2012-2013年重庆市南岸区公共场所集中空调嗜肺军团菌检测分析

目的检测重庆市南岸区公共场所集中空调嗜肺军团菌污染情况,为卫生监督提供科学依据。方法嗜肺军团菌鉴定采用常规生化法,分型采用血清学方法结果 2012年55件样品中检出嗜肺军团菌7件,阳性率为12.73%;其中LP1型4株,LP7型2株,LP13型1株;2013年53件样品中检出嗜肺军团菌7件,阳性率为13.21%,其中LP1型2株,LP4型3株,LP7型1株,LP10型1株。结论重庆市南岸区公共场所集中空调存在污染,污染菌型以LP1、LP4型为主,建议卫生监督部门加强监督管理。     

2009—2012年上海口岸空调及供水系统军团菌监测结果分析

目的调查上海口岸公共场所及入出境交通工具水系统军团菌污染情况。方法2009—2012年,在上海口岸逐步开展军团菌(Legionella)监测工作,采集空调水、管网水,进行浓缩培养、菌种鉴定、血清分型,并用SPSS进行统计分析。结果4年来于上海各类口岸采集水样共计435份,军团菌检测总阳性率为5.52%(24/435),空调冷却水阳性率为15.62%(15/96)。24份阳性样本共分离培养军团菌26株,血清分型分类为嗜肺军团菌(L.pneumophila,LP)1型、LP4型、LP6型、LP7型、LP8型、非1型LP。结论我国国境口岸水系统军团菌检测阳性率低于国内其他公共场所。空调冷却水军团菌污染风险最高。口岸卫生监督工作应重视军团菌监测,严格规范清洗消毒有利于控制水系统军团菌的滋生。     

钢铁厂冷却塔水嗜肺军团菌分离株分子流行病学研究

目的调查某钢铁企业冷却塔水嗜肺军团菌的污染状况及分子流行病学特征,为预防控制军团菌病的传播提供科学依据。方法 2011年3月—2012年9月,对石家庄市某钢铁厂车间冷却塔水进行监测,分离培养嗜肺军团菌,对得到的菌株进行血清分型、毒力基因检测(lvh、rtxA)和多位点序列分型研究。结果 182份冷却塔水中有67份检出嗜肺军团菌,检出率为36.8%;共分离培养得到菌株84株,包括7种血清型,其中LP1型占63.1%(53/84)、LP6型占19.0%(16/84)。lvh和rtxA基因检测阳性的分别有79株和83株,二者均为阳性的有78株。多位点序列分型可分为32个型,SBT1型占36.9%(31/84),为主要优势型别,有21个型别为首次发现。结论钢铁企业冷却水存在嗜肺军团菌污染,携带有毒力基因,血清型和SBT型呈多样性分布。     

漳州市嗜肺军团菌KatB与rcp毒力基因检测

目的了解漳州市公共场所中央空调冷却塔水及冷凝水分离的嗜肺军团菌的Kat B与rcp毒力基因携带状况,为军团菌病的防控提供基础研究资料。方法采用PCR法对40株嗜肺军团菌菌株进行Kat B与rcp基因检测。结果 40株嗜肺军团菌中Kat B毒力基因阳性11株,阳性率为27.50%(11/40);rcp毒力基因阳性27株,阳性率为67.50%(27/40)。Kat B基因阳性的11个菌株rcp基因均为阳性。Kat B基因阳性菌株中LP1血清型5株,LP7型4株,LP13型2株;rcp基因阳性菌株中LP1血清型13株,LP7型8株,LP13型6株。在检测的17株LP1血清型中,Kat B基因阳性率为29.41%(5/17),rcp基因阳性率为76.47%(13/17);12株LP7血清型中Kat B基因阳性率为33.33%(4/12),rcp基因阳性率为66.67%(8/12);6株LP13血清型中Kat B基因阳性率为33.33%(2/6),rcp基因阳性率为100.00%(6/6)。结论漳州市公共场所中央空调冷却塔水及冷凝水分离的嗜肺军团菌的Kat B与rcp毒力基因携带率较高。     

