be less well regulated. […] Older people, smokers and those with reduced immunity are more likely to be infected and are more likely to die. […] Public outbreaks of illness linked to recreational water use such as whirlpool spas or hot tubs have been found to be caused by Legionella species in 42% of cases. […] Legionella spp. are ubiquitous in water supplies and the role of hospital water supplies in the spread of nosocomial infection is unclear.

• #53 Legionnaires’ Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/legionnaires-disease-pro

  LD is 2 to 5 times more common in men than in women. […] The death rate from diagnosed infections is 10-15% (representing about 10% in previously well individuals and up to 80% in the elderly). […] 40-50% of all cases are related to travel, usually abroad, where air-conditioning systems and stored water may be less well regulated. […] Older people, smokers and those with reduced immunity are more likely to be infected and are more likely to die. […] Public outbreaks of illness linked to recreational water use such as whirlpool spas or hot tubs have been found to be caused by Legionella species in 42% of cases. […] Legionella spp. are ubiquitous in water supplies and the role of hospital water supplies in the spread of nosocomial infection is unclear.

• #54 Legionnaires’ disease: Causes, symptoms and treatment | Live Science

  https://www.livescience.com/legionnaires-disease.html

  One way that people can become sick is by aspirating contaminated drinking water. […] The mechanism to prevent aspiration may be defective in people who smoke or have lung disease two groups more likely to develop Legionnaires’ disease. […] Disease outbreaks are relatively rare but occur more frequently in summer and early fall, when cooling towers typically run. […] In fact, the 2019 report from the National Academies of Sciences, Engineering, and Medicine estimated that between 52,000 and 70,000 Americans develop Legionnaires’ disease every year. […] According to the Mayo Clinic, people at increased risk of developing Legionnaires’ disease include adults ages 50 and older, current or former cigarette smokers, people with chronic lung disease, and people with weak immune systems from diseases such as HIV/AIDS, cancer, diabetes or kidney failure. […] Legionnaires’ disease and Pontiac fever cannot be spread from one person to another.

• #55

  https://www.who.int/news-room/fact-sheets/detail/legionellosis

  Legionnaires disease is believed to occur worldwide. […] The identified incidence of Legionnaires disease varies widely according to the level of surveillance and reporting. […] Delay in diagnosis and administration of appropriate antibiotic treatment, increasing age and presence of co-existing diseases are predictors of death from Legionnaires disease. […] The death rate as a result of Legionnaires disease depends on the severity of the disease, the appropriateness of initial anti-microbial treatment, the setting where Legionella was acquired, and host factors (for example, the disease is usually more serious in patients with immuno-suppression).

• #56 Legionnaires’ disease – Wikipedia

  https://en.wikipedia.org/wiki/Legionnaires%27_disease

  The disease is particularly associated with hotels, fountains, cruise ships, and hospitals with complex potable water systems and cooling systems. […] Legionella spp. enter the lungs either by aspiration of contaminated water or inhalation of aerosolized contaminated water or soil. […] The most useful diagnostic tests detect the bacteria in coughed-up mucus, find Legionella antigens in urine samples, or allow comparison of Legionella antibody levels in two blood samples taken 36 weeks apart. […] A significant under-reporting problem occurs with legionellosis. Even in countries with effective health services and readily available diagnostic testing, about 90% of cases of Legionnaires’ disease are missed. […] The fatality rate of Legionnaires’ disease has ranged from 5-30% during various outbreaks and approaches 50% for nosocomial infections, especially when treatment with antibiotics is delayed.

• #57 Legionnaires’ disease – Wikipedia

  https://en.wikipedia.org/wiki/Legionnaires%27_disease

  The disease is particularly associated with hotels, fountains, cruise ships, and hospitals with complex potable water systems and cooling systems. […] Legionella spp. enter the lungs either by aspiration of contaminated water or inhalation of aerosolized contaminated water or soil. […] The most useful diagnostic tests detect the bacteria in coughed-up mucus, find Legionella antigens in urine samples, or allow comparison of Legionella antibody levels in two blood samples taken 36 weeks apart. […] A significant under-reporting problem occurs with legionellosis. Even in countries with effective health services and readily available diagnostic testing, about 90% of cases of Legionnaires’ disease are missed. […] The fatality rate of Legionnaires’ disease has ranged from 5-30% during various outbreaks and approaches 50% for nosocomial infections, especially when treatment with antibiotics is delayed.

