February 17, 2012 by staff
Legionnaires Disease, This week’s issue of The Lancet describes a case report of an 82-year-old woman in Italy who died of Legionnaires disease after becoming infected with L pneumophila at her dentist. This case has prompted the authors – led by Dr Maria Luisa Ricci at the Istituto Superiore di Sanità, Rome, Italy, to call for various control measures at dental surgeries to prevent similar incidents.
Suffering with fever and respiratory distress, the woman who was conscious and responsive and had no underlying disease, was admitted in February, 2011, to the intensive care unit of the “G.B. Morgagni-Pierantoni” Hospital, Department of emergency Anaesthesia and Intensive Care Unit, Forl?, Italy.
Results from a chest radiography showed multiple areas of lung consolidation. A Legionella pneumophila urinary antigen test quickly diagnosed the woman with Legionnaires’ disease and she was immediately given oral antibiotics (ciprofloxacin) every 12 hours. However, she sadly died two days later after developing rapid and irreversible septic shock, prompting an investigation to find the source of L pneumophila.
The patient had been at home for the majority of the time during the 2 to 10 day incubation period, leaving only twice to attend dentist appointments.
The investigators took water samples from the dental practice’s tap, the tap and the high-speed turbine of the dental unit waterlines, as well as from the woman’s home (shower and taps) in order to investigate possible L pneumophila contamination. They found that samples from her home tested negative for L pneumophila, but samples from the dental practice tested positive. After laboratory experiments were conducted, results showed genomic matching between L pneumphila in the dental unit waterline and in the women’s respiratory secretion.
L pneumophila is a Gram-negative bacterium found in man-made water systems and is ubiquitous in natural water environments. The bacteria can infect individuals by inhalation or microaspiration of aerosolized water causing Pontiac fever (a flu-like disease) or Legionnaires’ disease (severe pneumonia), mostly affecting immune-compromised patients and the elderly.
Spas, fountains, air-conditioning systems, and hot-water systems, have been demonstrated to be leading sources of infection.
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