1. 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

2. 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

3. 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

4. August 1976

5. 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)

6. 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

7. 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

8. Ice machines were source of Legionnaires' May 2, :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."

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

10. Case of Legionnaires’ disease at upper NW Washington retirement home
Local
Case of Legionnaires’ disease at upper NW Washington retirement home
By Martin Weil
September 25, 2018
Health officials name Johnsburg Walmart a possible source of exposure to Legionnaires'
By ED KOMENDA Follow
Oct. 28, 2018

11. 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

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

13. Biofilms

14. 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

15. 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.

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

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

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