• #58 Severe Legionnaires’ disease | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01252-y

  Legionnaires disease (LD) is a common but under-diagnosed cause of community-acquired pneumonia (CAP), although rapid detection of urine antigen testing (UAT) and advances in molecular testing have improved the diagnosis. […] The overall incidence of LD has increased worldwide in recent years due to the higher number of patients with risk factors, especially immunosuppression, and to improvements in diagnostic methods. […] Regarding pathogenesis, no Legionella-specific virulence factors have been associated with severity; however, recent reports have found high pulmonary Legionella DNA loads, and impairments in immune response and lung microbiome in the most severe cases. […] Numerous factors influence the mortality rate of LD, such as ICU admission, the underlying immune status, and the nosocomial source of the infection.

• #59 A Methodology for Classifying Root Causes of Outbreaks of Legionnaires’ Disease: Deficiencies in Environmental Control and Water Management

  https://www.mdpi.com/2076-2607/9/1/89

  Since the disease’s formal identification in 1976, the number of cases reported yearly has steadily increased. The Centers for Disease Control and Prevention (CDC) reported 9933 cases of LD in 2018, which represents a nearly 900 percent increase since 2000. Legionella has accounted for a majority of potable-water-associated outbreaks reported to CDC in recent years, including 66% of all such outbreaks reported in 2011 and 2012 and 57% of those reported in 2013 and 2014. Outbreaks of Legionella represented 61% of the waterborne outbreaks identified through the National Outbreak Reporting System in CDC’s latest report on data from 2017. Several theories have been proposed to explain the continued increase in LD prevalence, including improved surveillance, aging infrastructure (i.e., building water systems, heating, ventilation, and air-conditioning equipment), aging population, and a warming climate.

• #60 A Methodology for Classifying Root Causes of Outbreaks of Legionnaires’ Disease: Deficiencies in Environmental Control and Water Management

  https://www.mdpi.com/2076-2607/9/1/89

  Since the disease’s formal identification in 1976, the number of cases reported yearly has steadily increased. The Centers for Disease Control and Prevention (CDC) reported 9933 cases of LD in 2018, which represents a nearly 900 percent increase since 2000. Legionella has accounted for a majority of potable-water-associated outbreaks reported to CDC in recent years, including 66% of all such outbreaks reported in 2011 and 2012 and 57% of those reported in 2013 and 2014. Outbreaks of Legionella represented 61% of the waterborne outbreaks identified through the National Outbreak Reporting System in CDC’s latest report on data from 2017. Several theories have been proposed to explain the continued increase in LD prevalence, including improved surveillance, aging infrastructure (i.e., building water systems, heating, ventilation, and air-conditioning equipment), aging population, and a warming climate.

• #61 Legionnaires’ Disease FAQ

  https://www.health.ny.gov/diseases/communicable/legionellosis/fact_sheet.htm

  Legionnaires’ disease (Legionellosis) is a bacterial disease which may cause pneumonia. […] An outbreak of this disease in Philadelphia in 1976, largely among people attending a state convention of the American Legion, led to the name „Legionnaires’ disease.” Subsequently, the bacterium causing the illness was named Legionella pneumophila and the name of the illness was changed to Legionellosis. […] It is estimated that about 25,000 people develop Legionnaires’ disease in the United States each year. […] The disease appears to be spread through the air from a soil or water source. […] Most healthy individuals do not become infected with Legionella bacteria after exposure. […] Legionella exist naturally in water and moist soil. […] Antibiotics such as erythromycin, levaquin or azithromycin appear to be effective in treating the disease.

• #62 Legionnaires’ disease: Causes, symptoms and treatment | Live Science

  https://www.livescience.com/legionnaires-disease.html

  One way that people can become sick is by aspirating contaminated drinking water. […] The mechanism to prevent aspiration may be defective in people who smoke or have lung disease two groups more likely to develop Legionnaires’ disease. […] Disease outbreaks are relatively rare but occur more frequently in summer and early fall, when cooling towers typically run. […] In fact, the 2019 report from the National Academies of Sciences, Engineering, and Medicine estimated that between 52,000 and 70,000 Americans develop Legionnaires’ disease every year. […] According to the Mayo Clinic, people at increased risk of developing Legionnaires’ disease include adults ages 50 and older, current or former cigarette smokers, people with chronic lung disease, and people with weak immune systems from diseases such as HIV/AIDS, cancer, diabetes or kidney failure. […] Legionnaires’ disease and Pontiac fever cannot be spread from one person to another.

