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In 1970, William Stewart, the Surgeon General of the United States said
that the U.S. was "ready to close the book on infectious disease as a major health threat." His optimism resulted from his firm belief that modern antibiotics, vaccination, and sanitation methods seemed to have defeated most of the infectious diseases.
Even as late as 1988, it looked like we had won the battle against infectious disease as they didn't even make the Top Ten List of causes of death in the United States.
However, by 1995, infectious disease has again become the third leading cause of death and is still climbing!




Microb Ecol 1996 Jul;32(2):203-228

Ecology of Legionella: From Data to Knowledge with a Little Wisdom.

Fliermans CB

Savannah River Technology Center, Savannah River Company, Aiken, SC 29808, USA

The respiratory diseases produced by the Legionella genus of bacteria are collectively called Legionellosis. Presently more than 34 species of Legionella have been identified, 20 of which have been isolated from both environmental and clinical sources. The diseases produced by Legionella include the pneumonic form, Legionnaires' disease, and the flu-like form, Pontiac fever. Because the vast majority of Legionellosis is caused by the L. pneumophila species, this bacterium is the thrust of the discussion.Legionella is a global bacterium.
The relationship of the bacterium to its environment has told us many things about infectious diseases. Not until Legionellosis and the discovery of its etiologic agent, Legionella, has such a successful modern-day marriage been consummated between the agent and its environment.
Nearly two decades have passed since the term Legionellosis found its way into the vocabulary of the scientific journals, the popular press, and courtroom proceedings. Too often the scientific development, engineering implementation, and societal acceptance are disconnected.
The focus scientific research sometimes does not reflect engineering or societal needs and thus contributes little to the solution of immediate and important problems. At other times, scientific knowledge that could contribute to solutions is overlooked because of poor communication between the problem holders, the scientific community, regulatory agencies, the problem makers, and the public. The scope of this paper provides insights on the ecological niche of Legionella, describes the organism's ecological relationships in the natural world, and
provides wisdom for effective control of the bacterium for the industrial and user communities.

The epidemiology of Legionella pneumophila infections.

Doebbeling BN; Wenzel RP

Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City.

Semin Respir Infect, 2: 4, 1987 Dec, 206-21


The study of outbreaks of Legionella pneumophila has been essential in understanding the organism, the disease, and its pathogenesis. Early epidemics defined the clinical spectrum: Pontiac fever is an acute, self-limited, febrile illness with an attack rate of 95% to 100% and an incubation period of 36 hours. In contrast, legionnaires' disease is a life-threatening bronchopneumonia with an attack rate of 2% to 7% and an incubation period of two to ten days.
Three times as many males as females are affected with legionnaires' disease, and age, cigarette smoking, and chronic medical disease (particularly immunosuppression) appear to be separate risk factors. Furthermore, L pneumophila is responsible for approximately 1% to 3% of community-acquired pneumonias, 13% of those acquired in the hospital and as many as 26% of atypical pneumonias. Diverse environmental reservoirs have been identified, including cooling systems, potable or domestic water systems, respiratory therapy devices, industrial coolants, and whirlpool spas. Hot water temperature, stagnant water, sediment, and the presence of other microorganisms are important factors in the amplification of the Legionellaceae.
Although airborne transmission has been widely suggested, aspiration may be an important mode in certain patients. Regional and national surveillance may identify common sources and allow the introduction of early control measures. The latter have included primarily pulse and continuous hyperchlorination and super-heating hot water systems to 50 to 60 degrees C. Experimental data suggest that ozone and UV light may be useful in the future. Additionally, cooling towers and evaporative condensers have been decontaminated and maintained with a variety of biocides.
The prevention of outbreaks requires thoughtful planning, redesign, and good engineering practices.

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