广州市荔湾区公共场所集中空调冷却水嗜肺军团菌污染状况调查

目的了解广州市荔湾区公共场所集中空调冷却水嗜肺军团菌污染状况,为预防控制军团菌病提供科学依据。方法于2010--2013年对辖区内有集中空调通风系统的各类公共场所冷却水塔水采样检测嗜肺军团菌,并对检测出的嗜肺军团菌进行血清分型;另对其中28家公共场所作相关因素的卫生管理状况现场与问卷调查。结果共采集了荔湾区37家公共场所空调冷却水45份,其中19份水样检出21株嗜肺军团菌,水样检出率为42．2％（19／45）;37家公共场所空调冷却水中有18家检出嗜肺军团菌,总检出率为48．6％（18／37）;21株嗜肺军团菌以血清1型（LP1）为主,占57．1％（12／21）,其次LP4、LP12、LP13、LP14血清型各2株、LP11血清型1株,同一份水样中检出不同血清型（LP12和LP14）的水样有2份。相关卫生管理调查发现经营单位的系统卫生检查和清洗记录、空气过滤网／器定期清洗、冷却水塔定期消毒、风管系统清洗等项目的合格率较低,合格率分别为25．0％（7／28）、53．6％（15／28）、10．7％（3／28）、7．1％（2／28）。结论广州市荔湾区公共场所集中空调冷却水嗜肺军团菌污染较为严重,且经营单位规范管理不到位。应加强对公共场所集中空调通风系统卫生监督管理。     

江苏省某城市公共场所人群军团菌感染现况研究

目的：了解江苏省某城市公共场所人群军团菌感染现况,为国家公共场所空气传播疾病监控技术的研究提供基础资料。方法：抽取暴露组和对照组各200人,采用问卷调查,同时采集人群血清进行军团菌抗体检测。结果：某城市公共场所工作人群军团菌抗体总阳性率为57.42%,其中,暴露组军团菌抗体阳性率为62.38%,对照组为51.23%,两组相比,差异显著（P〈0.05）。血清分型从LP1~LP14型均有检出,其中以LP12阳性率最高,为42.31%;其次为LP4、LP5和LP14,阳性率分别为36.54%、14.01%和13.74%。军团菌抗体阳性率在性别、年龄和工作类别间无显著性差异（P〉0.05）。结论：调查人群中普遍存在不同程度的LP1~LP14的感染,感染血清型以LP12、LP4占优势,空调系统冷却塔水中军团菌污染水平可以直接影响人群的血清抗体水平,使用集中空调是人群军团菌抗体阳性率增高的危险因素。     

公共场所水环境军团菌污染及其从业人员军团菌感染状况分析

目的分析公共场所水环境中军团菌污染及其从业人员军团菌感染状况方法以公共场所为研究对象,采集集中空调冷却塔水、淋浴水和自来水进行军团菌分离培养,同时对从业人员进行军团菌血清抗体和尿抗原检测。结果公共场所中空调冷却塔水、淋浴水和自来水军团菌阳性率分别为75%(111/148)、27%(27/100)和44%(22/50),以嗜肺军团菌污染为主,其中LP1为优势菌性,其他LP2-8、LP10、L.micdadei、L.bozemanii均有检出。公共场所从业人员军团菌血清抗体阳性率66.0%(369/559),抗LP1-14有检出,以抗LP12(45.9%)、抗LP4(43.4%)为优势血清型,抗LP1阳性率8.8%。公共场所从业人员LP1尿抗原阳性率0.0%(0/202)。结论公共场所冷却塔水、淋浴水和自来水军团菌尤其是嗜肺军团菌污染严重,从业人员普遍存在军团菌既往感染,公共场所存在发生社区获得性军团菌病暴发的安全隐患。     

