集中空调冷却塔军团菌污染对宾馆从业人员血清军团菌抗体的影响

目的尽管很多公共场所的冷却塔的进行定期消毒,但是我们江苏常州市进行的调查依然在89.6%冷却塔水样品中检出了的军团菌。本研究的目的是探索这些军团菌污染的冷却塔对从业人员健康的影响。方法从公共场所从业人员中随机选取364名对象进行血清抗体测试和问卷调查。暴露组来自1型嗜肺军团菌污染的冷却塔所在场所的从业人员,对照组对象来自没有使用的集中空调的场所。血清军团菌抗体的检测采用间接免疫荧光(IFA)的方法。结果暴露组对象的1型嗜肺军团菌抗体的阳性率显著性高于对照组(OR=2.845,P=0.019)。自来水和淋浴水中的军团菌污染可能是混杂因素。其中暴露组人群感冒症状的的发生频率显著性高于对照组,室内空气质量的满意度也与1型嗜肺军团菌抗体的阳性率相关。结论嗜肺军团菌污染的冷却塔与场所从业人员血清军团菌抗体的阳性率相关,自来水和淋浴水中的军团菌也是可能的污染源。     

公共场所不同环境介质军团菌污染状况及从业人员感染状况分析

目的研究公共场所不同环境介质军团菌污染状况及从业人员军团菌感染状况。方法以商场、酒店为调查对象,采集不同类型环境样品进行军团菌检测,同时对调查单位从业人员进行军团菌血清抗体和尿抗原检测。结果公共场所集中空调系统(送风口空气、风管积尘和冷却塔水)、水系统(景观水、淋浴水和自来水)、花卉土中均检出军团菌,三者阳性率无统计学差异(P0.05)。公共场所从业人员军团菌血清抗体阳性率10.6%(17/160),尿抗原阳性率3.8%(6/160)。结论公共场所多种环境介质均受到军团菌污染,从业人员存在军团菌感染,需对公共场所多种环境介质均进行军团菌污染防治管理。     

北京市丰台区集中空调公共场所嗜肺军团菌污染状况及从业人员感染水平

目的了解北京市丰台区使用集中空调的公共场所嗜肺军团菌污染状况及从业人员嗜肺军团菌感染水平。方法于2012年7—9月采集北京市丰台区20家使用集中空调的公共场所环境样品进行嗜肺军团菌的巢氏PCR检测,于2012年12月—2013年1月对集中空调公共场所701名暴露人群和非集中空调场所440名对照人群进行血清嗜肺军团菌1~7IgG抗体检测。结果空气、景观水、室外景观土、室内花卉土及作为对照的土壤样品中均未检出嗜肺军团菌。冷却水、自来水、积尘、淋浴水中均检出嗜肺军团菌,阳性率分别为84.2%,10.9%,8.7%,3.6%。暴露组和对照组血清嗜肺军团菌1~7IgG抗体活力中位数分别为13、11U/ml,血清嗜肺军团菌抗体阳性率均为1.4%,差异均无统计学意义(P0.05)。结论本次调查的公共场所集中空调系统存在嗜肺军团菌污染,需采取防治措施。     

2012年10月-2013年10月深圳市公共场所水系统嗜肺军团菌污染现状

目的了解深圳市公共场所水系统嗜肺军团菌污染情况。方法 2012年10月-2013年10月随机采集本市41家公共场所冷却水、冷凝水、淋浴水、自来水、泳池水共194份水样按照《公共场所集中空调通风系统卫生规范》附录B方法进行检测嗜肺军团菌及其菌型。结果嗜肺军团菌阳性率冷却水为46.2%(32/69)、自来水为42.3%(22/52)、淋浴水为34.6%(18/52),冷凝水、泳池水未检出嗜肺军团菌;嗜肺军团菌冷却水阳性率在酒店宾馆为54.2%(13/24)、商场为36%(9/25)、候诊室为62.5%(5/8)、地铁站为41.7%(5/12),场所间差异无统计学意义(χ2=2.611,P=0.455);分离出79株嗜肺军团菌菌型以Lp1型为主,占68.1%(47/79),Lp3型占24.1%(19/79)、其他菌型占16.5%(13/79)。结论本市公共场所空调冷却水、生活用水中自来水、淋浴水均存在嗜肺军团菌污染,应加强空调系统和生活用水的清洗消毒。     

