Seasonal variation of Legionnaires' disease in Scotland

doi:10.1016/0163-4453(91)91569-J

Journal of Infection

Volume 22, Issue 2, March 1991, Pages 153-160

https://doi.org/10.1016/0163-4453(91)91569-J Get rights and content

Summary

A summer and autumn peak in incidence is a characteristic epidemiological feature of Legionnaires' disease, a fact which may help in diagnosis. Previous reports from Scotland have reported a winter peak. This study examined the seasonal variation in Legionnaires' disease in Scotland in each year and by category of diagnosis. A characteristic summer/autumn peak was seen for travel-related infection. For non-travel infection, there was an autumnal peak between 1978 and 1982 but an early winter peak between 1983 and 1986. Overall, the pattern could be described as a summer/autumn plateau reaching a peak in early winter. This pattern, seen in men and women, was clearest in the Greater Glasgow area. Nosocomial cases were clustered in the months of October, November and December.

In non-travel cases the classical seasonal pattern was not observed and clinicians cannot rely upon this epidemiological feature for diagnosis. However, the relative infrequency of the disease between January and May was a consistent and potentially useful feature.

Most reports on seasonal variation are based on aggregated data on travel and nontravel cases. The present observations question the hypotheses developed to explain the seasonal pattern and call for further studies.

References (26)

HelmsCM et al.
Sporadic Legionnaires' Disease: clinical observations on 87 nosocomial and community-acquired cases
Am J Med Sci
(1984)
MacfarlaneJT et al.
Hospital study of adult community-acquired pneumonia
Lancet
(1982)
RowbothamTJ
Pontiac fever, amoebae, and Legionellae
Lancet
(1981)
HoyleF et al.
Legionnaires' Disease: seeking a wider source
Lancet
(1985)
BandJD et al.
Legionellosis
BaxterD
Legionnaires' disease
BartlettCLR et al.
Legionella infections
(1986)
Public Health Laboratory Service
Communicable Disease Report
Commun Med
(1985)
Committee of Inquiry
Second report of the Committee of Inquiry into the outbreak of Legionnaires' disease in Stafford in April 1985
(1987)
FliermansCB
Philosophical ecology: Legionella in historical perspective

BercovierH et al.

Seasonal distribution of legionellae isolated from various types of water in Israel

Isr J Med Sci

(1986)

TobianskyL et al.

Seasonality of Legionella isolates from environmental sources

Isr J Med Sci

(1986)

ThacherSB et al.

An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' Disease bacterium

J Infect Dis

(1978)

Cited by (22)