江苏省某城市公共场所空调系统军团菌污染现况调查

目的：了解公共场所空调系统军团菌污染现况,为公共场所空气传播疾病监控技术的研究提供基础资料。方法：采用随机抽样方法,抽取江苏省某城市50家公共场所,进行现场环境调查和空调系统冷却塔水的军团菌、菌落总数等相关指标检测。结果：某城市公共场所空调系统冷却塔水的军团菌总检出率为86．0％,血清分型为LP1、LP3、LP5和LP6型4种,以LP1型为优势型,占83．0％。随着水温的升高,军团菌检出率呈现出增高的趋势,在30-35℃的水温中军团菌检出率为100％。每份水样均检出2～8种藻类,菌落总数检测值范围为10～4700CFU／ml,随着菌落总数的增多,军团菌检出率有上升趋势。空调使用年限越久,军团菌检出率越高,检出率差异有显著性（P〈0．05）。未消毒的空调其军团菌检出率明显高于已消毒的空调军团菌检出率（P＜0．05）。采用不同余氯浓度消毒,军团菌检出率差异有显著性（P〈0．05）,水中余氯浓度〉0．10mg／L时,军团菌检出率为0。结论：军团菌适宜在水温较高且有丰富的藻类和菌落种类的环境中生长繁殖。对冷却塔和空调系统进行定期清洗消毒,在水中添加消毒剂是抑制冷却塔水中军团菌生长的有效措施。     

北京某区部分医院和宾馆中央空调系统冷却塔水军团菌污染状况监测

[目的]了解北京市某区部分医院和宾馆冷却塔水的军团菌污染状况,为军团病的防控提供科学依据。[方法]选取北京某区3家医院和44家宾馆于2007年6月至2007年9月每月对上述场所的冷却塔水进行军团菌污染状况监测,同时对冷却塔的环境和冷却水处理方式进行调查。[结果]3家医院在监测期间均曾检出过军团菌,44家宾馆中有26家检出过军团菌,47家单位总的合格率为38.30%。采集的265件样本中,有76件检出军团菌,阳性率为28.68%。其中医院共采集样本17件,阳性样本9件,阳性率为52.94%;宾馆共采集样本248件,阳性样本67件,阳性率为27.02%。76件阳性样本中,63件为LP1型菌株污染,7件为LP2-14型菌株污染,LP1和LP2-14均检出的样本6件。冷却塔的工作环境有利于军团菌生长,冷却水的处理主要采取化学方式进行,使用的大部分化学制剂成分不明。[结论]北京某区部分医院和宾馆受军团菌污染较为严重,医院比宾馆的检测阳性率高。军团菌分型以LP1型为主。冷却塔水的处理方法需规范。     

2008年南京市公共场所空调冷却水中嗜肺军团菌的污染状况调查

[目的]了解南京市公共场所大量使用中央空调后军团菌污染情况。[方法]2008年9月在南京市33家宾馆、14家商场、3家写字楼合计采集50份中央空调冷却水,应用BCYE、BCY培养基进行嗜肺军团菌分离培养,并对分离菌株进行血清分型及种特异性PCR鉴定。[结果]检测50份冷却水,30份检出军团菌,阳性率60.00%。分离的33株嗜肺军团菌中,LP1型嗜肺军团菌25株,占75.76%;LP3型1株,LP4型4株,LP6型3株。[结论]南京市公共场所空调冷却水检出率较高,应引起有关部门的重视,尽快采取有效预防措施保护人群身体健康。     

Soil as a source of Legionella pneumophila serogroup 1 (Lp1)

OBJECTIVE: To investigate the potential source of a case of Legionnaires' disease caused by an unusual serotype of Legionella pneumophila serogroup 1 (Lp1) in regional Victoria in May 2001. METHOD: Epidemiological and environmental investigation of the source of infection of a case of Legionnaires' disease in regional Victoria in May 2001. RESULTS: Extensive environmental investigations did not reveal any cooling water tower systems close to the residence or the shopping centre that the case visited prior to illness. The sputum culture and a soil sample from the field at the plant nursery where the case worked prior to illness were both positive for Legionella pneumophilia serogroup 1, MDU pulsovar 97:103. CONCLUSION: Legionella pneumophila has been found in soil and was further found to be associated with a case of Legionella pneumophila. IMPLICATIONS: Public health authorities should consider exposures to soil and potting mixes when investigating cases of Legionella pneumophila where the case has no apparent association with cooling towers. Safe gardening practices should be promoted among the community.     