• #63 Severe Legionnaires’ disease | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01252-y

  The host immune response (hyperinflammation and/or immunoparalysis) may also be associated with increased severity. […] Human infection occurs due to the inhalation or aspiration of aerosols containing the pathogen. […] The main sources of contamination are water network systems, spas and cooling towers. […] The proportion of Lp among the causative agents of community-acquired pneumonia (CAP) was estimated to be 4.6% in a recent meta-analysis, and nearly twice this figure in patients admitted to the ICU. […] The pathogenesis of severe LD remains poorly understood. […] In clinical practice, no Legionella virulence factor is known to be associated with the severity of LD. […] Studies have shown an association between initial Legionella DNA load in respiratory samples and initial high pneumonia severity score, ICU admission or prolonged hospitalisation.

• #64 Legionella – Medical Microbiology – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK7619/

  The most common presentation of Legionella pneumophila is acute pneumonia (legionellosis); potentially any species of Legionella may cause the disease. […] Legionella bacilli reside in surface and drinking water and are usually transmitted to humans in aerosols. […] Legionella species are widespread in nature. […] The only documented source of Legionella species is water, particularly the surface waters of rivers and lakes and drinking water. […] Infection begins in the lower respiratory tract. […] The pathogenesis of Legionella infections begins with a supply of water containing virulent bacteria and with a means for dissemination to humans. […] The symptoms of Legionella infection undoubtedly result from a combination of physical interference with oxygenation of blood, ventilation-perfusion imbalance in the remaining lung tissue, and release of toxic products from bacteria and inflammatory cells.

• #65 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionellae are ubiquitous and transmitted to humans via aerosolized contaminated water from the environment or building water systems. […] The true incidence of Legionnaires disease is unknown; many countries lack appropriate diagnostic, surveillance, or reporting methods. […] Legionnaires disease has been reported as a travel-associated infection, most commonly associated with hotels with contaminated water systems or hot tubs. […] The reported incidence of travel-related or healthcare-associated legionellosis in the United States is 20%. […] Legionellae enter the lungs by aspiration of contaminated water or inhaling aerosolized contaminated water or soil. […] Legionellae enter alveolar macrophages and epithelial cells via phagocytosis. […] This intracellular bacterium is acquired from infected environmental sources, soil, or water.

• #66 Legionella – Medical Microbiology – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK7619/

  The most common presentation of Legionella pneumophila is acute pneumonia (legionellosis); potentially any species of Legionella may cause the disease. […] Legionella bacilli reside in surface and drinking water and are usually transmitted to humans in aerosols. […] Legionella species are widespread in nature. […] The only documented source of Legionella species is water, particularly the surface waters of rivers and lakes and drinking water. […] Infection begins in the lower respiratory tract. […] The pathogenesis of Legionella infections begins with a supply of water containing virulent bacteria and with a means for dissemination to humans. […] The symptoms of Legionella infection undoubtedly result from a combination of physical interference with oxygenation of blood, ventilation-perfusion imbalance in the remaining lung tissue, and release of toxic products from bacteria and inflammatory cells.

• #67 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionellae are ubiquitous and transmitted to humans via aerosolized contaminated water from the environment or building water systems. […] The true incidence of Legionnaires disease is unknown; many countries lack appropriate diagnostic, surveillance, or reporting methods. […] Legionnaires disease has been reported as a travel-associated infection, most commonly associated with hotels with contaminated water systems or hot tubs. […] The reported incidence of travel-related or healthcare-associated legionellosis in the United States is 20%. […] Legionellae enter the lungs by aspiration of contaminated water or inhaling aerosolized contaminated water or soil. […] Legionellae enter alveolar macrophages and epithelial cells via phagocytosis. […] This intracellular bacterium is acquired from infected environmental sources, soil, or water.

• #68 Severe Legionnaires’ disease | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01252-y

  The host immune response (hyperinflammation and/or immunoparalysis) may also be associated with increased severity. […] Human infection occurs due to the inhalation or aspiration of aerosols containing the pathogen. […] The main sources of contamination are water network systems, spas and cooling towers. […] The proportion of Lp among the causative agents of community-acquired pneumonia (CAP) was estimated to be 4.6% in a recent meta-analysis, and nearly twice this figure in patients admitted to the ICU. […] The pathogenesis of severe LD remains poorly understood. […] In clinical practice, no Legionella virulence factor is known to be associated with the severity of LD. […] Studies have shown an association between initial Legionella DNA load in respiratory samples and initial high pneumonia severity score, ICU admission or prolonged hospitalisation.

