Legionnaire’s Disease Emerging Diseases Lecture 11: Legionnaire’s Disease 11.1: Overview 11.2: Outbreak in 1976 11.3: Legionella is Common 11.4: Biofilms

11.1: Overview Our Commonwealth’s contribution to the array of emerging diseases An “old” disease with a new name Remains a serious problem to the present day

11.2: 1976 Outbreak American Legion Convention July, 1976 Bicentennial convention July 27, 1976-first cases Flu-like symptoms Can progress to more serious 221 cases, 34 deaths 72 non-convention but in hotel

August 1976 http://www.nytimes.com/2006/08/01/health/01docs.html?pagewanted=1&_r=1

CDC Identifies pathogen McDade asked to lead team Difficult to track down causative agent Does not grow on standard medium Months of effort Identification of “new” pathogen Legionella pneumophila (Legionella micdadei)

Linked to earlier outbreaks through “retrospective” analysis or analysis of old samples stored in freezer Mystery outbreak in 1968-Pontiac, Michigan “Pontiac Fever”-also caused by Legionella Mild disease compared to LD

11.3: Legionella is Common Legionella present in almost every body of water Prefers warm to hot water Enclosed space Enters host via mist or aerosol Or drinking water 1000s of cases Many nosocomial

Ice machines were source of Legionnaires' May 2, 2014 11:35 PM By Sean D. Hamill / Pittsburgh Post-Gazette After one patient died and two were sickened by Legionnaires' disease in November and December at UPMC Presbyterian, where they contracted the disease, UPMC has a message for hospitals nationwide. “Hospitals in the U.S.: If you have not been looking in ice machines for Legionella, please look," Tami Minnier, UPMC's chief quality control officer, said Friday. "That's the message."

L.A. NOW Southern California -- this just in Playboy Mansion bacteria points to Legionnaires’ disease outbreak March 1, 2011 |  6:31 am

Legionella lives in biofilms with other organisms 11.4: Biofilm a group of microbes growing together in a large group-protecting and shielding each other

Biofilms can form almost anywhere Water systems and plumbing Surgical equipment such as catheters Contact lenses Natural bodies of water

Biofilms

Review-1 Incidence of infectious diseases increases with growth of cities (Microbe Magnets). People had some incorrect ideas about the cause of infectious diseases-so they were hard to prevent The Diseases of Filth

Review-2 People became disgusted with dirt, filth and garbage-they began to clean up The Germ Theory has been a very powerful idea Stopping germs stops disease. Killing germs kills disease. Preventing germs prevents disease.

Review-3 Antibiotics, vaccines, antiseptics, cleanliness resulted in a dramatic drop in diseases. Except for polio-which moved in the op[posite direction. Salk’s vaccine marked the start of the Age of Optimism.

Review-4 The Age of Optimism was symbolized by the Disease Cowboys.

Review-5 1976 was the year that the sense of optimism was shaken Ebola outbreak-Yambuku Threat of re-emergence of deadly flue or “Swine Flu” Legionnaire’s Disease A new Health Transition began.