大连地区不同人群军团菌感染的比较研究

笔者采用微量凝集试验对３００名健康献血员、１２０名非肺炎免疫功能低下的住院病人及１５８名（７４名双份血清）肺炎病人血清三种（１０型）军团菌抗体进行了检测。结果表明，大连地区存在所测三种（１０型）军团菌感染。三组人群各型之间抗体阳性率及ＧＭＴ均有显著性差异，均以Ｌｐ６最高，Ｌｐ１、Ｌｐ８次之。Ｌｐ１、Ｌｐ２、Ｌｐ６、Ｌｐ８抗体阳性率及ＧＭＴ在三组人群之间有显著性差异，肺炎组最高，非肺炎免疫功能低下组次之。提示大连地区军团菌感染以Ｌｐ６、Ｌｐ１、Ｌｐ８为优势种型，人群中隐性感染、亚临床感染和军团菌肺炎同时存在。     

一起空调系统导致上呼吸道感染样军团病爆发的调查

１９９７年６月北京某写官楼员工发生一起上呼吸道感染样（上感样）疫情。为查明爆发原因，采用流行病学病例－对照调查研究方法，分别对病例组、对照组进行嗜肺军团菌（Ｌｐ）抗体－１￣１４型血清学检测，并对大厦空调系统采们进行细菌学培养检测。结果：该次爆发疫情的扁桃体炎罹患率为６１．８６％，上感罹患率３４．６２％，统计学检验发热与扁体关系密切（Ｘ＾２＝７７．８８，Ｐ〈０．０１）；上感病例ＬＰ９、１０、１２、１     

Epidemiologie der Legion?rskrankheit in Deutschland

Legionnaires' disease (LD) is a severe form of pneumonia which is caused by bacteria of the genus Legionella. They are widespread in fresh water and can also colonize technical water systems where they might present an infection risk. Since 2001, notification of laboratory-confirmed LD is mandatory in Germany. From 2001-2009, a total of 3672 cases of LD were registered. During the first 7 years, case numbers increased (2001: 127; 2007: 536 cases) but have remained stable during the past 2 years (2008: 525; 2009: 503 cases). In 2009, 49.6% of cases were attributed to an infection in the community, 33.2% were travel associated, and 13.6% were nosocomial. The average case fatality rate between 2001 and 2009 was 6.5%. However, the case fatality rate of nosocomial cases was three times as high compared to cases with non-nosocomial exposure. The network for community-acquired Legionnaires' disease (CAPNETZ) estimates that there are 20,000 cases per year in Germany. Thus, the number of reported cases represents only a small proportion of the actually occurring cases. It is likely that specific LD-diagnostics are insufficiently used. Hence, physicians should test more patients with pneumonia for LD. In particular, because of the high case fatality, nosocomial pneumonia cases need to be tested; identified LD cases require rigorous investigational and corrective action. In order to obtain evidence-based data on the relationship of water contamination and the risk for LD, it would be desirable, if (in addition to the patients' epidemiological data) the results of water texts relating to a given case were also reported systematically.     

An outbreak of nosocomial Legionnaires' disease in a renal transplant unit in S?o Paulo, Brazil. Legionellosis Study Team.

From June 1989 to March 1990 there were eight cases of Legionnaires' disease caused by Legionella pneumophila serogroup 1 in a renal transplant unit. There were seven cases of pneumonia and one case of pleural effusion. A study was conducted to identify the source of the outbreak. Legionella anisa was cultured from tap water. Twenty-seven staff members of the unit were serologically tested and antibody titres were positive in two. The probable source of infection was the potable water system. Control measures were hyperchlorination and heating of the water, after which there were no further cases during 5 months' follow up. We believe this is the first reported Legionnaires' disease outbreak in Latin America.     

A 3-year follow-up study of anti-Legionella antibodies in users of Japanese 24-hour hot water baths