深圳公共场所水系统嗜肺军团菌污染研究

目的了解深圳公共场所水系统嗜肺军团菌污染现状,为卫生监督管理提供依据。方法依照《公共场所集中空调通风系统卫生规范》附录A方法,随机采集本市177家公共场所冷却水、冷凝水、淋浴水、泳池水、生活饮用水共500份水样,检测嗜肺军团菌及其菌型。结果冷却水、冷凝水、淋浴水嗜肺军团菌检出率分别为11.0%(28/255)、1.1%(2/176)、30.0%(12/40),泳池水、生活饮用水未检出嗜肺军团菌;酒店、公共浴室、候诊室、地铁站冷却水嗜肺军团菌检出率分别为18.1%(19/105)、4.0%(1/25)、31.8%(7/22)、0.1%(1/103),差异有统计学意义(χ2=11.74,P<0.05);分离出44株嗜肺军团菌,菌型以LP1型为主,占70.5%(31/44),LP3型、LP6型分别占2.3%(1/44)、27.2(12/44)。结论本市公共场所空调冷却水和冷凝水、淋浴水受嗜肺军团菌污染,存在健康隐患,应加强空调系统和淋浴-热水系统的清洗消毒。     

镇江市公共场所集中空调军团菌污染状况调查

目的了解镇江市公共场所集中空调嗜肺军团菌的污染状况。方法 2012年采集市区7家公共场所集中空调的冷却塔水14份,并进行分离培养与鉴定。结果 14份样品中有5份检出军团菌,阳性率为35.7%,不同场所的阳性率依次为医院(66.7%)、商场超市(25.0%)、宾馆饭店(0)。不同处理方法的检出率分别为酸处理(35.7%)、热处理(21.4%)、直接过滤(7.1%)。检出5株嗜肺军团菌中,3株为LP7型,2株为LP1型。结论镇江市医院集中空调内嗜肺军团菌污染最为严重,应加强管理,定期清洗空调系统。     

重庆市公共场所水环境嗜肺军团菌污染研究

目的了解重庆市公共场所水系统嗜肺军团菌污染现状,监测公共场所水系统清洗消毒效果,为卫生监督管理提供依据。方法依照卫生部《公共场所集中空调通风系统卫生规范》(2006年)附录A方法(2013-04-01前)和《公共场所集中空调通风系统卫生规范》WS 394-2012附录B方法(2013-04-01实施),采集本市多家公共场所冷却水、冷凝水、冷冻水、温泉水、淋浴水、游泳池水、生活用水等共399件水样品,进行嗜肺军团菌检测以及菌型分布检测。结果在399件样品中检出44件阳性,阳性率为11.0%;空调系统水嗜肺军团菌阳性检出率逐渐下降(29.0%/15.6%/9.0%),差异有统计学意义(χ~2=8.53,P0.05);空调系统水嗜肺军团菌检出率高于生活水嗜肺军团菌检出率(13.9%/7.1%),差异有统计学意义(χ~2=4.608,P0.05);检出44株嗜肺军团菌,其中LP1型有32株(72.7%);LP2-14型有12株(27.3%)。结论本市公共场所水系统中存在嗜肺军团菌污染,应加强公共场所水系统的清洗消毒,严格监管。     

公共场所从业人员和综合医院肺炎患者嗜肺军团菌尿抗原和血清抗体检测

目的调查公共场所从业人员和综合医院肺炎患者嗜肺军团菌尿抗原和血清抗体的阳性情况。方法于2012—2014年选择华东两城市集中空调系统嗜肺军团菌培养法阳性的7家公共场所从业人员(n=280)和华北、华东和华南共4城市的7家综合医院肺炎患者(尿样:n=262;血样:n=269)为研究对象,采集人群的尿和血清样本,以酶联免疫吸附法检测尿中嗜肺军团菌抗原和血清嗜肺军团菌抗体。结果从业人员嗜肺军团菌尿抗原和血清抗体阳性率为10.4%和36.1%,肺炎患者嗜肺军团菌尿抗原和血清抗体阳性率为11.8%和18.2%。从业人员嗜肺军团菌尿抗原和血清抗体阳性检出率差异有统计学意义(χ~2=7.133,P=0.000),肺炎患者嗜肺军团菌尿抗原和血清抗体阳性检出率差异无统计学意义(χ~2=0.291,P=0.794)。结论本次调查的公共场所从业人员和综合医院肺炎患者均存在嗜肺军团菌感染。     

某市空调清洗从业人员嗜肺军团菌抗体水平调查

目的了解集中空调清洗从业人员嗜肺军团菌的抗体水平。方法随机抽取本市2家集中空调清洗公司空调清洗从业人员44人血清,采用胶体金法对血清样本进行嗜肺军团菌抗体检测;采用微量凝集试验对嗜肺军团菌抗体阳性血清样本进行感染菌型检测。结果 44份血清样本中嗜肺军团菌阳性4份,抗体阳性率为9.1%(4/44)。4份阳性样本中,检出LP6型抗体阳性率为75.0%(3/4),LP3型抗体阳性率为25.0%(1/4)。嗜肺军团菌LP6型抗体的阳性率在年龄组、工作岗位组、工作年限组间的差异均无统计学意义(P>0.05)。结论本市空调清洗公司空调清洗从业人员中曾有人受嗜肺军团菌感染,空调清洗工作仍存在感染风险,应加强集中空调卫生管理和空调清洗从业人员的职业防护。     