Legionella and legionellosis in touristic-recreational facilities: Influence of climate factors and geostatistical analysis in Southern Italy (2001–2017)
2019, Environmental Research
Citation Excerpt :
Thus, it is likely that when the outside temperature exceeds 25 °C, the bacteria can be dispersed in the air from wet roads or from vehicles driving through puddles and generating contaminated aerosols. Similar to a study of travel-related LD in Glasgow, Scotland (Bhopal and Fallon, 1991), our data showed a greater number of cases in autumn (September, October), when precipitation was increased compared with the rest of the year. The geostatistical analysis conducted in the current study revealed that the area with the highest Legionella load in water systems coincided with the area presenting the highest number of LD cases associated with staying in touristic-recreational facilities.
Legionella is the causative agent of Legionnaires' disease, a flu-like illness normally acquired following inhalation or aspiration of contaminated water aerosols. Our recent studies revealed that climatic parameters can increase the number of reported cases of community-acquired Legionnaires' disease. Here, we evaluated the presence of Legionella in water networks and the distribution of Legionnaires' disease cases associated with touristic-recreational facilities in the Apulia region (southern Italy) during the period 2001–2017 using geostatistical and climatic analyses. Geostatistical analysis data revealed that the area with the highest concentration of Legionella in water systems also had the greatest number of cases of Legionnaires' disease associated with touristic-recreational facilities. Climatic analysis showed that higher daily temperature excursion (difference between maximum and minimum temperature) on the day of sampling was more often associated with Legionella-positive samples than Legionella-negative samples. In addition, our data highlighted an increased risk of Legionnaires’ disease with increases in precipitation and average temperature and with decreases in daily temperature excursion (difference between maximum and minimum temperature over the course of 24 h in the days of incubation period of disease) and minimum temperature.
Healthcare professionals should be aware of this phenomenon and be particularly vigilant for cases of community-acquired pneumonia during such climatic conditions and among the tourist population. The innovative geo-statistical approach used in this study could be applied in other contexts when evaluating the effects of climatic conditions on the incidence of Legionella infections.
Legionnaire's Disease and Influenza
2017, Infectious Disease Clinics of North America
Citation Excerpt :
The disruption of the physiologic barriers of the respiratory system induced by influenza virus could facilitate the emergence of bacteria like Legionella that colonize the posterior nasopharynx. Seasonal distribution of legionellosis disease seems mostly in months with higher temperatures, rainfall, and humidity (autumn and summer).30–34 But in a recent study from Taiwan, where the presence of Legionella was examined in major water reservoirs with respect to seasonal variation, Legionella was detected in all seasons (Table 2).35
Atypical presentation of Legionella pneumonia among patients with underlying cancer: A fifteen-year review
2016, Journal of Infection
Citation Excerpt :
This might reflect meteorological factors in the northeastern United States, such as increased temperature and humidity that leads to more utilization of cooling systems.13 Although there are conflicting reports on seasonality of Legionella infections,14 the Centers for Disease Control and Prevention (CDC) and reports from Europe have described seasonal patterns associated with Legionella with cases peaking during the summer and early fall.15,16 Our study has several limitations given its retrospective nature and small number of cases despite inclusion of all microbiologically confirmed cases over a fifteen-year period.
Immunocompromised patients, especially those receiving treatment with corticosteroids and cytotoxic chemotherapy are at increased risk for developing Legionella pneumonia.
The aim of this study was to determine clinical and radiographic characteristics of pulmonary infection due to Legionella in persons undergoing treatment for cancer and stem cell transplant (SCT) recipients.
Retrospective review of Legionella cases at MSKCC over a fifteen-year study period from January 1999 and December 2013. Cases were identified by review of microbiology records.
During the study period, 40 cases of Legionella infection were identified; nine among these were due to non-pneumophila species. Most cases occurred during the summer. The majority [8/9, (89%)] of patients with non-pneumophila infection had underlying hematologic malignancy, compared to 18/31 (58%) with Legionella pneumophila infections. Radiographic findings were varied-nodular infiltrates mimicking invasive fungal infection were seen only among patients with hematologic malignancy and hematopoietic stem cell transplant (SCT) recipients and were frequently associated with non-pneumophila infections (50% vs 16%; P = 0.0594). All cases of nodular Legionella pneumonia were found incidentally or had an indolent clinical course.
Legionella should be considered in the differential diagnosis of nodular lung lesions in immunocompromised patients, especially those with hematologic malignancy and SCT recipients. Most cases of nodular disease due to Legionella are associated with non-pneumophila infections.
Outbreak detection and secondary prevention of Legionnaires' disease: A national approach
2007, International Journal of Hygiene and Environmental Health
To stop a possible outbreak of Legionnaires’ disease (LD) at an early stage an outbreak detection programme was installed in The Netherlands.