• #69 Severe Legionnaires’ disease | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01252-y

  The respiratory tract microbiome (RTM) balance is impaired in the case of severe LD. […] The interaction between the balance of the respiratory microbiome, the dynamics of the pathogen load and the interventions associated with hospitalisation (mechanical ventilation, antibiotics, etc.) plays an essential role in the recovery of patients with pneumonia. […] The potential role of combination therapy also remains controversial. […] The role of corticosteroids as an adjuvant therapy in CAP is a hot topic nowadays. […] LD has a higher mortality rate in immunocompromised individuals and in those requiring intensive care admission. […] The incidence of LD has increased in many countries in recent years. […] Despite its rising incidence, LD is probably still under-diagnosed, especially in cases of non-serogroup 1 Lp and L. non-pneumophila infections. […] Further studies comparing different regimens and/or evaluating host-directed therapies are now needed.

• #70 Severe Legionnaires’ disease | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01252-y

  The host immune response (hyperinflammation and/or immunoparalysis) may also be associated with increased severity. […] Human infection occurs due to the inhalation or aspiration of aerosols containing the pathogen. […] The main sources of contamination are water network systems, spas and cooling towers. […] The proportion of Lp among the causative agents of community-acquired pneumonia (CAP) was estimated to be 4.6% in a recent meta-analysis, and nearly twice this figure in patients admitted to the ICU. […] The pathogenesis of severe LD remains poorly understood. […] In clinical practice, no Legionella virulence factor is known to be associated with the severity of LD. […] Studies have shown an association between initial Legionella DNA load in respiratory samples and initial high pneumonia severity score, ICU admission or prolonged hospitalisation.

• #71 Legionellosis (Legionnaires’ Disease and Pontiac Fever) – Overview | Occupational Safety and Health Administration

  https://www.osha.gov/legionnaires-disease

  Legionnaires’ disease and Pontiac Fever are collectively known as Legionellosis, a disease caused by Legionella bacteria. […] Although Legionella are usually harmless and found naturally in water and soil, it becomes a potentially deadly human health hazard when it grow in places such as poorly maintained domestic and industrial water systems; cooling towers; or heating, ventilation, and air condition (HVAC) systems. […] Workers may develop Legionellosis if they are exposed to Legionella from these types of sources, especially in water droplets or respirable fine mists small enough to inhale. […] Improperly maintained water systems, such as domestic or industrial water systems or large HVAC systems, are among the leading sources of worker exposure to the bacteria that cause Legionnaires’ disease. […] Legionnaires’ disease is a serious condition with a 10-percent death rate.

• #72 Legionnaires’ Disease | Legionella Pneumonia | MedlinePlus

  https://medlineplus.gov/legionnairesdisease.html

  Legionnaires’ disease is a serious type of pneumonia caused by Legionella bacteria. […] Legionella is found naturally in freshwater, such as lakes and rivers. It can also be found in soil. But people usually only get sick from it when if it grows and spreads in man-made water systems. […] You can get the infection by breathing in mist or small drops of water that contain the bacteria. The mist may come from hot tubs, showers, or large building air conditioning units. […] The bacteria don’t spread from person to person. Disease outbreaks happen when many people are exposed to the same water source that contains the bacteria. […] Legionnaires’ disease can cause life-threatening complications such as respiratory failure, kidney failure, and sepsis. […] About 1 out of every 10 people who get sick with Legionnaires’ disease will die from complications of the illness.

• #73

  https://www.who.int/news-room/fact-sheets/detail/legionellosis

  Legionnaires disease is believed to occur worldwide. […] The identified incidence of Legionnaires disease varies widely according to the level of surveillance and reporting. […] Delay in diagnosis and administration of appropriate antibiotic treatment, increasing age and presence of co-existing diseases are predictors of death from Legionnaires disease. […] The death rate as a result of Legionnaires disease depends on the severity of the disease, the appropriateness of initial anti-microbial treatment, the setting where Legionella was acquired, and host factors (for example, the disease is usually more serious in patients with immuno-suppression).