贵阳市2014年冷却塔水军团菌污染状况调查

目的:了解贵阳市不同类型公共场所冷却塔水军团菌污染状。方法:随机对贵阳市39家公共场所冷却塔水进行采样,按照《公共场所集中空调通风系统卫生规范》附录B空调系统军团菌的检验方法对水样进行检测。结果:79份冷却塔水军团菌检出率为35.44%(28/79),阳性率以酒店最高,为41.51%(22/53)。军团菌血清LP1型占89.66%(26/29)、LP2型占10.34%(3/29)。冷却水消毒与不消毒、有无藻类生长对军团菌检出差异有统计学意义。结论:贵阳市不同公共场所冷却塔水中存在军团菌的污染,军团菌污染可能与冷却塔水不消毒、有藻类生长有关,可以为控制冷却塔水军团菌污染提供依据。     

土壤中的军团菌和嗜肺军团菌PCR检测研究

目的调查土壤中军团菌的污染状况并探讨土壤中军团菌的污染来源。方法于2009年7—9月,在江苏省南京市冷却塔水军团菌培养法阳性的公共场所集中空调冷却塔0～2m处及距离冷却塔2km的居民区分别采集20件和10件土壤样品。普通聚合酶链反应(PCR)方法扩增军团菌属5SrRNA基因,巢式PCR方法扩增嗜肺军团菌种Mip基因,琼脂糖凝胶电泳检测扩增产物。结果冷却塔旁土壤和居民区土壤中军团菌阳性率分别是80%(16/20)和70%(7/10);嗜肺军团菌阳性率分别是55%(11/20)和0。冷却塔旁土壤中军团菌的阳性率与居民区土壤比较,差异无统计学意义(χ2=0.373,P=0.542)。结论环境土壤中存在军团菌,受集中空调冷却塔水污染的土壤中可检出嗜肺军团菌。     

Legionella epidemic in the Netherlands]

In March 1999 an epidemic of Legionella pneumonia developed in the province of Noord Holland, the Netherlands: by the end of April 233 patients had become ill after a visit to a flower show, in 106 of whom the diagnosis of Legionella pneumonia was established, while in 48 the disease was probable and in 4 it was possible; 23 patients died, in 16 of whom the diagnosis of legionnaires' disease was established. In 37 patients Legionella pneumophila was isolated. There was a significant association with stands on the show that displayed anticondense fluids to clean glasses, steam ironing machines and whirlpools and bubble baths, making a relation to aerosol transmission of the causative agent very probable. Legionella (the same serotype) was indeed isolated from a whirlpool. As Legionella can readily be isolated from the human environment, a limited number of species can cause disease and laboratory tests are expensive and time consuming, an effective primary preventive programme is an illusion. Prevention should be aimed at monitoring the environment of susceptible hosts and tracing sources of infection of index cases. Patients with severe pneumonia requiring intensive care must be treated with antibiotics that cover Legionella, until this cause is excluded.     

Legionella pneumophila

Legionellae are environmental bacteria that can be frequently isolated from technical water supply systems. The most prevalent species is Legionella pneumophila, especially serogroup 1. In the environment, legionellae multiply in amoebae. Since Legionella pneumonias cannot be distinguished from pneumonias caused by other microbial pathogens, special microbiological tests, e.g., urinary antigen assays, are essential to detect Legionella infections. All water supply systems to which the patient is exposed during the incubation time of 2 to 10 days might be the source of the infection. This can be confirmed or excluded by molecular typing of isolates from patients and the environment. The most commonly used techniques are monoclonal antibody typing and sequence-based typing (SBT). Some sequence types (ST) are frequently found among clinical strains but are seldom isolated from the environment, e.g., ST 23, 42, 47, 62, and 146. It is safe to assume that such strains are highly virulent. Conversely, it does not seem to be justified to dedicate the same awareness to all environmental Legionella strains.     

Control of Legionella in hospitals

Legionellas are present in water distribution systems and cooling towers of many hospitals. No firm data are available regarding the need for prophylactic disinfection of these contaminated systems. Disinfection of water systems and cooling towers is an accepted and effective means of ending nosocomial Legionnaires' disease, but it should be performed in conjunction with good epidemiological and microbiological studies to pinpoint environmental reservoirs and disseminators. Chlorination, pasteurization, or both, are the only means of disinfection found to be effective in disease outbreaks. Prospective surveillance of immuno compromised patients with pneumonia is probably the most effective means to determine if a hospital is a source of Legionnaires' disease and, therefore, requires further investigations and disinfection.