Although it has been found that legionellae can exist in a 24-h hot water bath (24HHWB), which has been used recently in Japan, whether longer use of the 24HHWB causes legionellosis is unclear. The present longitudinal study was conducted in 2000 to investigate the 3-yr change in antibody titers in association with the continuous use, non-use, or canceling the use of the 24HHWB, and possible factors relating to the antibody changes. Ninety-two subjects (85 males and 7 females), who had had their anti-Legionella pneumophila (Lp) serum antibody titers measured in our initial study in 1997 and consented to blood sampling 3 yr later, were selected as subjects. There were no clinical cases who had experienced Legionnaires' disease or Pontiac fever during the 3 yr. The continuous users showed no significant changes in antibody titers within 3 yr, whereas the continuous non-users had a significant increase in antibody titers against the Lp serogroup (SG) 5 and 6. Eleven ex-users of the 24HHWB showed a significant decrease in antibody titers against Lp SG 6. The changes in the 24HHWB use, job sector, stress coping strategies, and alcohol-drinking habit were associated with the changes in antibody titers against Lp SG 1, 5 or 6. The anti-Lp antibodies were considered to be IgM dominant. In conclusion, this study indicates that 24HHWB use by healthy subjects does not tend to result in a higher onset risk of legionellosis, even if it is continuously used for 3 yr, although 24HHWB use is likely to induce production of antibodies against legionellae.     

Outbreak of Legionnaires' disease on a cruise ship: lessons for international surveillance and control

A sporadic case of Legionnaires' disease was linked to travel on a cruise ship. Investigation identified two further cases of Legionnaires' Disease and one case of non-pneumonic Legionella infection. An Incident Team confirmed the source to be the ship's water system and control measures were instituted that included pasteurisation, super chlorination and chlorine dioxide dosing. The Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC), through the European Surveillance Scheme for Travel Associated Legionnaires' Disease, identified three previous cases associated with the same ship's water system including one fatality. Lessons for the international surveillance and control of Legionnaires' disease on cruise ships are discussed.     

A study of Legionella pneumophilia in Tianjin, China

Legionella is a bacterium identified as the causative agent of Legionnaires' disease commonly found in water and soil in natural environments and human habitats. While most studies are focused on cooling tower water as the source of infection, few studies have compared Legionella from cooling-tower water and water in man-made environments. This cross-sectional study with a randomized cluster sampling design aims to provide information on Legionella found in cooling-tower water and water in man-made environments. Legionella was identified using a dual analytical approach: the serological and the 16SrRNA semi-nest PCR methods. Nine different types of Legionella were identified with the Lp7 type detected in China for the first time. Results indicated slight but insignificantly increased odds (OR = 1.64, 95%CI = 0.54-4.98) of Legionella detection in cooling tower water as compared to water obtained from fountains and parks, suggesting that the mechanism of exposure plays an important role in the causal pathway of outbreaks of Legionnaires' disease.     

Community-acquired Legionnaires' disease in Nottingham--too many cases?

The aim of this study was to compare the incidence of community-acquired Legionnaires' Disease in Nottingham with England and Wales and to explore reasons for any difference observed. Based on data from the National Surveillance Scheme for Legionnaires' Disease (1980-1999), the rate of infection in England and Wales was 1.3 per million/year compared with 6.6 per million/ year in Nottingham. Domestic water samples were obtained from 41 (95%) of 43 Nottingham cases between 1997 and 2000. In 16 (39%) cases, Legionella sp. were cultured in significant quantities. Proximity to a cooling tower was examined using a 1:4 case-controlled analysis. No significant difference in the mean distance between place of residence to the nearest cooling tower was noted (cases 2.7 km vs. controls 2.3 km; P = 0.5). These data suggest that Nottingham does have a higher rate of legionella infection compared to national figures and that home water systems are a source.     

Two outbreaks of Legionnaires' disease in Bolton Health District

In 1988, there were two outbreaks of legionellosis in Bolton Health District. Altogether 37 cases of Legionnaires' disease and 23 cases of non-pneumonic legionellosis were identified. Twenty-five patients with Legionnaires' disease were associated with an engineering plant, 4 with Bolton town centre, and 8 with both the plant and town centre. Twenty-two people with non-pneumonic legionellosis were linked with the engineering plant and one with the plant and the town centre. A case-control study carried out among 37 employees with legionellosis and 109 control subjects at the plant showed that infection was associated with one of the 15 cooling towers on the site. Legionella pneumophila indistinguishable by serological and genetic typing methods was isolated from this cooling tower and from sputum samples from two patients. In the town centre, no one tower was linked with infection and L. pneumophila was not cultured from any of the nine towers identified. Control measures were implemented and to date there have been no further cases of legionellosis associated with Bolton Health District.