The programme consisted of sampling and controlling of potential sources to which LD patients had been exposed during their incubation period. Potential sources were considered to be true sources of infection if two or more LD patients (cluster) had visited them, or if available patients’ isolates and environmental Legionella spp. were indistinguishable by amplified fragment length polymorphism genotyping.
Rapid sampling and genotyping as well as cluster recognition helped to target control measures. Despite these measures, two small outbreaks were only stopped after renewal of the water system. The combination of genotyping and cluster recognition lead to 29 of 190 (15%) patient–source associations.
Systematic sampling and cluster recognition can contribute to outbreak detection and lead to cost-effective secondary prevention of Legionnaires’ disease.
Source of infection for sporadic Legionnaires' disease: A review
1995, Journal of Infection
Infectious pathology in Provence during the summer period (data realised during summer 1992, by infectious institution of Marseille-Provence)
1994, Medecine et Maladies Infectieuses
Une enquête prospective a été réalisée pendant l'été 1992 entre le 15 juillet et le 14 août 1992 auprès de médecins généralistes et hospitaliers de diverses villes, réparties dans la région provençale (Apt, Avignon. La Ciotat, Embrun, Gap, Marignane, Marseille) afin d'évaluer la nature des pathologies infectieuses estivales, leurs variations éventuelles selon l'âge, le sexe, les zones géographiques, les sources médicales (omnipraticiens de ville ou médecins hospitaliers), le mode de logement (permanent ou non) et surtout d'étudier l'influence des divers types de baignade sur ces pathologies. Plus de 1000 fiches, correspondant chacune à un patient, ont pu être ainsi recueillies. La (ou les) pathologie(s) infectieuse(s) étant clairement indiquée(s) pour exactement 1001 d'entre eux. L'étude générale de l'échantillon montre une répartition homogène par sexe, un âge moyen de 10 ans plus jeune que celui de la population générale, un taux de participation particulièrement élevé à Marignanc représentant 43,9 % des patients et, dans une moindre mesure, à Embrun (19,3 %), un taux de résidents occasionnels proche de 25 % et surtout un nombre élevé de baigneurs (61 %). Les pathologies les plus souvent rapportées sont essentiellement des infections des voies aériennes supérieures (ORL) et stomatologiques qui affectent la moitié des patients ; viennent, ensuite, les infections respiratoires basses (10,7%), les atteintes cutanées infectieuses (10,3 %), les infections uro-génitales (9,5 %), les diarrhées (7,6 %), les fièvres éruptives (5,5 %), les infections oculaires (2,5 %). Nous nous sommes particulièrement intéressés à l'influence des baignades sur les diverses infections. Nous avons retrouvé, comme facteur de risque, pour les otites externes, les bains considérés dans leur globalité et, après une analyse détaillée, ceux effectués en piscine ; pour les rhinites, ceux effectués en rivière ; pour les otites moyennes et les mycoses génitales, les bains en mer ; pour les gastro-entérites, les bains en piscine et en rivière.
We conducted a prospective study during the summer 1992, between the 15th of july and the 14th of august, with the help of general practicioners practicing outside of hospital as well as specialists practicing solely in hospitals, throughout Provence (Apt, Avignon, La Ciotat, Embrun, Gap, Marignane, Marseille) in order to evaluate summer-occuring infectious diseases with respect to age, sex, geographic locations, type of medical attention saught and leaving conditions (resident or not). The main purpose was to study the influence of water activity on these diseases. More than one thousand histories were collected and infectious disease(s) was (were) indicated in 1001 cases. Study of this infected sample showed no bias with respect to sex and a mean age 10 years younger than the general population. There was a high participation rate from the town of Marignane (43,9 %) and Embrun (19,3 %). The percentage of non resident was almost 25 %. There was a high percentage of patients who participated in water activities (61 %). Half of the patients demonstrated infections of the upper respiratory tract and of the mouth area. Infections of less frequency were : lower respiratory diseases (10,7 %), cutaneous infections (10,3 %), uro-genital infections (9,5 %), diarrheas (7,6 %), fever associated with a rash (5,5 %) and ocular infections (2,5 %). We were particularly interested in the influence of water activities on these infections. When we considered all risk factors we found water activities to be partly responsible for otitis externa. Detailed analysis of the types of water activities showed that swimming in a swimming-pool was partly responsible for otitis externa. For rhinitis we found river water to be partly responsible. For otitis media and genital mycosis sea water appeared to be a risk factor. Both swimming-pool and river water were risk factors for gastro-enteritis.

View all citing articles on Scopus

View full text

Original articleSeasonal variation of Legionnaires' disease in Scotland

Summary

Am J Med Sci

Lancet

Lancet

Lancet

Legionellosis

Legionnaires' disease

Legionella infections

Communicable Disease Report

Commun Med

Second report of the Committee of Inquiry into the outbreak of Legionnaires' disease in Stafford in April 1985

Philosophical ecology: Legionella in historical perspective

Seasonal distribution of legionellae isolated from various types of water in Israel

Isr J Med Sci

Seasonality of Legionella isolates from environmental sources

Isr J Med Sci

An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' Disease bacterium

J Infect Dis

Original article
Seasonal variation of Legionnaires' disease in Scotland