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. 1990 Apr;80(4):431–434. doi: 10.2105/ajph.80.4.431

A rural outbreak of Legionnaires' disease linked to visiting a retail store.

S C Redd 1, F Y Lin 1, B S Fields 1, J Biscoe 1, B B Plikaytis 1, P Powers 1, J Patel 1, B P Lim 1, J M Joseph 1, C Devadason 1, et al.
PMCID: PMC1404578  PMID: 2316763

Abstract

Between May 7 and June 7, 1986, 27 residents of a rural county in Maryland developed legionellosis, and two died. Legionella pneumophila serogroup 1 was cultured from the sputum of two patients and identified in lung tissue of a third patient by direct fluorescent antibody staining. An additional 11 patients had four-fold rises in antibody titer to L. pneumophila, and 13 had single titers greater than or equal to 1:256. To determine risk factors for disease, we performed a case-control study. Twelve of 16 case-patients reported visiting store A in the two weeks before onset of illness compared with four of 28 control-patients. A serologic survey of employees showed that employees of store A were 3.63 times more likely than control employees to have titers of antibody to L. pneumophila greater than or equal to 1:256 (95% confidence intervals 0.8, 16.7). Cultures of soil specimens, samples of water from the hot water system of store A and from stagnant ponds near store A collected five weeks after the end of the outbreak were negative for Legionella species. Store A was adjacent to a site of excavation and construction during May 1986, when the community was experiencing an extended drought. This investigation suggests that exposure to excavation and construction activity may be a risk factor for legionellosis.

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Selected References

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  1. Fekety F. R., Jr, Caldwell J., Gump D., Johnson J. E., Maxson W., Mulholland J., Thoburn R. Bacteria, viruses, and mycoplasmas in acute pneumonia in adults. Am Rev Respir Dis. 1971 Oct;104(4):499–507. doi: 10.1164/arrd.1971.104.4.499. [DOI] [PubMed] [Google Scholar]
  2. Fliermans C. B., Cherry W. B., Orrison L. H., Smith S. J., Tison D. L., Pope D. H. Ecological distribution of Legionella pneumophila. Appl Environ Microbiol. 1981 Jan;41(1):9–16. doi: 10.1128/aem.41.1.9-16.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Fraser D. W., Tsai T. R., Orenstein W., Parkin W. E., Beecham H. J., Sharrar R. G., Harris J., Mallison G. F., Martin S. M., McDade J. E. Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med. 1977 Dec 1;297(22):1189–1197. doi: 10.1056/NEJM197712012972201. [DOI] [PubMed] [Google Scholar]
  4. Haley C. E., Cohen M. L., Halter J., Meyer R. D. Nosocomial Legionnaires' disease: a continuing common-source epidemic at Wadsworth Medical Center. Ann Intern Med. 1979 Apr;90(4):583–586. doi: 10.7326/0003-4819-90-4-583. [DOI] [PubMed] [Google Scholar]
  5. Helms C. M., Renner E. D., Viner J. P., Hierholzer W. J., Jr, Wintermeyer L. A., Johnson W. Indirect immunofluorescence antibodies to Legionella pneumophila: frequency in a rural community. J Clin Microbiol. 1980 Sep;12(3):326–328. doi: 10.1128/jcm.12.3.326-328.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Katz S. M., Hammel J. M. The effect of drying, heat, and pH on the survival of Legionella pneumophila. Ann Clin Lab Sci. 1987 May-Jun;17(3):150–156. [PubMed] [Google Scholar]
  7. Klein B. S., Vergeront J. M., Weeks R. J., Kumar U. N., Mathai G., Varkey B., Kaufman L., Bradsher R. W., Stoebig J. F., Davis J. P. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med. 1986 Feb 27;314(9):529–534. doi: 10.1056/NEJM198602273140901. [DOI] [PubMed] [Google Scholar]
  8. Morris G. K., Patton C. M., Feeley J. C., Johnson S. E., Gorman G., Martin W. T., Skaliy P., Mallison G. F., Politi B. D., Mackel D. C. Isolation of the Legionnaires' disease bacterium from environmental samples. Ann Intern Med. 1979 Apr;90(4):664–666. doi: 10.7326/0003-4819-90-4-664. [DOI] [PubMed] [Google Scholar]
  9. Muder R. R., Yu V. L., Woo A. H. Mode of transmission of Legionella pneumophila. A critical review. Arch Intern Med. 1986 Aug;146(8):1607–1612. [PubMed] [Google Scholar]
  10. Parry M. F., Stampleman L., Hutchinson J. H., Folta D., Steinberg M. G., Krasnogor L. J. Waterborne Legionella bozemanii and nosocomial pneumonia in immunosuppressed patients. Ann Intern Med. 1985 Aug;103(2):205–210. doi: 10.7326/0003-4819-103-2-205. [DOI] [PubMed] [Google Scholar]
  11. Storch G., Baine W. B., Fraser D. W., Broome C. V., Clegg H. W., 2nd, Cohen M. L., Goings S. A., Politi B. D., Terranova W. A., Tsai T. F. Sporadic community-acquired Legionnaires' disease in the United States. A case-control study. Ann Intern Med. 1979 Apr;90(4):596–600. doi: 10.7326/0003-4819-90-4-596. [DOI] [PubMed] [Google Scholar]
  12. Thacker S. B., Bennett J. V., Tsai T. F., Fraser D. W., McDade J. E., Shepard C. C., Williams K. H., Jr, Stuart W. H., Dull H. B., Eickhoff T. C. An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' disease bacterium. J Infect Dis. 1978 Oct;138(4):512–519. doi: 10.1093/infdis/138.4.512. [DOI] [PubMed] [Google Scholar]

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