• #74 Legionnaires’ disease – Wikipedia

  https://en.wikipedia.org/wiki/Legionnaires%27_disease

  The disease is particularly associated with hotels, fountains, cruise ships, and hospitals with complex potable water systems and cooling systems. […] Legionella spp. enter the lungs either by aspiration of contaminated water or inhalation of aerosolized contaminated water or soil. […] The most useful diagnostic tests detect the bacteria in coughed-up mucus, find Legionella antigens in urine samples, or allow comparison of Legionella antibody levels in two blood samples taken 36 weeks apart. […] A significant under-reporting problem occurs with legionellosis. Even in countries with effective health services and readily available diagnostic testing, about 90% of cases of Legionnaires’ disease are missed. […] The fatality rate of Legionnaires’ disease has ranged from 5-30% during various outbreaks and approaches 50% for nosocomial infections, especially when treatment with antibiotics is delayed.

• #75 Legionnaires’ Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/legionnaires-disease-pro

  LD is 2 to 5 times more common in men than in women. […] The death rate from diagnosed infections is 10-15% (representing about 10% in previously well individuals and up to 80% in the elderly). […] 40-50% of all cases are related to travel, usually abroad, where air-conditioning systems and stored water may be less well regulated. […] Older people, smokers and those with reduced immunity are more likely to be infected and are more likely to die. […] Public outbreaks of illness linked to recreational water use such as whirlpool spas or hot tubs have been found to be caused by Legionella species in 42% of cases. […] Legionella spp. are ubiquitous in water supplies and the role of hospital water supplies in the spread of nosocomial infection is unclear.

• #76 Legionnaires’ Disease | Legionella Pneumonia | MedlinePlus

  https://medlineplus.gov/legionnairesdisease.html

  Legionnaires’ disease is a serious type of pneumonia caused by Legionella bacteria. […] Legionella is found naturally in freshwater, such as lakes and rivers. It can also be found in soil. But people usually only get sick from it when if it grows and spreads in man-made water systems. […] You can get the infection by breathing in mist or small drops of water that contain the bacteria. The mist may come from hot tubs, showers, or large building air conditioning units. […] The bacteria don’t spread from person to person. Disease outbreaks happen when many people are exposed to the same water source that contains the bacteria. […] Legionnaires’ disease can cause life-threatening complications such as respiratory failure, kidney failure, and sepsis. […] About 1 out of every 10 people who get sick with Legionnaires’ disease will die from complications of the illness.

• #77 Legionnaires’ disease

  https://www.wcs-group.co.uk/legionnaires-disease

  There are several risk factors that make you more susceptible to the disease; the most serious include being a smoker or having chronic lung disease. […] Legionnaires disease can be fatal. […] Serious complications can include respiratory failure, shock, and acute renal and multi-organ failure. […] Although most patients will recover without ill effects after treatment, some may suffer from long term issues such as persistent pulmonary scars and restrictive pulmonary disease in patients who experience severe respiratory failure. […] The main British Standard dealing with legionella risk assessments was updated in 2019 and is called BS 8580-1:2019. […] Conducting a Legionella Risk Assessment (LRA) is a legal requirement under the Health and Safety at Work Act 1974.

• #78 Legionnaires’ disease

  https://www.wcs-group.co.uk/legionnaires-disease

  There are several risk factors that make you more susceptible to the disease; the most serious include being a smoker or having chronic lung disease. […] Legionnaires disease can be fatal. […] Serious complications can include respiratory failure, shock, and acute renal and multi-organ failure. […] Although most patients will recover without ill effects after treatment, some may suffer from long term issues such as persistent pulmonary scars and restrictive pulmonary disease in patients who experience severe respiratory failure. […] The main British Standard dealing with legionella risk assessments was updated in 2019 and is called BS 8580-1:2019. […] Conducting a Legionella Risk Assessment (LRA) is a legal requirement under the Health and Safety at Work Act 1974.

• #79 Legionnaires’ Disease – NYC Health

  https://www.nyc.gov/site/doh/health/health-topics/legionnaires-disease.page

  Legionnaires disease is a type of pneumonia. It is caused by bacteria (Legionella) that grow in warm water. […] People who inhale mist that contains Legionella bacteria can get sick. Sources of water with Legionella contamination may include cooling towers, showers and hot tubs. […] Most people who are exposed to the bacteria do not develop Legionnaires disease, and it is not contagious you cannot get it from someone else. […] You cannot get Legionnaires disease by drinking the water. […] There is no vaccine or medicine that can prevent Legionnaires disease. The best way to prevent it is through the proper maintenance of water systems where Legionella may grow. […] The Health Department investigates clusters of Legionnaires disease cases to find the source of the contamination in order to prevent other people from getting sick.

• #80 Legionnaires’ disease: Symptoms, transmission, and causes

  https://www.medicalnewstoday.com/articles/18413

  Temperatures between 68 and 113 degrees Fahrenheit, or from 20 to 45 degrees Celsius, can be ideal for the bacteria to multiply rapidly and spread. […] An ideal environment also provides the right food. Impurities, such as algae, sludge, rust, and lime scale are types of food for this sort of bacteria. […] The Centers for Disease Control and Prevention (CDC) state that most cases that occur could be prevented through better water management. […] They note that between 2000 and 2014, Almost all outbreaks were caused by problems preventable with more effective water management.

• #81 Legionnaires Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430807/

  Legionellae can adapt to human-made water systems in buildings, including healthcare institutions, by forming biofilms and resisting disinfectants. […] The prevention of Legionnaires disease requires proper maintenance and disinfection of water systems to reduce the risk of bacterial growth and exposure.

• #82 About Legionnaires’ Disease – MN Dept. of Health

  https://www.health.state.mn.us/diseases/legionellosis/basics.html

  Depending on environmental conditions, Legionella organisms can multiply and spread from many types of human-made water systems such as hot tubs, showerheads, sink faucets, decorative fountains and water features, hot water tanks and heaters, large complex plumbing systems, and cooling towers (structures containing water and a fan as part of centralized cooling systems for buildings or industrial processes). […] The key to preventing Legionnaires disease is to reduce the risk of Legionella growth and spread in building water systems and devices through good maintenance strategies.

• #83 A Methodology for Classifying Root Causes of Outbreaks of Legionnaires’ Disease: Deficiencies in Environmental Control and Water Management

  https://www.mdpi.com/2076-2607/9/1/89

  In 2016, CDC classified deficiencies in the environmental control of complex water systems to highlight opportunities for LD prevention. The researchers identified four types of environmental deficiencies (process failures, equipment failures, human errors, and unmanaged external changes) and recommended adoption of WMPs to prevent LD outbreaks. Our work builds on the methodology outlined in 2016 by formalizing a protocol for the abstraction of environmental deficiency (ED) information observed during outbreaks of LD. […] Nearly three quarters of the total LD cases and 8 in 10 fatalities in our sample originated at facilities without a WMP in place. A possible explanation of this observation is that facilities using a WMP may have an increased awareness of LD. These facilities might be better equipped to implement a quick and effective response once a confirmed case is identified. Staff at a facility with water management are more likely to be familiar with their building’s water system, and therefore, are better prepared to rapidly implement environmental controls when cases of disease or lapses in water management occur.

• #84 Legionnaires’ disease

  https://www.wcs-group.co.uk/legionnaires-disease

  There are several risk factors that make you more susceptible to the disease; the most serious include being a smoker or having chronic lung disease. […] Legionnaires disease can be fatal. […] Serious complications can include respiratory failure, shock, and acute renal and multi-organ failure. […] Although most patients will recover without ill effects after treatment, some may suffer from long term issues such as persistent pulmonary scars and restrictive pulmonary disease in patients who experience severe respiratory failure. […] The main British Standard dealing with legionella risk assessments was updated in 2019 and is called BS 8580-1:2019. […] Conducting a Legionella Risk Assessment (LRA) is a legal requirement under the Health and Safety at Work Act 1974.

• #85 Legionellosis (Legionnaires’ Disease and Pontiac Fever) | Wisconsin Department of Health Services

  https://www.dhs.wisconsin.gov/disease/legionellosis.htm

  Legionnaires’ disease can be prevented by minimizing growth in building water systems. This is accomplished with development and implementation of a comprehensive water management program complaint with American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) Standard 188.

• #86 Legionnaires’ Disease: Symptoms, Causes, and Treatment

  https://patient.info/chest-lungs/legionnaires-disease-leaflet

  About 2 in 100 cases of pneumonia that occur in previously well people are thought to be due to legionella bacteria. […] As mentioned, the main cause of outbreaks of Legionnaires’ disease is from contaminated water sources. […] This mainly involves keeping the water temperature at less than 20C or more than 60C. […] At present, there is no vaccine that can protect against legionella bacteria.

• #87 Legionnaires’ Disease – Causes and Prevention – MSU Extension

  https://www.canr.msu.edu/news/legionnaires_disease_causes_and_prevention

  The chances of legionella developing in home water systems are much smaller than in large public buildings systems. […] Avoiding smoking is the single most important thing that you can do to lower your risk of contracting Legionnaires disease. Smoking increases the chances of developing the disease if youre exposed to legionella bacteria. […] There are no vaccines that can help protect you from Legionnaires disease.

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